Stress and coping in hospice nursing staff. The impact of attachment styles

Previous research suggests that the attachment style developed during childhood informs adult attachment styles, which in turn affects adult relationships and responses to stress. This study considers the sources of stress in hospice nurses and addresses the potential impact of their attachment styles on stress and coping experiences. Adult attachment style, stress and coping were measured in 84 nurses recruited from five hospices. The results supported previous research regarding the most common sources of stress in this nursing group. The study found partial support for the hypothesis that nurses with insecure attachment styles experience more stress than securely attached nurses. Hospice nurses with a fearful or dismissing attachment style were found to be less likely to seek emotional social support as a means of coping with stress than hospice nurses with a secure or preoccupied attachment style. Supervision, support and career-long training for nurses in hospices are recommended. Further research is needed to clarify the involvement of attachment style in hospice nurse stress and coping experiences.     

永久性肠造口患者知觉压力状况及影响因素的调查研究

目的:探讨永久性肠造口患者知觉压力状况及影响因素。方法:采用便利抽样法,选取156例结直肠癌永久性肠造口患者,采用一般资料调查表、知觉压力量表、应对自我效能量表、罗森伯格自尊量表、社会支持评定量表、医学应对方式问卷及医院焦虑抑郁量表进行调查。结果:永久性肠造口患者知觉压力得分为（30.34±4.59）分,处于较高水平。多元逐步回归分析结果显示,屈服、抑郁、自尊、社会支持、应对自我效能及回避进入回归方程,共解释总变异的88.2%。结论:永久性结肠造口患者知觉压力问题值得关注,需要采取必要的干预措施,医护人员应建立有效的社会支持系统,提高患者自尊与自我效能水平从而积极应对以缓解知觉压力水平,提高患者生存质量。     

Psychosocial factors associated with posttraumatic stress and growth in Australian women with ovarian cancer

The study examined psychosocial factors (quality of life, depression, anxiety, optimism, coping, and social support) in relation to symptoms of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in 108 women diagnosed with ovarian cancer. Canonical correlational analysis showed that both PTSD and PTG were related to poorer quality of life, lack of social supports, and avoidant coping styles. However, higher PTG was also associated with the use of meaning and social support to cope with their experience. The findings highlight both negative and positive posttraumatic outcomes but longitudinal studies are now needed to more fully evaluate these relationships.     

Interaction of coping styles and psychological stress on anxious and depressive symptoms in Chinese breast cancer patients

Purpose: This study aimed to assess possible interactive effects of coping styles and psychological stress ondepression and anxiety symptoms in Chinese women shortly after diagnosis of breast cancer. Methods: Fourhundred and one patients with breast cancer were face-to-face interviewed by trained research staff according toa standardized questionnaire including information on socio-demographic characteristics, psychological stress,coping styles, and anxiety and depressive symptoms. Interactive effects were assessed by hierarchical multipleregression analyses. Results: There were significant associations of the four domains of psychological stress withanxiety and depressive symptoms except for the relationship between “worrying about health being harmed”and depressive symptoms. “Abreaction coping behavior” and “escaping coping behavior” significantly increasedthe level of both anxiety and depressive symptoms; whereas an “active coping style” reswulted in significantdecrease. The interaction of “active coping behavior” with “worrying about health being harmed” significantlyincreased the risk of the anxiety symptoms, while adopting “self-relaxing coping behavior” was associated withsignificant decrease. The interaction of “worry about daily life and social relationship being restricted” with“escaping coping behavior” significantly increased the risk of the depressive symptoms. Conclusions: The resultsof this study suggest that certain coping styles might moderate the association of psychological stress with anxietyand depressive symptoms in Chinese women with breast cancer.     

Religious beliefs,social support,self‐efficacy and adjustment to cancer

Purpose: Religious beliefs have received relatively little attention in research on coping with cancer. In this study, the relationship of religious beliefs and perceived social support with adjustment to cancer was studied in a coping model that included self‐efficacy for coping as a mediator. Of particular interest was the relationship between religious beliefs and social support. Method: Data were collected from 164 in‐treatment cancer patients. They completed measures of religious beliefs, social support, physical functioning, self‐efficacy for coping, and adjustment. A model comparison approach was used to assess the fit of models that included or excluded the contribution of religious beliefs while testing the relationship between religious beliefs and social support. Results: Religious beliefs were more strongly connected to perceived social support than with other constructs. Importantly, a coping model that included religious beliefs fit the data significantly better than a model without paths related to religious beliefs. Self‐efficacy partially mediated the relation of age, physical functioning, and perceived support to adjustment, but not religious beliefs. Discussion: Religious beliefs may not directly affect self‐efficacy and adjustment; however, cancer patients who have religious beliefs may experience an enhanced sense of social support from a community with whom they share those beliefs. Copyright © 2009 John Wiley & Sons, Ltd.     

Breast cancer and problems with medical interactions: relationships with traumatic stress, emotional self-efficacy, and social support

This investigation examined relationships between breast cancer patients' psychosocial characteristics (impact of the illness, traumatic stress symptoms, emotional self-efficacy, and social support) and problems they perceived in their medical interactions and their satisfaction with their physicians. Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer. The findings reported here are from a cross-sectional analysis of baseline data gathered prior to randomization. Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress (p < 0.01), less emotional self-efficacy for cancer (p < 0.05), less satisfaction with informational support from family, friends, and spouse, and a tendency to perceive those sources of support as more aversive (p < 0.05). Women who were less satisfied with emotional support from their family, friends and spouse were less likely to feel satisfied with their physicians (p < 0.05). These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians.     

Change in post-traumatic stress symptoms following psychosocial treatment for breast cancer

The diagnosis of cancer is a traumatic experience, which may result in post-traumatic stress symptoms, such as arousal, re-experiencing the diagnostic process and avoidance. Changes in post-traumatic symptoms were assessed in 181 women with breast cancer who participated in either a standard support group or complementary/alternative (CAM) oriented intervention. At baseline 26 women were classified as having significant PTSD symptoms. After the 12-week sessions, significant decreases in the number of women with PTSD was seen in both interventions, however it was more evident in the Standard group where there was a 91% reduction in the number of women with PTSD versus an 80% reduction in the CAM group. For women with PTSD both groups showed significant decreases in overall PTSD symptoms and arousal. However, only the women in the Standard support group showed significant decreases in re-experiencing and avoidance symptoms. For the entire sample only women in the Standard group had significant decreases in overall PTSD, re-experiencing, and arousal. These results indicate that PTSD symptoms can be prevalent among women with breast cancer, and that while psychosocial interventions can be effective in reducing this type of distress, a support group might be more effective than a more complementary/alternative oriented intervention.     

Depressive symptoms after lung cancer surgery: Their relation to coping style and social support

Lung cancer patients may experience greater emotional distress than patients with other cancers. Studies have shown social support to predict adjustment in other cancers, but findings among lung cancer patients have been equivocal. Coping style has been shown to predict distress among lung cancer patients, but has not been examined in the context of social support. We examined coping style and social support as predictors of depressive symptoms one week after surgery among 119 patients with non-small cell lung cancer. The Beck Depression Inventory was the primary outcome measure. Predictors included age, ECOG performance status, stage of disease, and measures of adaptive coping, less adaptive coping, Directive instrumental social support and Nondirective instrumental social support. Results indicated that 29% of lung cancer patients had scores above a standard cutoff for clinically significant depression. Results also showed that depressive symptoms were directly related to use of less adaptive coping methods and Directive instrumental social support, inversely related to age and use of adaptive coping methods, and unrelated to nondirective social support, stage of disease and performance status. Results extend previous findings by showing that adaptive coping methods are related to severity of distress, and that the benefits of social support may depend on the characteristics of that support.     

The combined contribution of social support and coping strategies in predicting post-traumatic growth: a longitudinal study on cancer patients

Objectives: The aim of this study is to investigate the role of social support and coping strategies in enhancing post‐traumatic growth (PTG) in cancer patients. The study focused on both avoidance and approaching coping and on four distinct types of social support: (a) perceived availability, (b) actual received, (c) satisfaction with received support, and (d) the competence of caregiver to satisfy the patient's basic psychological needs of autonomy, competence, and relatedness. Methods: A longitudinal study was conducted with a group of 41 cancer patients currently in the treatment and management phase of their illness. Data were collected by means of a written questionnaire, at two time points (T1 and T2) that were 6 months apart. Social support was assessed using the Interpersonal Support Evaluation List and the Need Satisfaction in Relationship Scale. Coping strategies were assessed using the Brief COPE questionnaire. Social support and coping strategies were assessed only at T1. PTG was assessed using the Post‐Traumatic Growth Inventory at T1 and T2. Correlation and regression analyses were used to examine the association between social support and coping strategies with short‐term reports of post‐traumatic growth. Results: Regression analyses showed that autonomy‐supportive caregivers and a problem‐focused strategy of coping significantly predicted greater PTG at T2. Conclusions: This study contributes to a deeper understanding of the type of social support that may specifically aid cancer patients in experiencing PTG. Furthermore, findings confirm the important role of problem‐focused coping strategies in growing psychologically. Copyright © 2010 John Wiley & Sons, Ltd.     

No evidence that social stress is associated with breast cancer incidence

Women commonly attribute the experience of stress as a contributory cause of breast cancer. The purpose of this study is to investigate the associations between a history of social stress and breast cancer risk. A total of 11,467 women with no prior history of breast cancer, participants in the European Prospective Investigation into Cancer (EPIC)-Norfolk population-based prospective cohort study, completed a comprehensive assessment of lifetime social adversity exposure. Summary measures of social adversity were defined according to difficult circumstances in childhood, stressful life events and longer-term difficulties in adulthood, derived measures representing the subjective ‘impact’ of life events and associated ‘stress adaptive capacity’, and perceived stress over a 10-year period. Incident breast cancers were identified through linkage with cancer registry data. During 102,514 (median 9) person-years of follow-up, 313 incident breast cancers were identified. No associations were observed between any of the summary social adversity measures and subsequent breast cancer risk, with or without adjustment for age, menopausal status, parity, use of menopausal hormones, age at menarche, age at first birth, family history of breast cancer, physical activity, social class, body mass index, height, and alcohol intake. This study found no evidence that social stress exposure or individual differences in its experience are associated with the development of breast cancer. These findings may aid strategies designed to meet the psychosocial and emotional needs of breast cancer survivors and may be interpreted in a positive way in the context of commonly voiced beliefs that the experience of stress is a contributory cause of their disease.     

A one-year follow-up of post-traumatic stress disorder (PTSD) symptoms and perceived social support in cancer

Aims

Diagnosis of post-traumatic stress disorder (PTSD) symptoms in cancer patients fluctuates over the course of cancer according to the timing of assessment. In this longitudinal study, the prevalence of PTSD symptoms and the association between PTSD symptoms and the buffering variable of perceived social support were examined at one year follow-up.

Procedure

People with different types of cancer were assessed (breast cancer, head and neck cancer, and colorectal tumor) on four occasions: pre-treatment, at the end of cancer treatment, at six months post-treatment, and at one year posttreatment. Multivariate analyses were used to assess associations of perceived social support in patients with PTSD symptoms at the aforementioned four time points.

Results

No significant differences in perceived social support were found at the various follow-up times. However, diagnosis of PTSD symptoms showed differences based on the time of assessment (F = 5.50, p = 0.02). At pre- and post-treatment, social support was negatively related to re-experiencing (p < 0.00) and numbing (p < 0.00) PTSD symptoms. At six months post-treatment, social support was negatively related to all symptoms of PTSD (p < 0.00). Finally, at one year post-treatment, perceived social support was negatively related only to numbing symptoms (p < 0.00) of PTSD.

Conclusion

Over the course of cancer, buffering effect of perceived social support had a specific influence on PTSD symptoms.     

Coping strategies of retinoblastoma survivors in relation to behavioural problems

Objective: To assess coping strategies of long‐term retinoblastoma (RB) survivors and explore determinants of behavioural functioning, including medical, socio‐demographic and coping variables. Methods: This population‐based cross‐sectional study included 117 RB survivors (12–35 years), registered in the Dutch national RB register. Survivors were asked to fill in coping, social support and behavioural questionnaires, and situational characteristics were obtained from medical archives and from an interview. Prevalence rates of coping strategies were computed based on self‐reports. One‐sample t‐tests were applied to analyse differences in the use of coping strategies compared with healthy reference samples. Multiple regression analyses were performed to identify various determinants for behavioural problems within the RB sample. Results: RB survivors differed from their healthy reference group in one coping style, i.e. they showed significantly less emotion‐oriented coping behaviour. Adolescents who came from a single‐parent family and/or experienced lower social support and used more emotion‐oriented coping reported more total problem behaviour. More internalizing problems were reported for adolescents who experienced less social support and less acceptance of the disease. For adults, more life events, emotion‐oriented coping and lower social support explained more total problem behaviour, especially internalizing problems. Conclusion: RB survivors showed less emotion‐oriented coping behaviour compared with the reference group. Behavioural problems are best determined by emotion‐oriented coping, social support, life events other than RB and acceptance of the disease, and not by medical variables. Therefore, these variables should be taken into consideration during interventions for this group. Copyright © 2009 John Wiley & Sons, Ltd.     

Post-traumatic stress after childhood cancer I: The role of appraisal

Life threat or physical injury have been shown to produce post-traumatic stress symptoms in children. Recent studies have demonstrated that a subset of survivors of pediatric cancer report post-traumatic stress symptoms years after completing successful treatment. However, it is not clear whether these symptoms represent a response to the perception of life-threat or to the repeated intrusive procedures that accompany cancer treatment. In this exploratory study, 30 childhood cancer survivors 8 to 19 years old, who were at least 22 months off treatment without recurrence of disease, were evaluated using self-report questionnaires. The survivor's appraisal of treatment intensity signficantly correlated with the severity of post-traumatic stress symptoms. When age at the time of diagnosis was evaluated, appraisal of treatment intensity was significantly correlated with symptoms only in those six years old and younger. For children aged seven years or older at the time of diagnosis, duration of treatment was a significant contributor to symptoms. Diagnostic category (leukemia or solid tumor), length of time since completion of treatment and the child's appraisal of life-threat were not significantly correlated with severity of post-traumatic stress symptoms. Further study of the impact of intensive pediatric treatment on children and the importance of developmental factors in traumatic response to illness appears to be indicated.     

Traumatic distress symptoms in early breast cancer I: Acute response to diagnosis

In this study, the concept of ‘acute traumatic stress response’ was applied to breast cancer diagnosis. A total of 106 patients were studied before surgery, by means of a psychiatric interview and questionnaires (Impact of Event Scale, General Health Questionnaire and Clinical Global Impression Scale). The traumatic stress response was related to age, marital status, occurrence of breast cancer in first-degree relatives, previous physical and psychological health parameters, social support and life events during the last year. Of the patients, 44% reported a high level of intrusive symptoms (mean score 17.2) and 29% of avoidance symptoms (mean score 15.0). Younger age and being married were positively correlated with intrusive symptomology while patients with a first-degree relative with breast cancer had less intrusive distress. Previous physical and psychiatric health parameters showed no association to acute traumatic stress symptoms except for those who had experienced ‘a serious illness/accident/hospitalisation last year’ who had some more avoidant symptomology. Multiple regression showed a statistically significant effect for age only on intrusive symptoms when other factors were controlled for in this analysis.     

Psychosocial characteristics associated with breast cancer survivors' intimate partners' needs for information and support after primary breast cancer treatment

This study examines which psychosocial characteristics are associated with breast cancer survivors' partners' posttreatment needs for information and support. Eighty-four partners completed measures of coping, social support, illness representations, perceived stress, self-efficacy, anxiety, depression, and marital malfunctioning. Partners in need reported higher anxiety and depression, emotional illness representations, and emotion-oriented coping than partners without needs. Moreover, partners needing information and support took a more negative view on the timeline and consequences of their spouse's posttreatment condition. Interventions aimed at enhancing partners' posttreatment adjustment should focus on partners responding emotionally as well as perceiving their spouse's condition as a chronic condition.     

Expressive writing as a presurgical stress management intervention for breast cancer patients

This study evaluated whether expressive writing (EW) was an effective stress management intervention for breast cancer patients. Women were recruited at the end of neoadjuvant chemotherapy and assigned to write about their cancer experience (EW group; n = 24) or neutral topics (neutral writing [NW] group; n = 25). Women were asked to write for 20 minutes a day for a total of four writing sessions that were completed over a 7-day period. Participants were reassessed approximately 3 days before and 2 weeks after surgery. The intervention did not significantly decrease women's distress, perceived stress, sleep disturbance, or pain. There was some evidence that the EW group used more sleep medication at the presurgical assessment than the NW group. Social constraints moderated the effect of the intervention. Among women with high social constraints, the EW group reported lower average daily pain than the NW group. Among women with low social constraints, the EW group reported higher average daily pain than the NW group. EW was not broadly effective as a stress management intervention for women with breast cancer. These data do not support the use of EW as a presurgical mind-body complementary medicine program for this population.     

Stability and change in posttraumatic stress disorder symptoms following breast cancer treatment: a 1-year follow-up

While some recent research has examined the prevalence and severity of posttraumatic stress disorder (PTSD)-like symptoms following cancer treatment, no research has examined temporal change or stability in these symptoms in cancer survivors. Female breast cancer survivors (n=46) participated in an initial telephone interview and a follow-up interview 12 months later. PTSD symptoms associated with breast cancer were assessed using the PTSD Checklist-Civilian version (PCLC). In general, PTSD symptoms in this population did not diminish over time. While group analyses indicated that PCLC-total and subscale scores were stable across the two assessments, analyses of PCLC scores indicated that many patients exhibited fairly large (>0.5 S.D.) increases and/or decreases in PCLC-total or subscale scores. Some evidence suggested that decreases in PCLC scores between the two study assessments were associated with greater social support and experience of fewer traumatic stressors prior to breast cancer diagnosis. Most significantly, the research suggested that women with greater PTSD symptoms at the initial interview were less likely to participate in the follow-up interview. Implications of this for research and clinical management of PTSD in this population are discussed.     

Predictors of psychological distress,sexual dysfunction and physical functioning among women with upper extremity lymphedema related to breast cancer

Sixty-nine women presenting for rehabilitation treatment for upper extremity lymphedema (UEL) were assessed by physical examination and validated self-report assessment instruments measuring demographics, psychological distress, sexual functioning, social support, coping style, pain and functional status. Statistical analyses revealed that women with UEL had high levels of psychological distress, and high levels of sexual, functional and social dysfunction. There were no linear relationships between severity of UEL and levels of distress. Women with UEL in their dominant hand, however, had more distress and less overall sexual satisfaction than those with UEL in their non-dominant limb. Women with pain of any intensity were the most distressed, and had the most significant difficulties in psychological and physical functioning. Women with pain also perceived significantly less interpersonal support than those without pain. Virtually none were receiving pain treatment. An avoidant coping style and low perceived social support were significant correlates of psychological distress. UEL poses significant functional, social and sexual functioning problems in women following breast cancer treatment. An assessment of pain, as well as social support and coping, might help identify those in need of consultation by psychiatry and pain specialists. Patients may also benefit from psychological support and sexual therapy in addition to physical rehabilitation. A psycho-educational and support group within the clinic may prevent the worsening of UEL through the adoption of preventive strategies, maximizing compliance with rehabilitative efforts, augmenting better coping methods through group support, decreasing isolation that accompanies the condition, and facilitating the identification of patients in need of formal consultation.     

Posttraumatic Growth and Social Support in Turkish Patients with Cancer

Posttraumatic growth (PTG) is the experience of positive change that occurs as a result of the struggle withhighly challenging life crises. The need to understand PTG in relation to actual changes in an individual’s life hasrecently been raised. Little is known about the role of social support in the experience of positive outcomes. Thepurpose of this study is to investigate the role of perceived social support in enhancing PTG in cancer patients.This study involved 105 cancer patients. The data were collected using a questionnaire that determined thesocio-demographic features, posttraumatic growth inventory (PTGI) and perceived social support. Participantsreported relatively high levels of PTG and social support. Total perceived social support, support from family, andfriends were significantly positive associated with the development of PTG among cancer patients. Accordingly,the social surroundings of the patient should be informed about the importance of social support and how ithelps the patient; they should be made aware of necessity of social support.     

Optimism and life events as predictors of fear appraisals in mothers of children undergoing hematopoietic stem cell transplantation

Although mothers' fear appraisals about their child's future health and well-being affect their own psychological adjustment to their child's hematopoietic stem cell transplantation (HSCT), little is known about antecedents of maternal fear appraisals. This longitudinal study investigated several potential antecedents of these fear appraisals: maternal optimism, recent negative life events, lifetime history of traumatic events, and medical characteristics of the child's disease and HSCT course. One hundred-forty mothers were interviewed during their child's hospitalization for HSCT and at 3-and 6-months post-HSCT. Structural equation modeling was used to test a model of hypothesized relations. Consistent with predictions, lower optimism and a greater number of negative life events were independently associated with greater maternal fear appraisals. Contrary to expectations, lifetime history of trauma was not associated with maternal fear appraisals. Mothers' fear appraisals during their child's hospitalization were, in turn, associated with their fear appraisals up to 6 months later. These data identify a subset of mothers who may be particularly in need of an intervention to increase optimistic coping strategies, improve coping with negative life events, and reduce fear appraisals to improve their adjustment following their child's HSCT.