Trajectories of Posttraumatic Growth Among Latvian Parents of Children with Cancer: A Mixed Methods Approach

Objectives: The factors that influence parents’ coping strategies after their child is diagnosed with cancer and the outcomes of coping are not fully understood. The challenges of coping can be accompanied by negative consequences, such as posttraumatic stress symptoms (PTSS), but can also result in positive long-term effects, like posttraumatic growth (PTG) experienced after the struggle of a challenging life event. This study aims to examine the relationship between care­givers’ cognitive beliefs about the illness, personality traits, coping strategies they use to adapt to childhood cancer, and the psychological outcomes (PTSS and PTG) after cancer treatment. Method: A prospective, longitudinal, exploratory design was used in this study. Fifty-nine care­givers (51 mothers, 8 fathers) of pediatric cancer patients completed the Latvian version of the Psychosocial Assessment Tool (PAT) and brief personality measure Big Five Inverntory-10 (BFI-10) shortly after the diagnosis (T1). The second data collection (T2) was after the completion of the curative treatment. During this phase, the Responses to Stress Questionnaire (RSQ), Survivors’ version, the Impact of Event Scale-Revised (IES-R), and the Posttraumatic Growth Inventory (PTGI) were administered. Parents were recruited from Children’s Clinical University Hospital in Riga, Latvia. Results: Significant correlations were found between psychosocial risk factors (e.g., acute stress reactions of parents after diagnosis and negative cognitive beliefs about the illness) at the beginning of the treatment and posttraumatic symptoms after the completion of the treatment. The differences in the choice of coping strategies (Primary / Secondary Control Engagement Coping), as well as two types of involuntary stress responses (involuntary engagement and involuntary disengagement) were observed and were significantly related to posttraumatic outcomes. Implications: The findings indicate that the intricate interconnection of initial cancer perceptions of parents, personality traits, and involuntary coping reactions plays a significant role in influencing levels of PTTS and PTG.

Posttraumatic growth (PTG), defined as a positive change after a traumatic event, has become the subject of various studies, and its relationship with posttraumatic stress symptoms (PTSS) has been extensively investigated. However, studies have indicated differences in the relationship between PTG and PTSS. Therefore, this study aimed to investigate the mediating role of PTSS in the relationship between the number of traumatic losses and PTG among the 2011 Van earthquake survivors. The sample of this study consisted of 917 participants who experienced the 2011 Van earthquake. A personal information form, impact of event scale-revised (IES-R), and posttraumatic growth inventory (PTGI) were used as data collection tools. Survivors with traumatic loss were found to have higher PTSS and PTG than survivors without traumatic loss. The mean scores of the PTGI subscales were higher among survivors with traumatic loss except for changes in self-perception. A positive correlation was found between IES-R and PTGI total scores. In the regression analysis, it was found that PTSS played a mediating role in the relationship between the number of traumatic losses and PTG. This study revealed that PTG is possible with the presence of PTSS. Mental health professionals assisting survivors with traumatic loss should take the enhancement of PTG into consideration in addition to their efforts to reduce PTSS.

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.

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.

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.

Contemporary models of trauma suggest that posttraumatic stress and growth should be related and that symptoms of stress resulting from a perceived trauma (e.g., childhood cancer) are prerequisite for posttraumatic growth (PTG) to occur. However, empirical data regarding the relationship of posttraumatic stress and growth have been equivocal. The purpose of this study is to examine the relationship between posttraumatic stress symptoms (PTSS) and PTG among adult survivors of childhood cancer. Survey methods were used to collect data from 6,162 survivors participating in the Childhood Cancer Survivor Study (CCSS). Nonparametric correlation was examined pairwise between PTG and PTSS using Spearman's correlation coefficient with 95% confidence intervals, with nonlinear canonical correlation analysis being conducted to examine relationships between subscales. A multivariable partial proportional odds model was also fit for PTG total quartiles focusing on associations with PTSS total quartiles while adjusting for sociodemographic and medical variables. Examination of unadjusted PTSS and PTG total scores revealed a Spearman correlation of 0.11 (p < .001), with coefficients ranging from 0.03 to 0.17 between total and subscale scores. The nonlinear canonical correlation analyses resulted in two dimensions with eigenvalues of 0.15 and 0.14, resulting in a fit value of 0.30 and evidence that little variability in the data (15%) was explained by the weighted combinations of the variables. Although statistically significant, these results do not indicate a robust relationship between PTSS and PTG among adult survivors of childhood cancer. Theories suggesting that PTSS is a prerequisite for PTG should be reconsidered.

Posttraumatic stress symptom (PTSS) and posttraumatic growth (PTG) were surveyed in parents of childhood, adolescent and young adult patients with high-grade osteosarcoma. A questionnaire survey was performed in parents of patients with osteosarcoma (51 families). The Impact of Event Scale-Revised (IES-R) and posttraumatic growth inventory (PTGI) were employed for the evaluation of PTSS and PTG, respectively. The mean scores were compared with those in preceding studies employing the same scales. In addition, the correlation between the IES-R and PTGI scores was investigated in the parents. Fifty-eight subjects of 34 families (30 fathers and 28 mothers) replied to the questionnaire. The mean IES-R score in the parents was 18.5, which was higher than that in patients with osteosarcoma (9.7) in our previous study. The mean PTGI score in the parents was 44.9, which was higher than that in university students (33.9) reported by Taku et al. A positive correlation was noted between the IES-R and PTGI scores in the parents. The PTSS level tended to be higher in the parents rather than in patients with osteosarcoma. The PTG level increased as the PTSS level rose in the parents.

Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG). To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness. Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis. Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs. For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs. Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.

IntroductionTwo-thirds of childhood cancer survivors are experiencing at least one significant physical or psychosocial late effect, yet they rate their health-related quality of life (HRQOL) as very good.PurposeTo explore factors...

Adolescents’ posttraumatic growth during the COVID-19 pandemic: The links between differentiation of self, parents’ posttraumatic growth, and adolescents’ gender

BackgroundAlthough some previous studies have suggested that posttraumatic growth (PTG) is comprised of several factors with different properties, few have examined both the association between PTG and posttraumatic stress disorder (PTSD) and between PTG and resilience, focusing on each of the factors of PTG. This study aimed to examine the hypothesis that some factors of PTG, such as personal strength, relate to resilience, whereas other factors, such as appreciation of life, relate to PTSD symptoms among Japanese motor vehicle accident (MVA) survivors.MethodsThis cross-sectional study was performed with 118 MVA survivors at 18 months post MVA. Data analyzed included self-reporting questionnaire scores on the Posttraumatic Growth Inventory (PTGI), the Impact of Event Scale- Revised (IES-R), and the Sense of Coherence (SOC) scale, which is one of the most widely used scales for measuring resilience. Correlations between scores on the PTGI and IES-R, the PTGI and SOC scale, and the IES-R and SOC scale were established by calculating Spearman's correlation coefficients.ResultsPTGI was positively correlated with both SOC and PTSD symptoms, in spite of an inverse relationship between SOC and PTSD symptoms. Relating to others, new possibilities, and personal strength on the PTGI were correlated positively with SOC, and spiritual change and appreciation of life on the PTGI were positively correlated with PTSD symptoms.ConclusionsSome factors of PTG were positively correlated with resilience, which can be regarded as an outcome of coping success, whereas other factors of PTG were positively correlated with PTSD symptoms, which can be regarded as signifying coping effort in the face of enduring distress. These findings contribute to our understanding of the psychological change experienced by MVA survivors, and to raising clinicians' awareness of the possibility that PTG represents both coping effort coexisting with distress and outcome of coping success.

BackgroundThe death of a child is one of the most devastating experiences for parents, yet some may experience positive changes known as posttraumatic growth (PTG). We aimed to describe PTG in bereaved parents whose child died of cancer, compare it to PTG in parents of childhood cancer survivors, and identify sociodemographic and child-related characteristics associated with PTG in bereaved parents.MethodsThis multicenter cross-sectional study included parents who lost a child to cancer (diagnosed ≤ 18 years and > 1 year after death). Data from the Swiss Childhood Cancer Survivor Study-Parents were used for comparison. We used the Posttraumatic Growth Inventory (PTGI) assessing five domains (appreciation of life, new possibilities, personal strength, relating to others, and spiritual change) on a 6-point scale.ResultsWe included 103 bereaved parents (mean age = 53.7 years, SD = 8.3; 66.7% female) of 81 deceased children (mean age at death = 9.5 years, SD = 5.9; mean time after death = 11.3 years, range 2–24 years). The PTG sum score was 63.2 (SD = 23.3, range = 4–105), which was higher than in parents of survivors (mean = 51.4; SD = 21.0, p = 0.002). Bereaved parents reported higher mean domain scores in appreciation of life (3.53, SD = 1.17 vs. 3.01, SD = 1.17, p = 0.003), personal strength (3.42, SD = 1.25 vs. 2.75, SD = 1.17, p = 0.001), relating to others (3.09, SD = 1.09 vs. 2.61, SD = 1.04 p 0.004), and new possibilities (2.69, SD = 1.26 vs. 1.97, SD = 1.17, p < 0.001). Parents within 10 years of their child’s death and those practicing religion reported higher PTG.ConclusionOur findings reveal that cancer-bereaved parents may experience PTG after their child’s death, embracing unique positive changes according to their circumstances and influencing factors.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-025-09892-x.

ABSTRACTExperiences during the COVID‐19 pandemic may be traumatic to healthcare workers (HCWs). This study investigated the associations of resilience and mindfulness with posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG), and the mediation role of adaptive coping and stigmatisation related to HCWs' role in these associations from the perspective of trauma and positive psychology research. An anonymous online survey was conducted among 1449 doctors and nurses (85.4% females; mean age 34.1 years) from five hospitals in different regions of China between October and November 2020, which was about six months after the COVID‐19 outbreak was almost ‘put under control’ in China. PTSS and PTG were assessed using the 17‐item PTSS Scale‐Self‐Report and Posttraumatic Growth Inventory, respectively. The prevalence of PTSS and PTG was 42% and 65%, respectively. Results of structural equation modelling suggested that the association between resilience and PTSS was partially mediated by adaptive coping, self‐stigma, and the serial path via adaptive coping and self‐stigma, which accounted for 66% of the total association. The association between mindfulness and PTSS was partially mediated by adaptive coping and serially mediated by adaptive coping and self‐stigma. In contrast, only adaptive coping was a significant mediator in the associations between resilience/mindfulness and PTG. The findings first unravelled the mechanisms between resilience, mindfulness, and posttraumatic outcomes of COVID‐19 among a large sample of HCWs. Health promotion may consider alleviating PTSS and promoting PTG for HCWs experiencing traumatic stressful events via strengthening resilience and mindfulness, fostering adaptive coping, and reducing stigmatisation.

Although COVID-19 brought many negative psychological consequences, many people also experienced psychological growth. The present study investigated why this happened and hypothesized that self-determination theory's (SDT's) basic psychological needs (BPNs) may play a role in this explanation. Based on SDT, this cross-sectional study hypothesized that both the satisfaction and frustration of BPNs mediated the associations between fear of COVID-19, post-traumatic growth (PTG), and post-traumatic stress (PTS) symptoms. A sample of 391 Peruvian adults (70.6% women; Mage = 35.04, age range between 18 and 84) responded to several valid and reliable questionnaires: Fear of COVID-19 Scale (FCV.19S); Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS); Impact Event Scale-Revised (IES-R); Post-Traumatic Growth Inventory (PTGI). The results showed that need satisfaction mediated the negative association between fear of COVID-19 and PTG, and need frustration mediated the positive association between fear of COVID-19 and PTG. In addition, a direct effect was found from fear of COVID-19 toward PTS symptoms. The results showed the importance of considering SDT's BPNs in explaining PTG and PTS after experiencing fear of COVID-19.

Purpose This study aims to contribute to the clarification of posttraumatic stress symptoms (PTSS) and growth (PTG) in childhood cancer survivors, taking into account the possibility of a nonlinear relationship and using a clinical approach to analyzing PTSS. Methods Childhood cancer survivors (n = 167) aged 11–27 completed measures of posttraumatic stress (UCLA_PTSD) and posttraumatic growth (BFSC). Based on the clinical analysis of UCLA_PTSD symptoms, the sample was divided into three PTSS severity groups (no, mild, moderate). These groups were compared in the mean level of PTG. Correlation analysis was performed to analyze the relationship of PTG with overall PTSS as well as its subscales. The analysis was completed using the curve estimation procedure evaluating linear and quadratic curve fit. Results There was no significant difference in the mean PTG scores between the three PTSS severity groups and no significant correlation of PTG with overall PTSS score and its clusters (re-experiencing, avoidance and increased arousal). PTG was positively associated with the fear of cancer recurrence. Conclusion We did not find support for the direct relationship of PTG and PTSS but we suggest the possibility of connection between the two through the specific nature of PTSS in cancer survivors and their future-oriented intrusive thoughts overlapping with fear of cancer recurrence. These findings offer a novel perspective for future research on PTSS and PTG relationship.