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Emotional Distress in Portuguese Cancer Patients: The Use of the Emotion Thermometers (ET) Screening Tool. Healthcare (Basel) 2023; 11:2689. [PMID: 37830726 PMCID: PMC10572115 DOI: 10.3390/healthcare11192689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Cancer patients may experience significant distress. The "Emotion Thermometers" (ETs) are a short visual analogue scale used to screen patients for psychosocial risk. This study aimed to assess emotional distress in a large sample of cancer patients attending psychological services at an non-governmental organization (NGO), and to explore factors that may contribute to it. The ETs were answered by 899 cancer patients. They were, on average, 59.9 years old, the majority were female, had breast cancer, were under treatment or were disease-free survivors, and reported high levels of emotional distress, above the cut-off (≥5). A Generalized Linear Model was used to measure the association between the level of distress, age, gender, disease phase and 33 items of the problem list. Four items-sadness, depression, sleep and breathing-were found to be significantly related to a higher level of distress. Additionally, women and patients who were in the palliative phase also had significantly higher levels of distress. The results confirm the need for early emotional screening in cancer patients, as well as attending to the characteristics of each patient. Additionally, they highlight the utility of the ETs for the clinical practice, allowing to optimize the referral to specialized psychosocial services.
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Racial and ethnic differences in post-traumatic stress trajectories in breast cancer survivors. J Psychosoc Oncol 2023; 42:1-15. [PMID: 37655715 PMCID: PMC10840938 DOI: 10.1080/07347332.2023.2253229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE To describe differences in post-traumatic stress (PTS) symptoms over time among racial and ethnic minoritized breast cancer survivors (BCS) with comorbid diabetes. DESIGN In a multisite longitudinal study, post-traumatic stress was evaluated at baseline, 6 and 12 months through self-reported questionnaires (Impact of Events Scale-Revised [IES-R]). PARTICIPANTS One hundred and seventy-eight post-treatment BCS with diabetes were recruited from three tertiary medical centers. FINDINGS Relative to non-Hispanic White women, minoritized women reported higher total IES-R scores at all time points. In the adjusted model, Latina women reported persistently higher IES-R total scores and Latina, and 'Other' women reported higher avoidance scores. CONCLUSIONS Minoritized BCS with comorbid diabetes report higher rates of cancer related PTS that persist over 12 months. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Post diagnosis PTS evaluation and support is important in survivorship and primary care practices. Linkage to socially and culturally sensitive community support may be warranted.
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Post-Traumatic Stress Disorder and Post-Traumatic Growth in Patients with Breast Cancer: A Retrospective Cross-Sectional Study in a Developing Country. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Evaluation of centers for information and support combining formal and informal care for patients with cancer: a systematic review of the literature. Support Care Cancer 2022; 30:7079-7098. [PMID: 35416500 PMCID: PMC9385827 DOI: 10.1007/s00520-022-07047-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Clear information and supportive care are necessary for patients with cancer to effectively manage their condition. Traditionally, healthcare professionals offer information and support via the so-called formal care route. In addition, research has found favorable effects of informal care provided by volunteer programs and informal "walk-in support centers." Less research has been done on initiatives that combine formal and complementary informal supportive care for patients with cancer. This systematic literature study aimed to discover (1) which types of initiatives are described in the literature, (2) what type of care they offer, and (3). how they are evaluated in terms of outcome measures. METHODS We performed a systematic literature search of MEDLINE, Embase, PsycINFO, and CINAHL. Studies were included if the collaboration between one type of formal care together with one type of informal care was explicitly mentioned in the article. The search was not restricted to a specific cancer type. RESULTS A total of 4869 records were retrieved and 18 studies were included. In most studies, the care provided consisted of emotional support for, and/or providing information to, patients and their families. Initiatives were evaluated with interviews and questionnaires. Patients with cancer reported that they were satisfied with the care offered, including information, social and emotional support, help with activities of daily living, and family-related issues. Volunteers reported that visits they made were experienced positive and rewarding and the volunteers were confident about their contribution to general healthcare. Some negative experiences were reported by volunteers, e.g., interference of their own cancer diagnosis with volunteer work. The importance of proper training was stressed. CONCLUSIONS Initiatives combining formal and informal supportive care hold the potential of added value in terms of providing emotional support for, and providing information to, patients with cancer. Support and specific training for volunteers can be viewed as success factors in the involvement of volunteers in formal care practices.
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Association of social support, spirituality with psychological factors in Iranian breast cancer survivors: An evidence from a cross-sectional study. Nurs Open 2021; 9:1173-1180. [PMID: 34908246 PMCID: PMC8859038 DOI: 10.1002/nop2.1158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/24/2021] [Accepted: 10/14/2021] [Indexed: 01/13/2023] Open
Abstract
Aims The aim of this study was to explore the protective role of social support and spirituality in the prevention of depression, anxiety and fatigue severity. Design In a cross‐sectional study, 305 women of breast cancer survivors were recruited in the study. Methods The participants answered a self‐reported the hospital anxiety and depression scale, fatigue severity scale (FSS), social support and spiritual health questionnaires. The data were analysed using a multiple linear regression model to estimate the adjusted regression coefficients. Results A greater proportion of patients had moderate depression (62.9%) and moderate anxiety (67.3%). The higher level of social support was significantly associated with a lesser degree of depression (β=−0.05, p = .001) and anxiety (β=−0.04, p = .001), but there had been no association with the severity of fatigue score, while the association of spiritual health with depression and anxiety was not independently significant. This study highlights the importance of perceived social support in the prevention of depression and anxiety.
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Optimal communication associated with lower risk of acute traumatic stress after lung cancer diagnosis. Support Care Cancer 2021; 30:259-269. [PMID: 34273032 DOI: 10.1007/s00520-021-06138-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to assess the role of the patient's background and perceived healthcare-related factors in symptoms of acute stress after lung cancer diagnosis. METHODS The study population consisted of 89 individuals referred for diagnostic work-up at Landspitali National University Hospital in Iceland and subsequently diagnosed with lung cancer. Before diagnosis, the patients completed questionnaires on sociodemographic characteristics, pre-diagnostic distress (Hospital Anxiety and Depression Scale), social support, and resilience. At a median of 16 days after diagnosis, the patients reported symptoms of acute stress on the Impact of Event Scale-Revised (IES-R) and experience of communication and support from healthcare professionals and family during the diagnostic period. RESULTS Patients were on average 68 years and 52% reported high levels of post-diagnostic acute stress (IES-R > 23) while 24% reported symptoms suggestive of clinical significance (IES-R > 32). Prior history of cancer (β = 6.7, 95% CI: 0.1 to 13.3) and pre-diagnostic distress were associated with higher levels of post-diagnostic acute stress (β = 8.8, 95% CI: 2.7 to 14.9), while high educational level (β = - 7.9, 95% CI: - 14.8 to - 1.1) was associated with lower levels. Controlling for the abovementioned factors, the patients' perception of optimal doctor-patient (β = - 9.1, 95% CI: - 14.9 to - 3.3) and family communication (β = - 8.6, 95% CI: - 14.3 to - 2.9) was inversely associated with levels of post-diagnostic acute stress after lung cancer diagnosis. CONCLUSIONS A high proportion of patients with newly diagnosed lung cancer experience high levels of acute traumatic stress of potential clinical significance. Efforts to improve doctor-patient and family communication may mitigate the risk of these adverse symptoms.
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Which Domains of Social Support Better Predict Quality of Life of Women with Breast Cancer? A Cross-Sectional Study. Asia Pac J Oncol Nurs 2021; 8:211-217. [PMID: 33688571 PMCID: PMC7934600 DOI: 10.4103/apjon.apjon_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives: The study aimed at investigating the specific role of social support types (SSTs) on quality of life (QoL) and its domains of women with breast cancer in Iran. Methods: In this cross-sectional study, a number of 223 women with breast cancer visiting three cancer centers of Tehran, Iran, participated from October 2014 to May 2015. Medical Outcome Study-Social Support Scale and Functional Assessment of Cancer Therapy-Breast Cancer were used for data gathering. Backward multiple regression was utilized, adjusted by age, education, and family size. Results: The study indicated positive correlations between all SSTs and QoL domains, whereas only positive social interaction (PSI) showed a significant association with physical well-being. PSI showed the only predictive performance in terms of all QoL outcomes, beyond the covariates. Conclusions: The study revealed the PSI as the most influential support type to enhance all domains of QoL of women with breast cancer.
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Posttraumatic stress in breast cancer survivors diagnosed at a young age. Psychooncology 2020; 29:1312-1320. [PMID: 32515073 DOI: 10.1002/pon.5438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Young breast cancer patients experience greater psychosocial distress compared with older patients, which raises concern for their risk of posttraumatic stress disorder (PTSD). We sought to characterize the prevalence of clinically significant symptoms of PTSD and associated factors among breast cancer survivors diagnosed at a young age. METHODS The Young Women's Breast Cancer Study, an ongoing prospective cohort study, enrolled 1302 women diagnosed with breast cancer at age ≤ 40 between 2006 and 2016. Participants complete serial surveys, and we obtained additional information from medical record review. Socio-demographics, anxiety and depression, social support, and psychiatric co-morbidities and medications were assessed at study baseline (median, 5 months post-diagnosis). We defined a participant as having clinically significant posttraumatic stress symptoms (PTSS) by scoring ≥50 on the PTSD Checklist-Specific Version, administered on the 30-month survey. RESULTS Among 700 women with stage 1-3 disease, the prevalence of PTSS was 6.3% (95%CI = 4.5-8.1). In multivariable analyses, PTSS was significantly associated with anxiety (OR 12.43, 95%CI = 5.81-26.59, P < .0001) and stage 2 vs 1 disease (OR 2.26, 95%CI = 1.04-4.93, P = .04). PTSS was inversely associated with having a college degree (OR 0.29, 95%CI = 0.13-0.62, P = .002) and greater social support (OR 0.44, 95%CI = 0.21-0.94, P = .03). CONCLUSIONS We found similar rates of cancer-related PTSS in breast cancer survivors diagnosed at a young age compared with the general breast cancer population despite their well-documented increased risk of overall distress. Nevertheless, factors associated with posttraumatic stress should be considered at diagnosis and in survivorship to identify young patients who may benefit from psychosocial resources.
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Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function. Cancer 2020; 126:3181-3191. [PMID: 32374431 DOI: 10.1002/cncr.32934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
Abstract
A breast cancer diagnosis can be a life-changing and stressful experience that can lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). Greater than one-third of patients initially diagnosed with PTSD after a diagnosis of breast cancer continue to have persistent or worsening PTSD symptoms after 4 years. An emerging body of literature has indicated several key environmental and biological risk factors for PTSD among survivors of breast cancer. Well-recognized risk factors include having a history of childhood trauma, being nonwhite, obesity, younger age at the time of diagnosis, diagnosis with a higher stage of breast cancer, and short time since treatment. Of the emerging risk factors related to fear circuitry in the brain, 2 pathways of particular importance are the stress-driven activation of inflammatory pathways and the long-term effect of antiendocrine therapies. These central and peripheral responses during and after stress exposure are important because increased fear and anxiety can lead to the maintenance of PTSD and worse patient outcomes. Given the poor outcomes associated with PTSD and the high prevalence of breast cancer in women, more research to identify those women at heightened risk of PTSD after breast cancer is warranted to reduce the number of diagnoses and lessen the negative impact of this chronic mental health condition.
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Post-Traumatic Stress Disorder Symptoms from Multiple Stressors Predict Chronic Pain in Cancer Survivors. J Palliat Med 2020; 23:1191-1197. [PMID: 32228350 DOI: 10.1089/jpm.2019.0458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the association between chronic pain and post-traumatic stress disorder (PTSD), little is known about the longitudinal course of pain and PTSD during cancer treatment. Objectives: We examined the prevalence of PTSD and chronic pain at three time periods in veterans with a diagnosis of cancer, and the relationship between the experience of pain and PTSD. Methods: Participants (N = 123) with oral-digestive cancers were recruited from the Veterans Healthcare System (age M = 65.31 and SD = 9.13; 98.4% male) and completed face to face interviews at 6, 12, and 18 months post-diagnosis. Measures included the Post-traumatic Stress Disorder Checklist-Stressor-Specific version (PCL-S), Primary care PTSD (PC-PTSD), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Impact Scale. Results: About one-third (26.8%) of the sample had chronic pain, defined as elevated pain at two time periods. About one-fifth (20.3%) endorsed symptoms of combat-related PTSD at 6 months, and 22.8% endorsed symptoms of cancer-related PTSD, exceeding a clinical cutoff for older adults (12 months = 21.1%, 18 months = 23.1%). Changes over time were observed for cancer-related PTSD symptom clusters of hyperarousal (F = 3.85 and p = 0.023) and emotional numbing (F = 4.06 and p = 0.018) with a statistically significant quadratic function increasing at 18 months. In logistic regression, individuals with both combat and cancer-related PTSD symptoms at six months had 8.49 times higher odds of experiencing chronic pain (χ2 = 25.91 and p < 0.001; R2 = 0.28). Conclusions: Persisting pain may be a concern in veterans with cancer. Individuals who have experienced traumatic events with persisting PTSD symptoms may be at elevated risk for chronic pain. Veterans with PTSD symptoms from both cancer and combat are at the highest risk to experience chronic pain.
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Patterns of posttraumatic stress disorder symptoms among cancer patients: A latent profile analysis. J Psychosom Res 2019; 125:109788. [PMID: 31421322 DOI: 10.1016/j.jpsychores.2019.109788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE It has been documented that posttraumatic stress disorder symptoms (PTSS) in traumatized individuals have naturally heterogeneous characteristics; studies have recently begun to assess the specific heterogeneous patterns of PTSS. However, most of them used the DSM-IV criteria for PTSS and focused on victims following combat, interpersonal violence, and natural disasters, with no studies focusing on cancer patients. To extend the existing literature and fill the gaps in previous studies, this study aims to examine the specific patterns of PTSS and their predictors. METHOD One hundred and ninety-one cancer patients were selected to complete self-reported questionnaires; the data analysis involved latent profile analysis and multinomial logistic regression. RESULTS Three patterns of PTSS were found: the non-symptom group (n = 29, 15.3%), the hyperarousal symptoms group (n = 84, 44.2%), and the severe PTSS group (n = 77, 40.5%). In addition, a longer elapsed time since diagnosis was related to fewer hyperarousal symptoms [OR (95%CI) = 0.98 (0.95-1.00)] and severe PTSS [OR (95%CI) = 0.98 (0.95-1.00)]; a greater fear of cancer recurrence was related to more hyperarousal symptoms [OR (95%CI) = 1.09 (1.00-1.19)] and severe PTSS [OR (95%CI) = 1.32 (1.18-1.47)]; and individuals with higher household incomes [OR (95%CI) = 1.65 (0.96-2.84)] and female patients [OR (95%CI) = 0.37 (0.16-0.87)] had more severe PTSS. CONCLUSIONS Cancer patients exhibited heterogeneous PTSS patterns.
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Symptoms of posttraumatic stress disorder among hospitalized patients with cancer. Cancer 2018; 124:3445-3453. [PMID: 29905935 DOI: 10.1002/cncr.31576] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with cancer experience many stressors placing them at risk for posttraumatic stress disorder (PTSD) symptoms, yet little is known about factors associated with PTSD symptoms in this population. This study explored relationships among patients' PTSD symptoms, physical and psychological symptom burden, and risk for hospital readmissions. METHODS We prospectively enrolled patients with cancer admitted for an unplanned hospitalization from August 2015-April 2017. Upon admission, we assessed patients' PTSD symptoms (Primary Care PTSD Screen), as well as physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ-4]) symptoms. We examined associations between PTSD symptoms and patients' physical and psychological symptom burden using linear regression. We evaluated relationships between PTSD symptoms and unplanned hospital readmissions within 90-days using Cox regression. RESULTS We enrolled 954 of 1,087 (87.8%) patients approached, and 127 (13.3%) screened positive for PTSD symptoms. The 90-day hospital readmission rate was 38.9%. Younger age, female sex, greater comorbidities, and genitourinary cancer type were associated with higher PTSD scores. Patients' PTSD symptoms were associated with physical symptoms (ESAS physical: B = 3.41; P < .001), the total symptom burden (ESAS total: B = 5.97; P < .001), depression (PHQ-4 depression: B = 0.67; P < .001), and anxiety symptoms (PHQ-4 anxiety: B = 0.71; P < .001). Patients' PTSD symptoms were associated with a lower risk of hospital readmissions (hazard ratio, 0.81; P = .001). CONCLUSIONS A high proportion of hospitalized patients with cancer experience PTSD symptoms, which are associated with a greater physical and psychological symptom burden and a lower risk of hospital readmissions. Interventions to address patients' PTSD symptoms are needed and should account for their physical and psychological symptom burden. Cancer 2018. © 2018 American Cancer Society.
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Post-Traumatic Stress Disorder, Neighborhood Residency and Satisfaction, and Social Network Characteristics among Underserved Women in Baltimore, Maryland. Womens Health Issues 2018; 28:273-280. [PMID: 29699907 DOI: 10.1016/j.whi.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) prevalence is high, but not well-understood, among women living in urban, impoverished areas. Although previous studies have established social support as an important factor in PTSD development and maintenance, little is known about how perceptions of neighborhood are linked to PTSD. This study examined the relationship between PTSD and social network and neighborhood factors among women with a low socioeconomic status. METHODS We analyzed cross-sectional data collected from a human immunodeficiency virus/sexually transmitted infection peer network study in Baltimore, Maryland (n = 438). We used bivariate analyses to examine the associations between PTSD and social network characteristics and time in neighborhood and satisfaction. We then constructed multivariable regression models that controlled for the following with PTSD: homelessness, cocaine/heroin use, and unemployment. MAIN FINDINGS Overall, 30% of women had PTSD symptom severity consistent with a clinical diagnosis. In the multivariable model, dissatisfaction with neighborhood block (odds ratio [OR], 1.80; p = .03) and living in one's neighborhood for more than 5 years (OR, 1.69; p = .03) were associated with PTSD. Social network factors that were significantly associated with PTSD included a higher number of network members in conflict with the participant (OR, 1.28; p = .02), presence of a network member who would let the participant stay with them (OR, 0.4; p = .004), and the number of network members with whom the participant socialized (OR, 0.6; p = .04). CONCLUSIONS In this sample of impoverished urban women with a high prevalence of PTSD, duration of residency, satisfaction with neighborhood, and network characteristics were found to be strongly associated with PTSD symptom severity.
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The stress-buffering effect of self-disclosure on Facebook: An examination of stressful life events, social support, and mental health among college students. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.05.043] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress. Health Psychol 2017; 36:1147-1160. [PMID: 28825498 DOI: 10.1037/hea0000524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to (a) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and (b) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. METHOD Patients (n = 957), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised. Coping strategies since beginning chemotherapy were assessed with the Brief COPE; 2 latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and Impact of Event Scale-Revised scores and the mediating role of engagement and disengagement coping on this relationship. RESULTS On average, patients reported 6.1 (SD = 4.0; range = 0-23 out of 30) SLEs. Patients who were not married/partnered, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship. CONCLUSIONS Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress. (PsycINFO Database Record
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Anxiety in the context of cancer: A systematic review and development of an integrated model. Clin Psychol Rev 2017; 56:40-54. [DOI: 10.1016/j.cpr.2017.06.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 12/23/2022]
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Association between social support and post-traumatic stress disorder symptoms among Chinese patients with ovarian cancer: A multiple mediation model. PLoS One 2017; 12:e0177055. [PMID: 28475593 PMCID: PMC5419605 DOI: 10.1371/journal.pone.0177055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/23/2017] [Indexed: 12/28/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) symptoms can develop after person experiences one or more traumatic events. Little research, however, has been done on PTSD symptoms of patients with ovarian cancer. The present study aimed to estimate the prevalence of PTSD symptoms in patients with ovarian cancer in China; the effects of demographic and clinical variables on PTSD symptoms; multiple mediation roles in the association between social support and PTSD symptoms in patients with ovarian cancer in China. We collected demographic and clinical information of patients with ovarian cancer in the first and second hospitals of China Medical University between January 1, 2014 and December 31, 2015. Qualified patients were asked to complete the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), Duke-UNC Functional Social Support Questionnaire, Herth Hope Index (HHI), and Resilience Scale-14 (RS-14). 201 patients provided responses. We performed hierarchical linear regression to assess the correlation between social support and PTSD symptoms and bootstrapping to test the mediating role of hope and resilience as potential mediators. After controlling demographic and clinical characteristics, social support negatively correlated with PTSD symptoms (β = -0.406, P < 0.01). Social support explained 14.7% of the variance in PTSD symptoms. Hope and resilience explained 17.0% of the variance in PTSD symptoms. The proportion of the hope mediating effect was 43.37% for social support and the proportion of the resilience mediating effect was 10.64% for social support. Hope and resilience partly mediated the correlation between social support and PTSD symptoms despite accounting for different proportions of the mediating effect. Future intervention plans should pay more attention to social support as well as hope and resilience to prevent, relieve and treat PTSD symptoms.
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Abstract
Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.
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Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis. Depress Anxiety 2017; 34:327-339. [PMID: 27466972 DOI: 10.1002/da.22542] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Since the introduction of serious illness as a potential traumatic stressor in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), research on the prevalence and predictors of posttraumatic stress disorder (PTSD) after cancer diagnosis has proliferated. Studies have reported widely varying estimates of the number of people with PTSD after cancer. The aim of this review is to synthesize quantitative data from studies reporting the proportion of people with PTSD among groups of cancer survivors. METHODS We undertook a diversified literature search strategy and identified 120 samples from 110 sources reporting a proportion of cancer survivors with PTSD. Of these, 11 studies, containing 12 samples, reported estimates of PTSD in cancer survivors compared to matched controls. RESULTS A random effects meta-analysis estimated the odds ratio as 1.66 (95% confidence interval (CI): 1.09-2.53) for PTSD in cancer survivors compared to controls, although some of this apparent increase may have arisen from publication bias. Factors influencing the reported proportion of a postcancer sample with PTSD included measurement type (clinical interview vs. self-report instrument), type of cancer, type of treatment, geographic region, whether the term "posttraumatic stress" was in the title or abstract, prior trauma, age, and time since diagnosis. CONCLUSIONS PTSD, diagnosed according to DSM-IV criteria, is more common in survivors of cancer than it is in the general population. Estimates of the occurrence of PTSD in patients with a history of cancer depend upon clinical and demographic factors, as well as upon study design.
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Racial/ethnic disparities in the risk of posttraumatic stress disorder symptoms among mothers of children diagnosed with cancer and Type-1 diabetes mellitus. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2016; 9:325-333. [PMID: 27936852 DOI: 10.1037/tra0000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research findings have indicated that mothers of children diagnosed with life-threatening illnesses can be at risk for posttraumatic stress disorder (PTSD) symptoms (PTSS), with African American mothers being especially vulnerable because of evidence suggesting higher rates of PTSD among both African Americans and women. Race/ethnicity, past trauma exposure and the interaction of these variables were evaluated as risk factors for PTSS, depression, and state and trait anxiety among African American and Caucasian mothers of chronically ill children. METHOD Mothers of children (N = 91) diagnosed with a life-threatening illness (i.e., cancer or Type-I diabetes mellitus [T1DM]) completed standardized measures and provided a salivary cortisol sample while attending medical appointments for their ill children. RESULTS A MANCOVA revealed that mothers of children diagnosed with T1DM had higher cortisol levels than mothers of children with cancer. There was no racial or ethnic disparity in the risk of PTSS among the mothers. CONCLUSION These findings suggest that mothers of children with T1DM may be vulnerable to stress reactions, as reflected by cortisol, a biological marker. Clinicians and researchers might consider illness-specific features when evaluating the risk of stress reactions among mothers of children with life-threatening illnesses. (PsycINFO Database Record
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Mitral Valve Prolapse, Psychoemotional Status, and Quality of Life: Prospective Investigation in the Current Era. Am J Med 2016; 129:1100-9. [PMID: 27235006 DOI: 10.1016/j.amjmed.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate whether mitral valve prolapse is associated with the patient's psychoemotional status and health-related quality of life. METHODS Mitral valve prolapse and mitral regurgitation were prospectively and comprehensively assessed in 281 patients (age 61 ± 13 years; 63% men); 216 patients with mitral valve prolapse were compared with 65 without mitral valve prolapse (of similar age and sex). Simultaneously, we assessed the patient's psychoemotional status (anxiety, depression, posttraumatic stress symptoms), health-related quality of life, and perceived severity of illness using validated questionnaires. RESULTS Twenty-nine percent of the patients had either no or mild mitral regurgitation (area of effective regurgitant orifice ≤0.2), and 71% had clinically significant mitral regurgitation (moderate/severe). Stratifying patients into no/mild vs moderate/severe mitral regurgitation revealed no differences in psychoemotional status or mental health-related quality of life between patients with mitral valve prolapse vs those without mitral valve prolapse within each subgroup; no/mild mitral regurgitation and moderate/severe mitral regurgitation (all P ≥ .5). In multivariate analysis, mitral valve prolapse was not independently associated with psychoemotional status or health-related quality of life (all P ≥ .4). In addition, while objective severity of the illness was not related to psychoemotional status or health-related quality of life (all P ≥ .2), the patient's perceived severity of illness predicted in and of itself all psychoemotional (all P < .03) and quality-of-life outcomes (all P < .003). CONCLUSION Mitral valve prolapse is not a determinant of the patient's psychoemotional status or quality of life. Psychoemotional status and health-related quality of life are determined by the patient's perception of the severity of the mitral valve disease, rather than by the presence of mitral valve prolapse.
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Treating Post-traumatic Stress Disorder in Patients with Multiple Sclerosis: A Randomized Controlled Trial Comparing the Efficacy of Eye Movement Desensitization and Reprocessing and Relaxation Therapy. Front Psychol 2016; 7:526. [PMID: 27148134 PMCID: PMC4838623 DOI: 10.3389/fpsyg.2016.00526] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Multiple Sclerosis (MS) is a demyelinating autoimmune disease that imposes a significant emotional burden with heavy psychosocial consequences. Several studies have investigated the association between MS and mental disorders such as depression and anxiety, and recently researchers have focused also on Post-traumatic Stress Disorder (PTSD). This is the first study that investigates the usefulness of proposing a treatment for PTSD to patients with MS. METHODS A randomized controlled trial with patients with MS diagnosed with PTSD comparing Eye Movement Desensitization and Reprocessing (EMDR; n = 20) and Relaxation Therapy (RT; n = 22). The primary outcome measure was the proportion of participants that no longer meet PTSD diagnosis as measured with Clinician Administered PTSD Scale 6-months after the treatment. RESULTS The majority of patients were able to overcome their PTSD diagnosis after only 10 therapy sessions. EMDR treatment appears to be more effective than RT in reducing the proportion of patients with MS suffering from PTSD. Both treatments are effective in reducing PTSD severity, anxiety and depression symptoms, and to improve Quality of Life. CONCLUSION Although our results can only be considered preliminary, this study suggests that it is essential that PTSD symptoms are detected and that brief and cost-effective interventions to reduce PTSD and associated psychological symptoms are offered to patients, in order to help them to reduce the psychological burden associated with their neurological condition. TRIAL REGISTRATION NCT01743664, https://clinicaltrials.gov/ct2/show/NCT01743664.
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Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer 2016; 122:806-12. [PMID: 26650840 PMCID: PMC4788001 DOI: 10.1002/cncr.29818] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/27/2015] [Accepted: 11/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND During hospitalization for hematopoietic stem cell transplantation (HCT), patients experience a steep deterioration in quality of life (QOL) and mood. To our knowledge, the impact of this deterioration on patients' QOL and posttraumatic stress disorder (PTSD) symptoms after HCT is unknown. METHODS We conducted a prospective longitudinal study of patients hospitalized for HCT. They assessed QOL using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at the time of admission for HCT, during hospitalization, and 6 months after HCT. We also used the Hospital Anxiety and Depression Scale (HADS) to measure patients' anxiety and depression symptoms at baseline and during HCT hospitalization. The PTSD Checklist was used to assess for PTSD symptoms. Multivariable linear regression models were used to identify predictors of QOL and PTSD symptoms at 6 months. RESULTS We enrolled 90 of 93 consecutively eligible patients (97%) undergoing autologous and allogeneic HCT. Data at 6 months were available for 67 participants. At 6 months, 28.4% of participants met the criteria for PTSD and 43.3% had clinically significant depression. On multivariable regression analyses adjusting for significant covariates, changes in QOL and depression scores from week 2 of HCT hospitalization to baseline predicted worse QOL (changes in scores between week 2 and baseline [Δ] QOL: β, 0.94 [P<.0001] and Δ PHQ-9: β, -2.59 [P = 0.001]) and PTSD symptoms (Δ QOL: β, -0.40 [P<.0001] and Δ PHQ-9: β, 1.26 [P<.0001]) at 6 months after HCT. CONCLUSIONS Six months after HCT, a significant percentage of patients met the criteria for PTSD and depression. A decline in QOL and an increase in depressive symptoms during hospitalization for HCT were found to be the most important predictors of 6-month QOL impairment and PTSD symptoms. Therefore, managing symptoms of depression and QOL deterioration during HCT hospitalization may be critical to improving QOL at 6 months and reducing the risk of PTSD. Cancer 2016;122:806-812. © 2015 American Cancer Society.
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Abstract
Research examining victimization and posttraumatic symptomatology among Latinos is lacking in the extant literature. This analysis used the victimized subsample (N = 752) of the Sexual Assault Among Latinas Study. The aim was to evaluate victimization prevalence and test the following hypotheses: (a) that victimization would be associated with higher levels of posttraumatic symptoms, (b) that cultural factors that move away from traditional Latino culture would be associated with higher levels of posttraumatic symptomatology, and (c) that cultural factors associated with traditional Latino culture would be related to lower posttraumatic symptomatology. Average age of the sample was 44.57 years, with three fourths having a high school education or higher, and two thirds having a household income below $30,000. Of exposure types, adulthood threats were most likely to result in Criterion A traumatic events (23.4%). Using the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) based PTSD Checklist, between 8.8% and 45.5% of individuals met presumed PTSD diagnosis based on various PCL cut scores or algorithm criteria. Regression analyses indicated that the combined different types of adult and childhood victimizations, masculine gender role, and negative religious coping were associated with increased symptoms (βs ranging from .16 to .27). The results suggested a role of culture in posttraumatic symptoms for Latinas.
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The Mediating Effects of Social Support and Locus of Control on the Relationship between Post-Traumatic Stress and Depressive Symptoms in a Jamaican University Sample. JOURNAL OF DEPRESSION & ANXIETY 2015; 4:194. [PMID: 26798566 PMCID: PMC4718585 DOI: 10.4172/2167-1044.1000194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The increasing rate of comorbid posttraumatic stress and depressive symptoms among young adults presents a unique symptom presentation and challenges to treatment. The current study examined psychosocial barriers--external locus of control-- and facilitators-- social support-- in the posttraumatic stress and depressive symptoms association. METHODS The current cross-sectional study was conducted among 701 Jamaican university participants, ages 18-30 years. Participants completed self-report measures of general demographic information as well as target variables which include the CES-D-10, Sense of control (external and internal locus of control), Short screening scale for DSM-IV posttraumatic stress disorder and social support measures. RESULTS Majority of the sample was female (76.2%; n=534); and slightly more than half of the sample self-identified as Black/African ancestry (59.7%). External locus of control (LOC) partially mediated the relationship between posttraumatic stress and depressive symptoms, external locus of control (LOC) had a greater mediation magnitude than social support in the posttraumatic stress-depressive symptoms association (Indirect Effect=0.133, 95% CI-0.075-0.211). In post-hoc analyses women appeared more highly traumatized than their male counterparts (14.3%, χ2 =8.032, p=0.005). The sub-sample of highly traumatized individuals reported higher levels of depression, posttraumatic stress symptoms, external LOC, and lower levels of social support and internal LOC than did individuals with lower levels of trauma. CONCLUSION Contrary to previous research, our findings indicate that external LOC partially mediated the relationship between posttraumatic stress and depressive symptoms among a Jamaica university sample more so than social support. These findings therefore suggest that psychosocial treatments should consider locus of control focused interventions or skill building for young adults who suffer from posttraumatic stress and depressive symptoms.
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A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psychooncology 2015; 24:371-81. [PMID: 25146298 PMCID: PMC4409098 DOI: 10.1002/pon.3654] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Systematic reviews highlight a broad range of cancer-related post-traumatic stress disorder (CR-PTSD) prevalence estimates in cancer survivors. This meta-analysis was conducted to provide a prevalence estimate of significant CR-PTSD symptoms and full diagnoses to facilitate the psychological aftercare of cancer survivors. METHODS A systematic literature search was conducted for studies using samples of cancer survivors by using validated clinical interviews and questionnaires to assess the prevalence of CR-PTSD (k = 25, n = 4189). Prevalence estimates were calculated for each assessment method using random-effects meta-analysis. Mixed-effects meta-regression and categorical analyses were used to investigate study-level moderator effects. RESULTS Studies using the PTSD Checklist-Civilian Version yielded lower event rates using cut-off [7.3%, 95% confidence intervals (CI) = 4.5-11.7, k = 10] than symptom cluster (11.2%, 95% CI = 8.7-14.4, k = 9). Studies using the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition (SCID), yielded low rates for lifetime (15.3%, 95% CI = 9.1-25, k = 5) and current CR-PTSD (5.1%, 95% CI = 2.8-8.9, k = 9). Between-study heterogeneity was substantial (I(2) = 54-87%). Studies with advanced-stage samples yielded significantly higher rates with PTSD Checklist-Civilian Version cluster scoring (p = 0.05), and when assessing current CR-PTSD on the SCID (p = 0.05). The effect of mean age on current PTSD prevalence met significance on the SCID (p = 0.05). SCID lifetime prevalence rates decreased with time post-treatment (R(2) = 0.56, p < 0.05). DISCUSSION The cancer experience is sufficiently traumatic to induce PTSD in a minority of cancer survivors. Post-hoc analyses suggest that those who are younger, are diagnosed with more advanced disease and recently completed treatment may be at greater risk of PTSD. More research is needed to investigate vulnerability factors for PTSD in cancer survivors. © 2014 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.
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The effects of extraversion, social support on the posttraumatic stress disorder and posttraumatic growth of adolescent survivors of the Wenchuan earthquake. PLoS One 2015; 10:e0121480. [PMID: 25815720 PMCID: PMC4376870 DOI: 10.1371/journal.pone.0121480] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/31/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to examine the relationships among extraversion, social support, posttraumatic stress disorder and posttraumatic growth among adolescent survivors of the Wenchuan earthquake. Methods Six hundred thirty-eight participants were selected from the survivors of the 2008 Wenchuan earthquake. Participants completed four main questionnaires, including the Extraversion Subscale, the Social Support Scale, the Child PTSD Symptom Scale, and the Posttraumatic Growth Inventory. Results A bivariate correlation analysis revealed significant correlations among extraversion, social support, posttraumatic stress disorder and posttraumatic growth. Extraversion had significant indirect effects on posttraumatic stress disorder (β = −.037, p < .01) and posttraumatic growth (β = .077, p < .001) through social support. The results also indicated that extraversion had a significant direct effect on posttraumatic growth and a nonsignificant direct effect on posttraumatic stress disorder. Conclusions Social support fully mediates the relationship between extraversion and posttraumatic stress disorder and partially mediates the relationship between extraversion and posttraumatic growth. Psychological interventions and care for survivors of the earthquake should include the various functions and sources of social support and how they serve to benefit individuals.
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Trauma history as a resilience factor for patients recovering from total knee replacement surgery. Psychol Health 2015; 30:1005-16. [DOI: 10.1080/08870446.2014.1001391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psychooncology 2014; 24:624-34. [PMID: 25393527 DOI: 10.1002/pon.3719] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study is to examine the relationships among demographic, medical, and psychosocial factors and post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG) in oncology populations. METHOD A systematic search identified k = 116 relevant studies published between 1990 and 2012. Meta-analyses synthesized results from studies that reported data on correlates of PTSS (k = 26) or PTG (k = 48). A meta-analysis was performed for k = 5 studies reporting the correlation between PTSS and PTG. RESULTS Post-traumatic stress symptoms were associated with depression (r = 0.56), anxiety (r = 0.65), distress (r = 0.62), social support (r = -0.33), and physical quality of life (r = -0.44). PTG was associated with age (r = -0.08), gender (r = -0.15), distress (r = -0.16), depression (r = -0.06), social support (r = 0.30), optimism (r = 0.27), positive reappraisal (r = 0.46), spirituality (r = 0.33), and religious coping (r = 0.36). There was a small positive relationship between PTSS and PTG (r = 0.13). CONCLUSIONS Post-traumatic stress symptoms and PTG appear to be independent constructs, rather than opposite ends of a single dimension. This is reflected in a small relationship between these variables and different psychosocial correlates. PTSS were strongly associated with variables reflecting a general state of negative affect. Optimism, spirituality, and positive coping styles were associated with PTG. It remains unclear how they are associated with PTSS, given the lack of relevant studies. Longitudinal research is required to examine how psychosocial factors influence the relationship between PTSS and PTG.
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Effects of Resilience, Post-traumatic Stress Disorder on the Quality of Life in Patients with Breast Cancer. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2014; 20:83-91. [PMID: 37684783 DOI: 10.4069/kjwhn.2014.20.1.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to identify relationships of resilience, Post-Traumatic Stress Disorder(PTSD), and quality of life of breast cancer patients. The findings from this study would provide baseline data needed for nursing intervention. METHODS A sample of 129 breast cancer patients was recruited from three hospitals in J and C cities in Korea. The survey was conducted with participants by utilizing self-reported questionnaires. RESULTS Quality of life showed statistically significant differences on religion (t=2.11, p=.033) and hobby (t=2.79, p=.006). Resilience and PTSD had a negative correlation (r=-.22, p=.010). Resilience and quality of life of the participants had a positive correlation (r=.58, p<.001), whereas PTSD and quality of life had a negative correlation (r=-.45, p<.001). Significant predictors of quality of life were resilience and PTSD. These variables explained 44.9% of the variance in quality of life. CONCLUSION Findings indicate that as resilience of breast cancer patients rose higher and PTSD got lower, their quality of life increased. Based on these results, nursing interventions directed towards improving resilience and relieving PTSD is proposed.
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Cancer-related PTSD symptoms in a veteran sample: association with age, combat PTSD, and quality of life. Psychooncology 2014; 23:921-7. [PMID: 24519893 DOI: 10.1002/pon.3494] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/03/2014] [Accepted: 01/10/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The diagnosis and treatment of cancer is a potentially traumatic experience that may evoke posttraumatic stress symptoms (PTSS) among survivors. This paper describes the rates of endorsement of cancer-related PTSS along with the relationship of demographic, cancer, and combat variables on PTSS and quality of life. METHODS Veterans (N = 166) with head and neck, esophageal, gastric, or colorectal cancers were recruited through tumor registries at two regional Veterans Administration Medical Centers. Standardized scales were used to assess self-report of PTSS, combat, and quality of life. RESULTS Most participants (86%) reported experiencing at least some cancer-related PTSS; 10% scored above a clinical cutoff for probable PTSD. In linear regressions, younger age and current combat PTSS were associated with cancer-related PTSS, whereas disease and treatment characteristics were not; in turn, cancer-related PTSS were negatively associated with physical and social quality of life. CONCLUSIONS Individual characteristics and psychosocial factors may play a larger role than disease-related variables in determining how an individual responds to the stress of cancer diagnosis and treatment. Given the rates of reported cancer-related PTSS in this sample, and other non-veteran samples, clinicians should consider screening these following diagnosis and treatment, particularly in younger adults and those with previous trauma histories.
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Optimism, social support, and mental health outcomes in patients with advanced cancer. Psychooncology 2013; 23:299-306. [PMID: 24123339 DOI: 10.1002/pon.3418] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 08/15/2013] [Accepted: 09/03/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Optimism and social support serve as protective factors against distress in medically ill patients. Very few studies have specifically explored the ways in which these variables interact to impact quality of life (QOL), particularly among patients with advanced cancer. The present study examined the role of optimism as a moderator of the relationship between social support and anxiety, depression, hopelessness, and QOL among patients with advanced cancer. METHODS Participants (N = 168) completed self-report assessments of psychosocial, spiritual, and physical well-being, including social support, optimism, hopelessness, depressive and anxious symptoms, and QOL. Hierarchical multiple regression analyses were conducted to determine the extent to which social support and optimism were associated with depressive and anxious symptomatology, hopelessness and QOL, and the potential role of optimism as a moderator of the relationship between social support and these variables. RESULTS Higher levels of optimism were significantly associated with fewer anxious and depressive symptoms, less hopelessness, and better QOL. Higher levels of perceived social support were also significantly associated with better QOL. Additionally, optimism moderated the relationship between social support and anxiety, such that there was a strong negative association between social support and anxiety for participants with low optimism. CONCLUSIONS This study highlights the importance of optimism and social support in the QOL of patients with advanced cancer. As such, interventions that attend to patients' expectations for positive experiences and the expansion of social support should be the focus of future clinical and research endeavors.
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Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation. Am J Med 2013; 126:916-24. [PMID: 23932160 DOI: 10.1016/j.amjmed.2013.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation. METHODS We prospectively enrolled 186 patients with moderate or severe organic mitral regurgitation, presenting class I (absent) or II (minimal) dyspnea, who were compared with 80 controls of similar age (38 with completely normal cardiac function; 42 with mild mitral-valve prolapse; all with no, or at most mild, mitral regurgitation). Mitral-regurgitation severity and consequences were comprehensively measured, simultaneously with PTSD, anxiety, and depression. RESULTS PTSD prevalence was higher in mitral-regurgitation patients vs controls (23% vs 9%, P <.01). Although mitral-regurgitation objective severity (regurgitant volume 77.8 ± 28.9 vs 79.0 ± 27.5 mL, P = .8) and objective consequences (left-atrial volume 59.1 ± 20.9 vs 54.02 ± 15.6 mL, P = .1; right-ventricular systolic pressure 34.1 ± 11.4 vs 32.9 ± 7.2 mm Hg, P = .6) were similar with and without PTSD (all P ≥.1), patients with PTSD were more symptomatic (class II 74 vs 38%; fatigue 71% vs 38%, both P <.0001) and had higher anxiety and depressions scores (P <.0001). CONCLUSIONS PTSD is prevalent in organic moderate or severe mitral-regurgitation patients but is not determined by objective mitral-regurgitation severity or consequences. PTSD is linked to anxiety and depression and to symptoms usually considered cardiac, such as dyspnea. Thus, PTSD and psycho-emotional manifestations, linked to symptoms, represent important responses to chronic-valve disease that may affect clinical outcomes.
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Trauma and mental health of medics in eastern Myanmar's conflict zones: a cross-sectional and mixed methods investigation. Confl Health 2013; 7:15. [PMID: 23899166 PMCID: PMC3750555 DOI: 10.1186/1752-1505-7-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In conflict and disaster settings, medical personnel are exposed to psychological stressors that threaten their wellbeing and increase their risk of developing burnout, depression, anxiety, and PTSD. As lay medics frequently function as the primary health providers in these situations, their mental health is crucial to the delivery of services to afflicted populations. This study examines a population of community health workers in Karen State, eastern Myanmar to explore the manifestations of health providers' psychological distress in a low-resource conflict environment. METHODS Mental health screening surveys were administered to 74 medics, incorporating the 12-item general health questionnaire (GHQ-12) and the posttraumatic checklist for civilians (PCL-C). Semi-structured qualitative interviews were conducted with 30 medics to investigate local idioms of distress, sources of distress, and the support and management of medics' stressors. RESULTS The GHQ-12 mean was 10.7 (SD 5.0, range 0-23) and PCL-C mean was 36.2 (SD 9.7, range 17-69). There was fair internal consistency for the GHQ-12 and PCL-C (Cronbach's alpha coeffecients 0.74 and 0.80, respectively) and significant correlation between the two scales (Pearson's R-correlation 0.47, P<0.001). Qualitative results revealed abundant evidence of stressors, including perceived inadequacy of skills, transportation barriers, lack of medical resources, isolation from family communities, threats of military violence including landmine injury, and early life trauma resulting from conflict and displacement. Medics also discussed mechanisms to manage stressors, including peer support, group-based and individual forms of coping. CONCLUSIONS The results suggest significant sources and manifestations of mental distress among this under-studied population. The discrepancy between qualitative evidence of abundant stressors and the comparatively low symptom scores may suggest marked mental resilience among subjects. The observed symptom score means in contrast with the qualitative evidence of abundant stressors may suggest the development of marked mental resilience among subjects. Alternatively, the discrepancy may reflect the inadequacy of standard screening tools not validated for this population and potential cultural inappropriateness of established diagnostic frameworks. The importance of peer-group support as a protective factor suggests that interventions might best serve healthworkers in conflict areas by emphasizing community- and team-based strategies.
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The relationship between posttraumatic stress disorder, mood states, functional status, and quality of life in oncology outpatients. J Pain Symptom Manage 2012; 44:520-31. [PMID: 22743157 DOI: 10.1016/j.jpainsymman.2011.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 10/20/2011] [Accepted: 10/27/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Oncology patients are at risk for developing posttraumatic stress disorder (PTSD) and other comorbid mood states, which are associated with decreases in functional status and quality of life (QOL). However, few studies have investigated the relationship between PTSD, other mood states, functional status, and QOL in oncology outpatients. OBJECTIVES This study had four aims: 1) determine the percentages of patients with PTSD and partial PTSD; 2) evaluate for differences in demographic and clinical characteristics among patients with PTSD, partial PTSD, and no PTSD; 3) evaluate for differences in mood states, functional status, and QOL among the three PTSD groups; and 4) evaluate whether demographic and disease characteristics were predictors of PTSD. METHODS As part of a larger clinical trial that evaluated the effects of a cognitive-behavioral intervention on cancer pain management, 289 adult oncology patients (M(age)=61.3, SD=11.6) completed self-report measures that assessed PTSD, other mood states, functional status, and QOL. RESULTS Forty-five percent of the sample met the diagnostic criteria for PTSD (n=78) and partial PTSD (n=53) and were younger than those with no PTSD. Patients with PTSD had a significantly lower Karnofsky Performance Status, shorter time since diagnosis, higher ratings of mood disturbance, lower ratings of functional status, and lower QOL than patients with no PTSD. A lower Karnofsky Performance Status, fewer months since diagnosis, and presence of bone metastases predicted a higher likelihood of being classified as having PTSD. CONCLUSION Early identification and interventions may mediate the onset of psychological distress and improve health outcomes.
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Therapeutic Assessment Case Study: Treatment of a Woman Diagnosed With Metastatic Cancer and Attachment Trauma. J Pers Assess 2012; 94:331-44. [DOI: 10.1080/00223891.2012.656860] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Posttraumatic Stress Disorder and Posttraumatic Growth in Breast Cancer Patients: A Systematic Review. Women Health 2012; 52:503-16. [DOI: 10.1080/03630242.2012.679337] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Post-traumatic stress disorder (PTSD) in cardiology and oncology--which diagnostic tools should be used? J Psychosom Res 2012; 72:434-8. [PMID: 22656439 DOI: 10.1016/j.jpsychores.2012.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 02/23/2012] [Accepted: 02/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES PTSD prevalence rates in cardiac and cancer patients greatly vary probably due to diverging samples, designs and assessments. Aim of this study was therefore to compare prevalence rates of PTSD as well as instruments assessing PTSD in different cardiac and cancer patient groups. METHODS A total of 274 cardiac and cancer patients were examined with the Post-Traumatic Stress Scale 10 (PTSS-10) and the Impact of Event Scale - revised (IES-R). Presence of PTSD was validated by Structured Clinical Interview for DSM-IV (SCID). RESULTS Diagnostic criteria for the existence of PTSD were met by 29.2% of all patients via PTSS-10, by 7.6% in IES-R and by 4.8% in SCID, indicating substantial discrepancy among assessments. This is further underlined by the moderate correlation between self-reports and poor agreement with the standardised interview. CONCLUSION A structured interview is the "gold standard" for diagnosing PTSD in cardiac and cancer patients. Questionnaires can be used as screening instruments when they reliably assess trauma-related diagnostic criteria. Further studies are necessary to clarify the specifics of trauma criteria in medical setting.
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Posttraumatic stress disorder (PTSD) in survivors of Hodgkin's lymphoma: prevalence of PTSD and partial PTSD compared with sibling controls. Psychooncology 2011; 22:434-40. [PMID: 22162210 DOI: 10.1002/pon.2109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/24/2011] [Accepted: 11/04/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Studies of posttraumatic stress disorder (PTSD) document a significant proportion of cancer survivors reporting severe posttraumatic stress symptoms, even when they do not meet full diagnostic criteria. However, few studies have directly examined the clinical significance of these 'partial PTSD' symptoms in survivors. This study aimed to investigate the prevalence of PTSD symptoms in a cohort of long-term survivors of Hodgkin's lymphoma (HL) and to explore the clinical relevance of the partial PTSD phenomenon by assessing impairment of function secondary to sub-threshold symptomatology. METHODS The Posttraumatic Diagnostic Scale was completed by 105 HL survivors and 101 sibling controls. Survivors' age at time of participation ranged from 24 to 71 years, age at time of diagnosis ranged from 6 to 61 years, and the median time since diagnosis was 16 years (range = 7-34). RESULTS Posttraumatic stress disorder prevalence was not significantly higher in HL survivors (13%) compared with sibling controls (6.9%, p = 0.098). However, a significantly larger proportion of survivors (35.2%) met criteria for partial PTSD compared with siblings (17.8%, p = 0.004). Moreover, the majority of the survivors with partial PTSD (86.5%) reported experiencing some functional impairment related to these posttraumatic stress symptoms. CONCLUSIONS A significant number of HL survivors experience posttraumatic stress symptoms severe enough to result in functional impairment. This finding underscores the importance of future research detailing the psychological and functional outcomes in survivors with partial PTSD and of careful clinical practice that assesses for functional impairment secondary to partial PTSD symptomatology, in male and female survivors, even years after completion of therapy.
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The valence of attentional bias and cancer-related rumination in posttraumatic stress and posttraumatic growth among women with breast cancer. Psychooncology 2011; 20:544-52. [PMID: 20878854 DOI: 10.1002/pon.1761] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the effects of self-reported attentional bias on posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) through the potential mediator of cancer-related rumination. DESIGN A cross-sectional survey design was used and women with breast cancer (N=170) were recruited. MEASURES Attentional biases, cancer-related ruminations, PTSD symptoms, and PTG were assessed. RESULTS Negative attentional bias and negative cancer-related rumination were positively related to PTSD symptoms following cancer diagnosis and treatments, but they were not related to PTG. Positive attentional bias and positive cancer-related rumination were positively related to PTG, but positive attentional bias was not related to PTSD symptoms. Findings showed that negative cancer-related rumination partially mediated the relationship between negative attentional bias and PTSD symptoms, while positive cancer-related rumination partially mediated the relationship between positive attentional bias and PTG. CONCLUSION Findings support that there are differential trajectories to PTSD symptoms and PTG with respect to different valence of habitual attentional style and cancer-related rumination. They may serve as potential therapeutic leverages in the alleviation of PTSD symptoms and facilitation of PTG following cancer diagnosis and treatments.
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A longitudinal study on emotional adjustment of sarcoma patients: the determinant role of demographic, clinical and coping variables. Eur J Cancer Care (Engl) 2011; 21:41-51. [PMID: 21812845 DOI: 10.1111/j.1365-2354.2011.01269.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study examined change on emotional distress of sarcoma patients from the diagnostic to treatment phases, the distinct trajectories of adjustment and the influence of demographic, clinical and coping variables on anxiety and depression. Thirty-six sarcoma patients completed questionnaires on emotional distress (Hospital Anxiety and Depression Scale) and coping strategies (Brief Cope) at time of diagnosis, and again during treatment. No significant change in emotional distress levels was found from diagnostic to treatment phase, with mean anxiety and depression scores remaining below the clinical range. Over time, 52.8% and 66.7% of patients maintained non-clinical anxious and depressive symptoms respectively, and 25% and 11.1% remained with clinical anxiety and depression. Living with partner, less use of humour and more denial were associated with high emotional distress at time of diagnosis and during treatments, and high levels of distress at baseline were predictive of poorer emotional adjustment during treatments. Although sarcoma patients, in general, seem to exhibit good psychological adjustment, there is a significant minority that requires mental health services in order to help decrease their emotional distress following the diagnosis, and prevent psychological difficulties during treatments. Our findings are an important contribution to understanding the psychological adjustment of patients with a specific and rare type of cancer.
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Anxiety, depression, traumatic stress and quality of life in colorectal cancer after different treatments: A study with Portuguese patients and their partners. Eur J Oncol Nurs 2011; 16:227-32. [PMID: 21783416 DOI: 10.1016/j.ejon.2011.06.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 05/29/2011] [Accepted: 06/12/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE This study examines the impact of different modes of treatment on depression, anxiety, traumatic stress and quality of life in colorectal cancer patients and their partners. METHODS The sample was comprised of 114 oncology patients and 67 partners. All patients were diagnosed with colorectal cancer. Participants were recruited from an Oncology Hospital in the North of Portugal and had been submitted to three modes of treatment: surgery, surgery plus chemotherapy or surgery followed by radiotherapy. RESULTS The results showed that patients who received only surgery, as treatment, had lower levels of depression, anxiety and traumatic stress symptoms when compared with patients who received surgery and chemotherapy or surgery plus radiotherapy. Partners of surgical patients presented lower levels of state anxiety and traumatic stress symptoms when compared with the other two groups. Patients with more depression had partners also more depressed. No relationship was found between anxiety and traumatic stress symptoms in patients and partners. Patients who received a diagnosis longer than 12 months had more traumatic stress, intrusion and hypervigilance. Patients with illness recurrence showed more traumatic symptoms. Anxiety and depression were the main predictors of patient's quality of life. Traumatic stress was a predictor of symptom distress - pain/bowel pattern. CONCLUSION This study highlights the importance of providing psychological interventions for cancer patients and their partners. Chemotherapy patients and those diagnosed over a year, as well as their partners, are more at risk.
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Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS. J Psychiatr Res 2011; 45:942-8. [PMID: 21636097 PMCID: PMC3118254 DOI: 10.1016/j.jpsychires.2011.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/09/2011] [Accepted: 05/06/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are approximately 1,000,000 persons living with HIV/AIDS (PLH) in the United States; to reduce rates of new infection and curb disease progression, adherence to HIV medication among PLH is critical. Despite elevated trauma rates in PLH, no studies to date have investigated the relationship between dissociation, a specific symptom of trauma, and HIV medication adherence. We hypothesized that Post-Traumatic Stress Disorder (PTSD) symptoms would be associated with lower adherence, and that dissociation would moderate this relationship. METHODS Forty-three individuals with HIV were recruited from community-based clinics to participate in a cross-sectional study. The relationship of trauma, dissociation, and their interaction to the probability of antiretroviral adherence was assessed using a hierarchical binary logistic regression analysis. RESULTS Among 38 eligible participants, greater PTSD was associated with lower odds of adherence (OR = .92, p < .05). Dissociation moderated the effect of PTSD on adherence, resulting in lower odds of adherence (OR = .95, p < .05). PTSD symptoms were significantly associated with lower odds of adherence in individuals reporting high levels of dissociation (OR = .86, p < .05) but not in those reporting low levels of dissociation (OR = 1.02, p > .05). CONCLUSIONS This is the first study to demonstrate a relationship between dissociation and medication adherence. Findings are discussed in the context of clinical management of PLH with trauma histories and the need for interventions targeting dissociative symptomatology to optimize adherence.
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Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety 2011; 28:596-606. [PMID: 21681864 PMCID: PMC3128669 DOI: 10.1002/da.20837] [Citation(s) in RCA: 617] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/27/2011] [Accepted: 04/27/2011] [Indexed: 12/18/2022] Open
Abstract
The posttraumatic stress disorder checklist is a commonly used measure, with military (PCL-M), civilian (PCL-C), and specific trauma (PCL-S) versions. This synthesis of the psychometric properties of all three versions found the PCL to be a well-validated measure. The PCL shows good temporal stability, internal consistency, test-retest reliability, and convergent validity. The majority of structural validity studies support four factor models. Little is available on discriminant validity and sensitivity to change. Strengths, limitations, and future research directions are discussed. Understanding the PCL's psychometric properties, strengths (e.g., items map on to DSM-IV diagnostic criteria), and limitations (e.g., may overestimate PTSD prevalence) will help clinicians and researchers make educated decisions regarding the appropriate use of this measure in their particular setting.
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A longitudinal study of psychosocial distress in breast cancer: prevalence and risk factors. Psychol Health 2011; 27:72-87. [PMID: 21678180 DOI: 10.1080/08870446.2010.542814] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.
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Clinical, demographic, and situational factors linked to distress associated with benign breast biopsy. J Psychosoc Oncol 2011; 29:35-50. [PMID: 21240724 DOI: 10.1080/07347332.2011.534024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Benign breast biopsy (BBB) can be distressing for many women. Few studies have examined specific aspects of the BBB more or less distressing or risk factors for distress. Women (N = 51) who had a recent BBB reported the magnitude of distress associated with specific aspects of their experience. Clinical and demographic variables were also examined as risk factors for distress. All women reported some distress associated with the BBB with one third reporting their experience was "very stressful." Generally, biopsy-specific events were more distressing than follow-up mammography. Distress risk factors included younger age, less education, nonsurgical biopsy, and no family history of breast cancer. Clinical efforts to better manage biopsy-related distress are warranted. The authors identified clinical and demographic risk factors that furnish a simple, efficient, and potentially cost-effective means of stratifying risk for distress in the breast biopsy setting.
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The mediating effects of social support and self-efficacy on the relationship between social distress and emotional distress in head and neck cancer outpatients with facial disfigurement. Psychooncology 2010; 21:144-52. [DOI: 10.1002/pon.1877] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 08/29/2010] [Accepted: 10/13/2010] [Indexed: 11/06/2022]
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Engagement and Vicarious Traumatization in rescue workers. Int Arch Occup Environ Health 2010; 84:67-75. [PMID: 21079988 DOI: 10.1007/s00420-010-0601-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aims of this study are (1) to investigate the incidence of the symptoms of Vicarious Traumatization in a group of rescue workers; (2) to explore some of the main predictors of Engagement and Vicarious Traumatization; and (3) to identify the individual and organizational factors able to improve the state of well-being of those working in the helping professions. METHODS A total of 782 rescue workers, involved in critical operations of various kinds in constant contact with traumatized subjects, were investigated applying the Maslach Burnout Inventory-General Scale (MBI-GS) and the Secondary Traumatic Stress Scale (STSS). RESULTS The post-traumatic symptoms most frequently reported were those of an intrusive nature. A partial overlap emerged between the predictors of Vicarious Traumatization and Engagement: if compared with social and demographic characteristics and with the degree of commitment required by the work, organizational variables would appear to have the greatest influence over the two constructs. A supportive working environment in particular favors Engagement, reducing the probability of developing Burnout. CONCLUSIONS The results confirm the hypotheses that Engagement and Vicarious Traumatization are primarily determined by organizational variables, and, particularly, by the level of job support.
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Social support and depressive mood 1 year after diagnosis of breast cancer compared with the general female population: a prospective cohort study. Support Care Cancer 2010; 19:1379-92. [DOI: 10.1007/s00520-010-0960-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 07/19/2010] [Indexed: 11/12/2022]
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