Survivor's Life Research Articles

"A whole ball of all-togetherness": The interwoven experiences of intimate partner violence, brain injury, and mental health.

Intimate partner violence (IPV) is a global public health crisis, with physical violence leaving IPV survivors at high risk of brain injury (BI). Both BI and IPV have significant physical, psychological, cognitive, and social impacts, including a high risk of mental health concerns, yet there is limited exploration of IPV survivors' experiences with BI and mental health. This study aimed to explore the BI- and mental health-related needs and experiences of IPV survivors from the perspectives of survivors and service providers with the objective of developing knowledge translation materials to raise awareness and support survivors and service providers in addressing these concerns. This qualitative interpretive description study involved 19 semi-structured interviews and two focus group discussions (2-3 participants each) with 24 participants including IPV survivors experiencing BI and mental health concerns as well as IPV, mental health, and BI service providers between October 2020 and February 2021. Three screening questions were used to identify probable BI among survivors. Participants across groups were an average of 48.5±12.7 years old and were predominantly cisgender women (96%), of European origin (75%), with a university degree (71%). Interviews were recorded, transcribed, and thematically analyzed. Across interviews, participants spoke about IPV, BI, and mental health as being complex and interrelated experiences that have impacts across the survivor's life and extend well beyond the abusive relationship. Because of the underrecognized nature of BI in IPV, finding and accessing care requires persistence that survivors spoke of as being like "a full-time job." The benefit of making meaningful connections, particularly with other survivors, was highlighted. Recognition of BI as a contributing factor shaping the lived experience of IPV survivors; acknowledgement that the impacts of IPV, BI, and mental health are far reaching and long lasting; and reducing barriers to finding and accessing appropriate care are critical to better supporting IPV survivors with BI and mental health concerns. Clinicians should consider BI and its lingering impacts among the IPV survivors with whom they work. Health and social policy that supports integration of care and the reduction of unnecessary barriers should be a priority.

Risk factors and screening for neurocognitive impacts of therapy

Long-term survivors of pediatric hematologic malignancies are at elevated risk for neurocognitive impairment. Such impairment manifests in different ways at different times during survivorship, with deficits in processing speed, attention, and memory often appearing before deficits in executive function, intelligence, and academics. Survivors exposed to therapies that directly target the central nervous system (CNS), as is the case in acute lymphoblastic leukemia, may demonstrate subtle deficits during frontline therapy, and these deficits may grow and evolve over time. Survivors who do not receive CNS-directed therapies (eg, Hodgkin lymphoma) are also at elevated risk for neurocognitive impairment, although the influence on brain function is indirect through cancer therapy impact on systemic organ function vital to brain health (eg, cardiopulmonary morbidity). Over the course of the survivor's life span, the presence and impact of neurocognitive deficits will be determined by a complex interaction between premorbid development and environment, cancer therapy and clinical care, and posttreatment recovery and health. The timing and type of these treatment and health events will dictate the approach to screening and monitoring for neurocognitive impairment.

Révéler des violences sexuelles subies dans l’enfance à un professionnel de santé : une métasynthèse

ObjectiveChild sexual abuse is a major public health issue, and disclosure of such abuse to a healthcare professional could mitigate its impact on the survivor's life. Qualitative studies are relevant in this context, focusing as they do on the lived experience of the stakeholders, victims and professionals. We aimed to conduct a metasynthesis, i.e. a systematic review and analysis of qualitative studies, exploring the qualitative literature about the lived experience of child's sexual abuse disclosure. Method and data sourcesFour databases and two journals were screened (Medline, PsycINFO, EMBASE, SSCI, Journal of Sexual Abuse and Child Abuse and Neglect) so as to identify studies concerning the lived experience of child sexual abuse disclosure from the point of view of survivors or healthcare professionals or both. We used the “Critical Appraisal Skills Program” to assess the methodological quality of each article and performed a thematic analysis of the data extracted to identify key themes and synthesize them. ResultsTwenty-six articles were included, covering data from 673 participants (333 survivors, adult at the time of the study; 122 survivors still minor at the time of the study and 218 health professionals). Data analysis produced three themes: (1) to reveal or not to reveal, (2) the narrative of the disclosure by the participants, (3) positive and negative outcomes of the disclosure. Our results show that, on the one hand, health professionals and minor survivors both have a negative experience of disclosure that could impede the process. On the other hand, some adult survivors underlined the importance and the positive impact of such disclosure to a healthcare professional. ConclusionWe identified a gap in the literature regarding disclosure of such abuse within child and adolescent psychiatry services and drew research perspectives. Concrete clinical implications can also be drawn from our results, especially the involvement of adult survivors within the training of concerned healthcare professionals so as to raise awareness among them and help them better cope with the disclosure process.

PSYCHORELIGIOUS THERAPY INCREASE SELF-ESTEEM OF LUPUS SURVIVORS AT KUPU PARAHITA INDONESIA FOUNDATION

Lupus is a disease of thousand faces with various clinical manifestations and can interfere survivor's appearance, activity, and life. It can cause an inability to realize the strengths and positives that survivors have. This study's aim was to determine the psychoreligious therapy effect on the self-esteem of lupus survivors at Kupu Parahita Indonesia Foundation. The method used was quasi-experimental without a control group with One-group pretest-posttest design on 16 lupus survivors at Kupu Parahita Indonesia Foundation, selected by simple random sampling according to inclusion and exclusion criteria. Respondents were given psychoreligious therapy videos for a month, every weekend with 4 videos in total. We measured the respondent’s self-esteem using the Rosenberg Self-Esteem Scale (RSES) which was translated into Indonesian before and after therapy (Cronbach alpha=0.7, validity=0.422-0.63). The results showed that mean of pre-test score was 27.44, the post-test was 31.94, and the data were normally distributed (p>0.05). The results of the paired T-test showed a significant difference between the pre-test and post-test scores (p=0.000). In conclusion, the administration of psychoreligious therapy increases the self-esteem of lupus survivors at Kupu Parahita Indonesia Foundation.

Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon.

Introduction: Stroke continues to be a common and debilitating medical condition which has a significant effect on public health as the second primary source of mortality and the third major root of disability worldwide. A wide range of complications affecting the survivor's life and interfering with the recovery process usually follows stroke; anxiety and depression are considered one of the major complications post-stroke. This study sought to investigate the short-term psychological consequences of stroke among Lebanese survivors and to identify their correlates.Methods: This study is a prospective observational epidemiological study. 143 stroke patients admitted to hospitals in Mount Lebanon and Beirut between February and May 2018.were included in this study. Assessments of complications were carried out at 3 months post-stroke by completing a 30-min face-to-face interview questionnaire. The survey included the socio-demographic -characteristics of the patients, their lifestyle, health indicators, the severity of stroke, and the post-stroke consequences disturbing their quality of life.Results: Complications were recorded for 117 stroke survivors (mean age, 72.46 years; 60.7% male). The analysis of results 3 months post stroke showed that 29 survivors suffered from neuropathic pain (24.8%), 110 (94%) suffered from fatigue, and 81 (69.2%) from cognitive impairment. High rates of anxiety (51.3%), and depression (76.1%) were recorded as well. Multivariate logistic regression confirmed that there is a significant association between depression and the following variables: anxiety (OR = 4.814, p-value = 0.017), pain (OR = 6.868, p-value = 0.002), and physical activity, which acts as a protective factor against depression (OR = 0.261; p-value = 0.029). However, the results of the multivariate logistic regression analysis for anxiety indicated that immobility-related complications increase the risk of anxiety by 8.457 in sedentary duration longer than 12 h (ORa = 8.457, p-value = 0.01). Furthermore, patients with neuropathic pain (24.8%) are 3.858 times more likely to have anxiety compared to patients without neuropathic pain (ORa = 3.858, p-value = 0.019).Conclusion: Using a patient-centered structure more interventions should take place to evaluate stroke survivors' outcomes, and organize rehabilitation services that deal with stroke consequences, particularly high anxiety and depression levels, which are prevalent and persistent among the Lebanese stroke survivors.

Cost-Utility of Sildenafil for Persistent Pulmonary Hypertension of the Newborn.

While advanced therapies for severe persistent pulmonary hypertension of the newborn (PPHN) such as inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO) are standard treatments in high-income countries, these therapies are often unavailable in resource-limited settings such as middle-income countries. However, there are small clinical trials illustrating the efficacy of sildenafil at reducing mortality in PPHN. This analysis sought to determine the cost-utility of enteral sildenafil for the treatment of severe PPHN. A Markov-state transition model was constructed for the two clinical approaches to compare costs, clinical outcomes, and quality of life: (1) "conventional," (2) "sildenafil." The impact of sildenafil was modeled as a relative risk modifier of the conventional strategy's mortality risk. Transitional probabilities, costs, and utility metrics were extracted from the literature. Sensitivity analyses for each model input as well as 100-patient Monte Carlo simulations were used to test the durability of the model conclusion. The sildenafil strategy was cost-effective for upper but not lower middle-income countries with an incremental cost-effectiveness ratio of $2,339 per quality-adjusted life year. This conclusion was durable across a wide-range of model assumptions; the sildenafil strategy only failed to meet criteria for cost-effectiveness when sildenafil therapy had a mortality relative risk efficacy of >0.89, if life expectancy in that country is <40 years, or if the lifetime forecasted costs of a survivor's life was quite high. Enteral sildenafil is a cost-effective intervention for severe PPHN for upper middle-income countries where ECMO and iNO are not available. · PPHN is a common life-threatening condition in newborns.. · Sildenafil improves survival of PPHN.. · Sildenafil is cost-effective for upper-middle income countries..

Targeting NLRP3 inflammasome improved the neurogenesis and post-stroke cognition in a mouse model of photothrombotic stroke.

Post-stroke cognitive impairment (PSCI) severely affects the quality of a survivor's life, but its neurophysiological basis remains unknown. Neuroinflammation has been considered as an important contributor to PSCI, which could be induced or exacerbated by system inflammation. NACHT-LRR- and pyrin-domain-containing protein 3 (NLRP3) inflammasome is the most widely studied in the initiation of inflammation. Here, using a mouse model of photothrombotic stroke, we demonstrated that NLRP3 activation plays a critical role in PSCI. Intraperitoneal injection of the lipopolysaccharide-activated NLRP3 inflammasome, exacerbated the microglial activation and decreased the number of neurons, impaired the hippocampal neurogenesis, eventually aggravated PSCI. Intraperitoneal injection of MCC950 inhibited the NLRP3 activation, decreased the number of microglia, increased the number of neurons and promoted the hippocampal neurogenesis, eventually improved PSCI. Our results identified NLRP3 inflammasome as an important modifier of neuropathology in PSCI, which could be a could be a potential therapeutic target for PSCI treatment.

CN19 - How an empowerment program can touch cancer survivor's life by improving post-traumatic growth?

CN19 - How an empowerment program can touch cancer survivor's life by improving post-traumatic growth?

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors.

The trauma symptoms of child sexual abuse (CSA) survivors don't end with the abuse, or even with the advent of adulthood. Instead, these symptoms can persist into all the realms of a survivor's life, including education, which sets the foundation for career advancement. This retrospective study of adult survivors of childhood sexual abuse (n=260) examined the relationships between trauma symptoms, dissociation, dissociative amnesia, anxiety, depression, sleep problems and higher education attainment. The purpose of this study was to determine if these factors are associated with higher education completion for childhood sexual abuse (CSA) survivors. Linear regressions and ANOVAs suggest that many of these variables are significantly associated with survivors' educational trajectory, and multiple linear regressions show that trauma symptoms (as measured by the Trauma Symptom Checklist-40), caregivers' education levels, and age at onset of abuse are significant predictors of decreased education levels. This information can provide insight into additional risk and protective factors for CSA survivors in order to enhance acute and long-term management of trauma symptoms to increase levels ofattainment of higher education.

Repetitive Transcranial Magnetic Stimulation Ameliorates Cognitive Impairment by Enhancing Neurogenesis and Suppressing Apoptosis in the Hippocampus in Rats with Ischemic Stroke.

Cognitive impairment is a serious mental deficit caused by stroke that can severely affect the quality of a survivor's life. Repetitive transcranial magnetic stimulation (rTMS) is a well-known rehabilitation modality that has been reported to exert neuroprotective effects after cerebral ischemic injury. In the present study, we evaluated the therapeutic efficacy of rTMS against post-stroke cognitive impairment (PSCI) and investigated the mechanisms underlying its effects in a middle cerebral artery occlusion (MCAO) rat model. The results showed that rTMS ameliorated cognitive deficits and tended to reduce the sizes of cerebral lesions. In addition, rTMS significantly improved cognitive function via a mechanism involving increased neurogenesis and decreased apoptosis in the ipsilateral hippocampus. Moreover, brain-derived neurotrophic factor (BDNF) and its receptor, tropomyosin-related kinase B (TrkB), were clearly upregulated in ischemic hippocampi after treatment with rTMS. Additionally, further studies demonstrated that rTMS markedly enhanced the expression of the apoptosis-related B cell lymphoma/leukemia gene 2 (Bcl-2) and decreased the expression of the Bcl-2-associated protein X (Bax) and the number of TUNEL-positive cells in the ischemic hippocampus. Both protein levels and mRNA levels were investigated. Our findings suggest that after ischemic stroke, treatment with rTMS promoted the functional recovery of cognitive impairments by inhibiting apoptosis and enhancing neurogenesis in the hippocampus and that this mechanism might be mediated by the BDNF signaling pathway.

Alcohol's Role in Social Reactions to Sexual Assault Disclosures: A Qualitative Study of Informal Support Dyads.

Studies of informal support dyads are lacking to understand the disclosure of sexual assaults and social reactions informal supporters make to survivors. This study of 19 informal support dyads using interview data examined how three relationship types-significant others (i.e., romantic partners), family, and friends-differ in social reactions to sexual assaults in the context of drinking or alcohol problems. It was expected that alcohol's role in responses to such disclosures would differ depending on relationship type as well as role alcohol played in the assault and/or in the survivor's life or those in her social network, including the perpetrator. Results show that alcohol has mixed effects and that alcohol-related assaults as well as contexts where survivors, perpetrators, and/or their support networks have alcohol problems need further study to understand how such disclosures and social reactions occur and the impact they have on survivors, their relationships, and recovery.

Surviving Sudden Cardiac Arrest: A Pilot Qualitative Survey Study of Survivors.

Research describing survivors of sudden cardiac arrest (SCA) has centered on quantifying functional ability, perceived quality of life, and neurocognitive assessment. Many gaps remain, however, regarding survivors' psychosocial perceptions of life in the aftermath of cardiac arrest. An important influence upon those perceptions is the presence of support and its role in a survivor's life. An Internet-based pilot survey study was conducted to gather data from SCA survivors and friends and/or family members (FFMs) representing their support system. The survey was distributed to members of the Sudden Cardiac Arrest Foundation (SCAF) via the Internet by SCAF leadership. Questions included both discrete multiple-choice and open-ended formats. Inductive thematic analyses were completed by three independent researchers trained in qualitative research methodology to identify primary themes consistent among study participants until thematic saturation was achieved. No statistical inferences were made. A total of 205 surveys were returned over the 5-month study period (July to November 2013); nine were received blank, leaving 196 surveys available for review. Major themes identified for survivors (N = 157) include the significance of and desire to share experiences with others; subculture identification (unique experience from those suffering a heart attack); and the need to seek a new normal, both personally and inter-personally. Major themes identified for FFMs (N = 39) include recognition of loved one's memory loss; a lack of information at discharge, including expectations after discharge; and concern for the patient experiencing another cardiac arrest. This pilot, qualitative survey study suggests several common themes important to survivors, and FFMs, of cardiac arrest. These themes may serve as a basis for future patient-centered focus groups and the development of patient-centered guidelines for patients and support persons of those surviving cardiac arrest.

The Role of Religious Coping and Resilience in Individuals With Dissociative Identity Disorder

Survivors with dissociative identity disorder (DID) often report a history of traumatic events in their lives. Past studies indicated a link between trauma, resilience, and spiritual coping in both positive and negative aspects of a survivor's life. This article includes a review of existing literature salient to these constructs in relation to individuals with DID, as well as results from a study examining the relationships between these constructs and individuals with DID (N = 52). Implications are discussed based on the findings for counselors treating individuals with DID.

Misconceptions and Misattributions About Traumatic Brain Injury: An Integrated Conceptual Framework

The objective of the present narrative review was to provide a conceptual framework to address common misconceptions in the field of traumatic brain injury (TBI) and enhance clinical and research practices. This framework is based on review of the literature on TBI knowledge and beliefs. The comprehensive search of the literature included seminal and current texts as well as relevant articles on TBI knowledge and education, misconceptions, and misattributions. Reviewed materials ranged from 1970 to 2013 and were obtained from PubMed and PubMed Central online research databases. Research findings from the reviewed literature were integrated with existing social and cognitive psychological concepts to develop a framework that includes: (1) the identification antecedents of TBI-related misconceptions and misattribution; (2) understanding of how inaccurate beliefs form and persist as the result of pre- and postinjury cognitive operations such as informational cascades and attribution biases; and (3) a discussion of ways in which these beliefs can result in consequences in all domains of a survivor's life, including physical and mental health, stigma, and discrimination. This framework is intended to serve as a first stage of development of a model that will improve treatment endeavors and service delivery to individuals with TBI and their families.

The experience of cancer survivors in community-based psycho-social support activities in Shanghai, China: a qualitative study.

Cancer survivors are often embroiled in various physical and psycho-social issues as a consequence of cancer diagnosis and treatment. Psycho-social support activities in the phase of rehabilitation were provided to enhance their quality of life. This study seeks to explore and understand their experience of engagement in Shanghai Cancer Rehabilitation Club (SCRC). Sixty-eight participants attended eight semi-structured focus group interviews. Data were transcribed verbatim, and thematic analysis framework was adopted for data analysis. The participants reported benefits such as psychological support, informational provision and tangible support in the activities. Public services were reported to have restored their dignity and enabled them to rediscover their own meaning of life. Participants also pointed out challenges on functioning and opportunity for development of SCRC. The psycho-social support activities of SCRC had influenced cancer survivor's life. Public health resources and supportive policies should be in place to support local self-help cancer rehabilitation groups.

Development and Evaluation of a Hospital-Based Peer Support Group for Younger Individuals with Stroke

ABSTRACTThe incidence of stroke in younger individuals is rising, producing unique challenges due to loss of productive roles and long-term impact in the survivor's life. This paper reports the results of a hospital-based program based on occupational therapy principles that was designed to provide support and education for 13 younger individuals (<65) with stroke. Participants demonstrated improved socialization, healthy coping, and role attainment as measured by the Stroke Impact Scale (SIS), the Community Integration Questionnaire (CIQ), and a member satisfaction questionnaire. Key factors for successful implementation and considerations for future programs to meet the needs of younger adults with stroke are discussed.

Understanding the cancer pain experience.

Cancer pain management is a major element of successful cancer survivorship. Regardless of where someone is along the cancer experience, from a newly diagnosed patient to long-term survivor, pain is a potential treatment-related effect that can have a significant impact on a survivor's life. Quality pain management for cancer survivors is complicated by the fact that cancer-related pain can be due to the tumor, surgery, radiation, and/or chemotherapy. Additionally, the pain experience is related to many psychosocial/spiritual factors. Despite almost 40years of attention devoted to improving cancer pain management, many cancer survivors are less than optimally treated, often owing to survivor and healthcare provider knowledge barriers. This article reviews some of the latest research related to cancer pain management treatment options, measurement/assessment, and interventions. Progress has been made in understanding new aspects of the pain experience, but more work is yet to be done.

Therapy for Childhood Sexual Abuse Survivors Using Attachment and Family Systems Theory Orientations

The aim of this article is to understand the effects of childhood sexual abuse on a survivor's later life. For understanding and treating the emotional distress and interpersonal problems resulting from childhood sexual abuse, attachment theory provides a valuable framework. When this framework is combined with family systems theory, it can help therapists understand the family context where sexual abuse occurs and how this affects health and functioning throughout the lifespan. Case examples of female adult sexual abuse survivors are also explored, with insight from the intersection of systems and attachment theories.

Masculinity and strokes: the challenges presented to younger men by chronic illness

Stroke is a major cause of disability in the Western world, changing not only to the victim's body but also his or her lifestyle. Men tend to experience stroke at a younger age than women. Most people understand stroke as a disease of the elderly, however, this study looks at the effects of stroke on the young adult male. Adolescence, and young- and middle-adulthood are the periods in which the intergenerational dialectics and the interactions between society and the individual are most salient, as it is during these periods that people are completing their education, launching careers, forming intimate relationships, establishing a family and developing an identity. Serious chronic illnesses during these periods may threaten a man's taken-for-granted masculinity. Studies also show that men suffering chronic illness negotiate and renegotiate their masculinity in light of the limitations placed on them by their own and others' understanding of the social and personal consequences of their disease. This current single case study with a narrative approach is drawn from a larger phenomenological study of 16 men suffering from stroke and aims to explore how masculinity is challenged in a young stroke survivor's life. One survivor experienced challenges to his masculinity with respect to those characteristics of masculinity described by Connell and Courtenay: being the family breadwinner, strength, toughness, power, control and independence.

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.