Retrospective and prospective measures of post-traumatic growth reflect different processes: longitudinal evidence of greater decline than growth following a hematopoietic stem-cell transplantation

Jacques-Olivier Bay,Isabelle Brindel,Marie-Thérèse Rubio,Aurélie Cabrespine,Michaël Dambrun,Maya Corman,Régis Peffault De La Tour

doi:10.1186/s12888-020-03007-y

Abstract

BackgroundThis prospective longitudinal study examined and compared two measures (prospective and retrospective ones) of post-traumatic growth (PTG) following Hematopoietic Stem-Cell Transplantation (HSCT) and their respective relationships with mental health and psychological disposition. We also tested the hypothesis that unwillingness to be in contact with distressing thoughts and feelings—i.e. experiential avoidance—would moderate the relationship between Post-Traumatic Stress Disorder (PTSD) and growth.MethodsThis study was carried out with 187 patients. Patients completed the Post-Traumatic Growth Inventory (PTGI) 5 months after HSCT and scales tapping into the five domains of PTGI during hospitalisation and 5 months after HSCT. Mental health and psychological disposition were also assessed prior to hospitalisation. A PTSD scale was administered at the five-month follow-up.ResultsProspective and retrospective measures of PTG were weakly correlated. Bayesian pre/post-HSCT comparisons in the prospective measure of PTG revealed substantial to very strong decline in four of the five dimensions assessed. Overall, RCI indicated a reliable increase for 5.6% of patients and a reliable decrease for 40.8% of patients. Confirming that retrospective and prospective measures of PTG reflect different processes, they were not related to the same mental health and psychological disposition variables. Moreover, the hypothesis that acquiring positive outcomes from a potentially traumatic experience, such as HSCT, requires direct confrontation with the source of distress was supported in the case of the retrospective measure of growth but not in the case of the prospective measure growth.ConclusionsRetrospective measures such as the PTGI do not appear to assess actual pre- to post-HSCT change. HSCT seems more linked to psychological decline than to growth.

Highlights

This prospective longitudinal study examined and compared two measures of post-traumatic growth (PTG) following Hematopoietic Stem-Cell Transplantation (HSCT) and their respective relationships with mental health and psychological disposition
To go further in the study of the differences and similarities between both measures of PTG, we studied their relationships with mental health and several psychological dispositions that we assessed 3 weeks prior to hospitalisation for HSCT
Contrary to an acute stress, the temporal delimitation of the traumatic event in the case of cancer is not as perceptible or delimited for various reasons such as the risk of relapse. These differences have major implications on the lived experiences of patients who have to face an ongoing threat, which often engenders psychological distress. This observation is true in the case of HSCT since patients are constantly confronted with the risk of relapse, infections, and graft versus host disease (GvHD) in the long-term, despite an improvement of patients’ quality of life over time revealed by some studies

Summary

Introduction

This prospective longitudinal study examined and compared two measures (prospective and retrospective ones) of post-traumatic growth (PTG) following Hematopoietic Stem-Cell Transplantation (HSCT) and their respective relationships with mental health and psychological disposition. When comparing scores for actual change between before and after trauma, Frazier et al did not find more evidence for reliable psychological growth than decline, raising issues about the characteristics of genuine post-traumatic growth and the best measure to describe it This lack of robust empirical evidence, accompanied by significant methodological limitations, led Infurna and Jayawickreme [12] to recommend (a) caution when interpreting studies using retrospective self-perceived measures, and (b) the use of prospective longitudinal designs that allow a more reliable assessment of the change between before and after the adverse event. We conducted a prospective longitudinal study among hematological cancer patients

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