Perceived stress and posttraumatic growth in caregivers of pediatric burn patients undergoing mHealth-enhanced outpatient burn care: A pilot study

Post-traumatic stress symptoms (PTSS) and other emotional/behavioral challenges are common in children exposed to traumatic events. However, many children also experience positive psychological benefits, termed posttraumatic growth (PTG). PTG has been found in a variety of pediatric populations, as well as in adult burn patients. However, to our knowledge the specific construct of PTG has not been assessed in pediatric burn survivors. This study examined prevalence of PTG, demographic/burn injury correlates of PTG, and associations between PTG and PTSS. Participants were part of a larger Burn Model System national database and included children between the ages of 8 and 17. Participants completed the Child PTSD Symptom Scale (CPSS) and Post Traumatic Growth Inventory-Child (PTGI-C). Demographic and burn injury data were also gathered. Linear regression models were completed at 6 months to predict PTGI scores. One model included demographic and injury characteristics as predictors and one model included the psychosocial CPSS score as a predictor. A total of 59 individuals had data for PTGI at 6 months post-burn. The mean PTGI score was 20.6, indicating moderate posttraumatic growth. PTGI scores at 6 months were significantly different (p<.01) between the ethnicity groups, with Hispanic participants indicating higher levels of PTG (mean = 23.5) than non-Hispanic participants (mean = 14.9). Regression results indicate other burns (i.e., non-fire/electric) (p=.01) and TBSA (p<.001) are significantly related to PTGI scores. Those with burns other than flame have on average 9.07 points higher PTGI scores, and for each 10% increase in TBSA, there is an average increase of 2.21 points in PTGI scores after adjusting for other factors (age, ethnicity, type of burn, amputation, and sex). With CPSS scores included in the model, regression results indicate that burns other than flame (p=.01), TBSA (p<.001), and CPSS scores (p=.02) are significantly related to PTGI after adjusting for other factors. For each point increase in CPSS total score, there is an average decrease of 0.27 points in PTGI scores. The majority of children exhibit at least some psychosocial growth following a burn. Hispanic children exhibit significantly more growth than their non-Hispanic peers. Fire/flame injured children exhibit less growth than those burned by other mechanisms. As traumatic stress symptoms increase, PTG slightly decreases. Mental health providers should screen for PTG and look for ways to facilitate PTG, especially in groups that exhibit low rates of growth. Moderate levels of posttraumatic growth occur in most pediatric burn patients. Data on PTG and PTSS should be gathered at discharge in order to better examine change over time and to guide interventions.

e22528 Background: Adolescents and young adults (AYA) who experienced cancer treatment sometimes show posttraumatic stress symptoms (PTSS) and yet report positive psychological changes, known as posttraumatic growth (PTG). Literature suggests PTSS and PTG are not on opposite ends of a single spectrum but rather coexist. It is expected to have distinct relationships with social support, and yet, the roles of peer support remain unknown. This study examines PTG and PTSS, and their correlates with peer support among AYA cancer survivors. Methods: A cross-sectional study was conducted using a questionnaire survey with AYA cancer survivors. A total of 212 AYA survivors were recruited from 11 cancer centers and 12 cancer patients’ communities. They completed a self-report measure of the PTG Inventory and the Impact of Event Scale revised (IES-R) to assess PTSS. Diagnosis, treatment, peer support (i.e., affiliation to AYA patients’ community and friendship with other AYA cancer patients), and social status information was also collected from questionnaires. A series of multiple regression analyses was used to identify significant correlates among peer support, PTG and PTSS. Results: PTG and PTSS were not significantly correlated with each other, being consistent with the previous studies. PTG was positively associated with male gender, years since diagnosis, good communication with others, and friendship with other AYA cancer patients. Friendship with other AYA cancer patients was positively associated with not just the overall PTG but all five domains of PTG. PTSS was associated with years since diagnosis, unemployed status, and symptom of late effects. PTSS was, however, unlike PTG, not related with friendship with other AYA cancer patients or affiliation to AYA patients’ community. Conclusions: Good communication and friendship with other AYA cancer patients is suggested to play an important role in PTG but not PTSS. Psychosocial intervention to facilitate peer support among AYA cancer patients would possibly contribute to revive their lives through PTG. Future studies should further investigate what factors would contribute to alleviation of PTSS and foster PTG. Clinical trial information: UMIN000035439.

Simple SummaryA diagnosis of childhood cancer, and its subsequent treatment, initiates a difficult and long-lasting experience for families which can result in posttraumatic stress symptoms. However, positive change, such as growth, may also occur. The relationship between posttraumatic stress symptoms and growth in the wake of childhood cancer is poorly understood. We sought to better understand the relationships between children’s posttraumatic stress symptoms and growth and those of their parents via a survey. The results from our study showed that the children and parents in our study were faring relatively well, reporting low levels of posttraumatic stress symptoms and moderate levels of growth. The children’s posttraumatic stress symptom score was not related to, nor did it predict their growth. The same was true for their parents wherein their posttraumatic stress symptom score was not related to, nor did it predict their growth. Notably, lower posttraumatic stress symptom scores among children were associated with greater growth in their parents, and vice versa, but the parents’ posttraumatic stress symptom score was not associated with the children’s growth.There is a growing focus on describing both negative and positive outcomes in the wake of childhood cancer. The purpose of this study was to describe and explore the relationships between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among children living beyond cancer and one of their parents. As part of a larger online survey, 113 children (Mage at time of study = 15.82 (SD = 4.81); Mage at diagnosis = 5.86 (SD = 4.66)) and one of their parents completed questionnaires assessing PTSS and PTG. Descriptive statistics were used to describe the sample and levels of PTSS and PTG. Data were z-transformed and analyzed using bivariate correlations and t-tests. An actor–partner interdependence model (APIM) was used to test whether children’s and their parents’ PTSS was associated with their own PTG (actor effect) and the others’ PTG (partner effect). PTSS was low and PTG was moderate in this sample relative to scale ranges. There were no significant differences between the children’s and their parents’ PTSS (p = 0.535) or PTG (p = 0.534). Results from the APIM showed no significant actor effects (p = 0.185). A significant overall partner effect (p = 0.020) emerged. Lower PTSS for children was associated with greater PTG for their parents (b = −0.29, p = 0.018), but parent’s PTSS was not associated with children’s PTG (p = 0.434). This sample reported similar levels of PTSS and PTG to that which has been reported in the literature. Children and their parents’ scores on PTSS and PTG measures were not significantly different from one another. Children’s PTSS was negatively associated with their parents PTG, illuminating the ways in which PTSS and PTG may be related in the context of childhood cancer. Exploring family-based strategies to reduce PTSS and enhance PTG may be warranted, though further studies are required.

The diagnosis and treatment of cancer triggers not only a negative psychological response for the patient, but also a positive psychological outcome. Positive dyadic coping, as a form of coping for mental health outcomes, can maintain or reestablish internal stability between the patient and his or her spouse, resulting in positive physical and psychological changes. However, there is a paucity of research on body image, dyadic coping, and post-traumatic growth in breast cancer patients. The purpose of this study was to explore the relationship and pathways between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A cross-sectional study was conducted from November 2022 to November 2023 at a tertiary care hospital in Wuxi, Jiangsu, China. This study was conducted among 154 breast cancer patients treated at the Affiliated Hospital of Jiangnan University, all of whom completed demographic and clinical information questionnaires, Body image self-rating questionnaire for breast cancer (BISQ-BC), Dyadic Coping Inventory (DCI) and Post Traumatic Growth Inventory (PTGI). A Pearson correlation analysis was used to explore the relationship between body image, dyadic coping, and post-traumatic growth. Structural equation modeling was used to analyze the path relationships among the three and to explore the mediating role of dyadic coping. The level of body image was negatively correlated with post-traumatic growth (r = -0.462, p < 0.01); and the level of body image was negatively correlated with dyadic coping (r = -0.308, p < 0.01). And dyadic coping was positively associated with post-traumatic growth (r = 0.464, p < 0.01). The structural equation modeling results supported the mediation model with the following model fit indices, chi-square to degrees of freedom ratio (χ2/df = 2.05), goodness of fit index (GFI = 0.93), comparative fit index (CFI = 0.99), canonical fit index (NFI = 0.93), incremental fit index (IFI = 0.99), non-canonical fit index (TLI = 0.99) and the root mean square of the difference in approximation error (RMSEA = 0.03). Body image and dyadic coping directly affected post-traumatic growth (β = -0.33, p < 0.05; β = 0.43, p < 0.05). And body image indirectly influenced post-traumatic growth through dyadic coping (β = -0.17, p < 0.05). Interconnections between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A preliminary validation of the mediating role of dyadic coping between body image and post-traumatic growth, body image can have an impact on dyadic coping, which in turn can have an impact on post-traumatic growth. Whereby higher levels of dyadic coping in patients may also be associated with higher levels of post-traumatic growth, whereas body image disturbance may impede levels of post-traumatic growth.

Recent research indicates that 25%-30% of IBD patients experience chronic post-traumatic stress (IBD-PTS), which is linked to poorer health outcomes. Post-traumatic growth (PTG) refers to positive psychological changes resulting from coping with trauma or major life crises. PTG may mitigate the negative effects of IBD-PTS and may be influenced by disease activity. We aimed to explore the relationship between disease status, expectations about achieving and maintaining remission, and PTG among IBD patients. Adults (18+) with IBD participated in an online survey via Qualtrics, which included demographic information, the Patient Simple Clinical Colitis Activity Index (P-SCCAI), the Post-Traumatic Growth Inventory (PTGI), and the PTSD Checklist for DSM-5 (PCL-5). Participants indicated whether they were in remission or experiencing a flare and their expectations of having a flare in the next two months using a 4-point Likert scale. The study included 313 adults with IBD: 140 with ulcerative colitis (UC) and 173 with Crohn’s disease (CD), aged 18-70 years (M=33, SD=11), with 75.1% being female. Most participants had active disease and exhibited high levels of IBD-PTS. No significant correlation was found between P-SCCAI scores and PTG (r= -.09, p=.127). Those currently experiencing a flare (n=133, 42.4%) reported lower confidence in the longevity of their remission over the next two months compared to those in remission (Χ2=114.01, p&amp;lt;.001), but PTG levels did not differ significantly between groups (p=.310). However, participants confident in their remission status exhibited higher PTG levels (F(3,309)=4.688, p=.003). Participants who endorsed “I am positive I will experience a flare in the next two months” scored lower on PTG (M=65.91, SD=25.33) than those who endorsed “I am positive I will not experience a flare in the next two months” (M=81.52, SD=25.58; p=.004). Those who were at least 50% sure of another flare also showed lower PTG (M=69.99, SD=22.95) compared to the most confident group (p=.026). A linear regression confirmed that confidence in remission significantly influenced PTG levels (F(3,309)=4.688, p=.003), with less confident participants scoring 15.61 points lower on PTG than their most confident counterparts. IBD patients who are confident in remission are likely to have higher levels of PTG than those who are more pessimistic about their disease course independent of current symptom activity.Patients with confidence in remission longevity may conceptualize remission as an “end” to the threat of IBD-PTS, allowing PTG to occur. Conversely, if remission is seen as a temporary reprieve before the next inevitable flare, it may limit patients’ cultivation of PTG. Providers can help patients move towards a PTG mindset by assessing patients’ expectations of remission, modeling confidence, and providing evidence for ongoing hope. Results Table Key Finding

Family members can be required to take on the role of "caregiver" at any stage of life, causing disruption and psychological distress. This review sought to describe the traumatic impact (i.e., posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) of cancer caregiving across the lifespan. This systematic review characterizes the current literature on cancer caregiver PTSS and PTG through a developmental lens with respect to caregiver age and their relationship to the patient. Three electronic databases (PubMed/MEDLINE, Embase, and PsycInfo) were searched for relevant studies using a combination of controlled vocabulary and text words. Studies were limited to English-language only articles, but not limited by geography or publication date. A literature review management tool, Covidence, was used to screen for article eligibility as well as for data extraction and article quality assessment. A final total of 275 studies underwent data extraction and quality assessment. Studies indicated that at all ages, caregivers experience PTSS. A gap in the literature was identified for child (<18) and older adult (65+) caregivers. At other ages, most studies found elevated PTG in caregivers. Small variations of number of studies finding PTSS and PTG were found across age ranges. Posttraumatic stress and growth appear to be experienced across the lifespan. However certain age groups are under-researched. Few studies focus on younger or older caregivers, especially in respect to PTG. There is a crucial need for studies in caregivers, particularly in these groups to fully address and support their unique caregiving needs and current population-based research does not attempt to depict the proportion of cancer caregivers at different developmental stages.

IntroductionSome family caregivers of breast cancer patients experience post-traumatic growth, which is influenced by various psychological factors. However, limited studies have explored these factors. This study aims to examine the psychological factors affecting post-traumatic growth in primary caregivers of breast cancer patients.MethodsThis cross-sectional study was conducted on 194 primary caregivers of breast cancer patients at a referral oncology hospital in Mazandaran Province (Babol, Iran). Participants completed questionnaires assessing post-traumatic growth, Hospital Anxiety and Depression Scale, the NEO Five-Factor Inventory, Perceived Social Support, Perceived Stress Scale, and Spiritual Well-Being. Correlation matrices were used to evaluate the relationships between psychological factors and post-traumatic growth, and stepwise regression analysis identified predictors of post-traumatic growth.ResultsThe prevalence of post-traumatic growth (77.3%) among caregivers of breast cancer patients was higher than anxiety (47.9%) and depression (22.2%). post-traumatic growth was negatively associated with perceived stress, depression, anxiety, and neuroticism, while it was positively correlated with extraversion, agreeableness, conscientiousness, and spiritual well-being (p-value < 0.05). Stepwise regression analysis revealed that conscientiousness (β = 0.285, p-value < 0.001) and spiritual well-being (β = 0.209, p-value = 0.002) were positive predictors of post-traumatic growth, whereas perceived stress (β = -0.150, p-value = 0.025) was a negative predictor.ConclusionSpiritual health and high conscientiousness are facilitators, while stress is a barrier to post-traumatic growth (PTG) in caregivers of breast cancer patients. These findings emphasize the need to consider psychological factors in clinical interventions to support caregivers.

Pediatric cancer can be considered an event potentially leading to posttraumatic stress symptoms (PTSS) as well as posttraumatic growth (PTG). While clinically significant levels of PTSS are rare in childhood cancer survivors, PTG is common in this population. However, the relationship of PTG to overall adaptation and quality of life (QOL) in pediatric cancer patients is not clear. Therefore, our study aims to analyse the relationships of PTSS and PTG with QOL in childhood cancer survivors. In this study, 172 childhood cancer survivors completed measures of quality of life (Minneapolis-Manchester Quality of Life Scale; child and adolescent version), posttraumatic stress (UCLA PTSD Reaction Index for DMS-IV) and posttraumatic growth (Benefit Finding Scale for Children). Correlation analyses were carried out separately for the child (up to 13 years, N = 47) and adolescent (more than 13 years, N = 125) groups and each QOL dimension. In the adolescent group, the relationship of PTSS and PTG with QOL was further verified by regression analyses while controlling for age, gender, and time off treatment. In children, negative relationships between PTSS and QOL were found, but the relationships between QOL and PTG were not significant. In adolescents, significant relationships were found for all dimensions of QOL and PTSS and also for several dimensions of QOL and PTG. The relationships between PTSS and QOL dimensions were negative in both groups, and the relationships between PTG and QOL in the adolescent group were weakly positive. In adolescents, regression analyses controlling for age, gender and time off treatment were performed and confirmed a negative relationship of PTSS with all QOL dimensions except for social functioning. For PTG, regression analyses revealed a significant positive relationship with QOL dimensions of social functioning, outlook on life and intimate relations. While the relationship between PTSS and QOL is negative for almost all QOL dimensions in children and adolescents, the nature of the relationship between PTG and QOL appears to be more complex and changing over time. PTG in children may reflect different processes with different outcomes than PTG in adolescents.

The COVID-19 pandemic is a collective trauma causing profound psychological distress and, in some cases, positive psychological changes. The present study ascertained the most influential symptoms and strong connections between posttraumatic stress (PTS) symptoms and posttraumatic growth (PTG) elements. It also examined the symptoms/elements that acted as a bridge between the two, to elucidate how PTS and PTG co-exist. The PTSD Checklist (PCL-5) and Posttraumatic Growth Inventory (PTGI) were used to assess PTS symptoms and PTG, respectively, in a sample of 509 adults from Kashmir, India. The network analysis revealed negative trauma-related emotions as the most influential symptom in the PTS network, and the ability to do better things with life as the most influential element in the PTG network. Eight bridge symptoms/elements emerged between the PTS and PTG, namely intrusive thoughts, nightmares, more compassion for others, sleep disturbances, trauma-related amnesia, hypervigilance, willingness to express emotions, and counting on others more. The study identified the most influential symptom in the PTS network and the bridge symptoms in the combined network of PTS symptoms and PTG elements in the context of the COVID-19 pandemic in the present sample. The bridge symptoms helped in understanding how PTS and PTG co-existed in adults exposed to disasters such as COVID-19. Identification of these symptoms can be highly significant for developing targeted interventions. These implications have been discussed further in the present study. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Receiving a diagnosis of HIV can be challenging. People with HIV (PWH) can experience high levels of distress, as well as some positive psychological changes associated with post-traumatic growth. However, the mechanisms which underlying the association of a highly stressful event (i.e., being diagnosed with HIV) and posttraumatic growth (PTG) and posttraumatic stress symptoms (PTSS) are under-explored, and this is the focus of the study. Cross-sectional survey data were provided by 77 PWH living in New Zealand. An analysis examined the roles of deliberate rumination and coping strategies as serial mediators of the associations between event centrality and PTG and PTSSs. The relationships between event centrality and PTG and PTSSs were found to be sequentially mediated by deliberate rumination and avoidance coping, but not by deliberate rumination and active coping. Further analyses explored active coping and deliberate rumination as parallel mediators, with avoidance coping as a subsequent mediator, between event centrality and PTG and PTSSs. However, these analyses were not supported. The findings indicate that the more participants appraised the HIV diagnosis as central, the greater PTG they perceived; however, the more they deliberately ruminated on it, and the more avoidance coping they adopted, the less PTG and greater PTSSs they perceived. Future studies need to explore the relationships of event centrality and coping and their associations with PTG and PTSSs.

Conversion practices aim to suppress or change minority gender identity or sexual orientations to cisgender and heterosexual. They are ineffective at achieving these goals and instead cause harm to those who experience them. Conversion practices may lead to posttraumatic stress disorder (PTSD). Prior research has shown that posttraumatic growth – the positive psychological changes that can arise after exposure to a traumatic event – may account for the absence of PTSD symptoms. The present study investigated if posttraumatic growth mediates the relationship between exposure to conversion practices and PSTD symptomatology. It was hypothesised that conversion practices would predict PTSD and posttraumatic growth, and that posttraumatic growth would mediate the relationship between conversion practices and PTSD symptomatology. Notably, we disentangled formal conversion practices (e.g., psychotherapy) from informal conversion practices (e.g. prayer from religious leaders). Participants were 238 Australian adult LGBTQA+ survivors of conversion practices. In multiple regression, both formal and informal conversion practices were related to PTSD (although informal practices were a better predictor). Both formal and informal practices significantly predicted posttraumatic growth. Posttraumatic growth mediated the relationship between PTSD and informal conversion practices, but not formal practices. The current study suggests that promoting posttraumatic growth may help to alleviate PTSD following conversion practices.

Pandemic-related posttraumatic psychological growth in U.S. military veterans: A 3-year, nationally representative, longitudinal study

There is a gap in the literature concerning the temporal course, and the bidirectional nature, of the relationship between posttraumatic growth (PTG) and posttraumatic stress symptoms. This longitudinal study investigated PTG and posttraumatic stress in individuals directly exposed to the 2011 Oslo bombing ( N = 240). To investigate the relationships between PTG and posttraumatic stress 10 (T1) and 22 (T2) months after the bombing, a cross-lagged autoregressive model was applied. High levels of PTG at T1 were associated with high levels of posttraumatic stress at T2. Furthermore, high levels of posttraumatic stress at T1 were associated with high levels of PTG at T2. The association between PTG and stress declined from 10 to 22 months and was not significant after 22 months. These findings indicate that PTG may be both a consequence and antecedent of posttraumatic stress.

We sought to explore whether post-traumatic growth (PTG) (positive change or benefit finding resulting from trauma) moderates relationships between post-traumatic stress symptoms (PTSS) and both depression and quality of life (QOL) among breast cancer survivors. We interviewed 161 women previously treated for early stage breast cancer. We assessed PTG using the Post-traumatic Growth Inventory, PTSS using the PTSD Checklist, depressive symptoms using the CES-D and QOL using the FACT-B. Higher PTSS was associated with greater depressive symptoms and lower QOL (p<0.01). The relationship between PTSS and depression was attenuated among women with higher levels of PTG (PTSS x PTG interaction, p<0.05). The same pattern of results was found for QOL (interaction p<0.01). We report the novel finding that PTG moderated relationships between PTSS and both depression and QOL. We speculate that finding positive meaning in response to a distressing event, such as diagnosis of cancer, may be psychologically protective and could indirectly influence the long-term occurrence of depressive symptoms and impaired QOL.

Although traumatic events are generally associated with negative psychosocial consequences, trauma survivors also report positive changes in themselves, human relationships and spirituality. Our aims are, first to study associations between exposure to torture and ill-treatment and posttraumatic growth and negative emotions, and second, to examine the role of adult attachment in moderating the association between exposure and positive growth. The participants were 275 Palestinian men imprisoned in a political context. They completed the Posttraumatic Growth Inventory (PTGI), adult attachment questionnaire (AAQ) and reported exposure to traumatic events. The results show that a high level of torture and ill-treatment was associated with a low level of posttraumatic growth and a high level of negative emotions. However, adult attachment style moderated that association, among men with secure attachment exposure to torture and ill-treatment was associated with a high level of posttraumatic growth, whereas among insecure-avoidant men exposure was associated with relatively higher level of negative emotions. Main effects show that men with secure attachment reported generally more posttraumatic growth, i.e., personal strength, positive affiliation to others and spiritual change, while insecure-preoccupied attachment was associated with negative emotions. Finally, favourable socio-economic characteristics were associated with posttraumatic growth: men with high professional position, steady employment, and good economic situation reported more personal strength and positive affiliation to others. Of demographic factors, only education was associated with attachment, secure men being more educated.