Posttraumatic growth in cancer patients and partners—effects of role, gender and the dyad on couples' posttraumatic growth experience
Diana Zwahlen
Department of Psychiatry, University Hospital of Zurich, Switzerland
Department of Psychosomatic Medicine, University Hospital of Basel, Switzerland
Search for more papers by this authorNiels Hagenbuch
Department of Psychiatry, University Hospital of Zurich, Switzerland
Search for more papers by this authorJosef Jenewein
Department of Psychiatry, University Hospital of Zurich, Switzerland
Search for more papers by this authorCorresponding Author
Stefan Buchi
Department of Psychiatry, University Hospital of Zurich, Switzerland
Clinic for Psychotherapy and Psychosomatics “Hohenegg”, CH-8706 Meilen, SwitzerlandSearch for more papers by this authorDiana Zwahlen
Department of Psychiatry, University Hospital of Zurich, Switzerland
Department of Psychosomatic Medicine, University Hospital of Basel, Switzerland
Search for more papers by this authorNiels Hagenbuch
Department of Psychiatry, University Hospital of Zurich, Switzerland
Search for more papers by this authorJosef Jenewein
Department of Psychiatry, University Hospital of Zurich, Switzerland
Search for more papers by this authorCorresponding Author
Stefan Buchi
Department of Psychiatry, University Hospital of Zurich, Switzerland
Clinic for Psychotherapy and Psychosomatics “Hohenegg”, CH-8706 Meilen, SwitzerlandSearch for more papers by this authorAbstract
Background/Aim: Little is known about factors influencing positive effects in couples facing a cancer diagnosis.
Methods: A heterogeneous sample of 224 couples from a multi-site study (four oncology units) completed questionnaire surveys including the Posttraumatic Growth Inventory (PTGI) as a measure of positive psychological effects.
Results: The data demonstrated that all three investigated factors—gender, role (patient vs partner) and the dyad (belonging to any of the 224 couples)—significantly contributed to variation in PTGI total scores and subscales. Variability between couples (factor dyad) appeared stronger than variability between patient and partner participants (factor role) and between male and female participants (factor gender). Role and gender analysis showed that patients demonstrated higher levels of posttraumatic growth than partners; and female participants scored higher on PTGI than males. Male patient–female partner pairs show greater association in their experience of posttraumatic growth than female patient–male partner pairs. Correlations also suggested that, regardless of the gender and role composition, patients and partners may experience parallel growth.
Conclusions: Our findings indicate that positive psychological experiences may be shared by partners affected by cancer in similar ways as have been shown for negative psychological effects. Intra-couple similarities or processes may have a more important function in experiencing benefits than factors like gender or being the patient or the partner. These results underline the importance of a family approach to understanding negative and positive psychological effects of cancer. Copyright © 2009 John Wiley & Sons, Ltd.
References
- 1Powe BD, Finnie R. Cancer fatalism: the state of the science. Cancer Nurs 2003; 26(6): 454–465; quiz 466–467.
- 2Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol 2003; 22(5): 487–497.
- 3Ho SM, Chan CL, Ho RT. Posttraumatic growth in Chinese cancer survivors. Psycho-Oncology 2004; 13(6): 377–389.
- 4Dirksen SR. Search for meaning in long-term cancer survivors. J Adv Nurs 1995; 21: 628–633.
- 5Bellizzi KM, Blank TO. Predicting posttraumatic growth in breast cancer survivors. Health Psychol 2006; 25(1): 47–56.
- 6Taylor SE. Adjustment to threatening events: a theory of cognitive adaptation. Am Psychol 1983; 38: 1161–1173.
- 7Davis CG, Nolen-Hoeksema S, Larson J. Making sense of loss and benefiting from the experience: two construals of meaning. J Pers Soc Psychol 1998; 75(2): 561–574.
- 8Affleck G, Tennen H. Construing benefits from adversity: adaptational significance and dispositional underpinnings. J Pers 1996; 64(4): 899–922.
- 9Schaefer JA, Moos RH. Life crisis and personal growth. In Personal Coping, Theory, Research and Application, BN Carpenter (ed.). Praeger: Westport, CT, 1992; 149–170.
- 10Park CL, Cohen LH, Murch RL. Assessment and prediction of stress-related growth. J Pers 1996; 64: 71–105.
- 11Joseph S, Linley PA, Andrews L et al. Assessing positive and negative changes in the aftermath of adversity: psychometric evaluation of the changes in outlook questionnaire. Psychol Assess 2005; 17(1): 70–80.
- 12Tedeschi RG, Calhoun LG. Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inq 2004; 15: 1–18.
- 13Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 1996; 9(3): 455–471.
- 14Tedeschi RG, Calhoun LG. Trauma & Transformation: Growing in the Aftermath of Suffering. Sage: Thousand Oaks, CA, 1995.
10.4135/9781483326931 Google Scholar
- 15Tallman BA, Altmaier E, Garcia C. Finding benefit from cancer. J Couns Psychol 2007; 54(4): 481–487.
- 16Thornton AA, Perez MA. Posttraumatic growth in prostate cancer survivors and their partners. Psycho-Oncology 2006; 15: 285–296.
- 17Park CL, Helgeson VS. Introduction to the special section: growth following highly stressful life events—current status and future directions. J Consult Clin Psychol 2006; 74(5): 791–796.
- 18Cobb AR, Tedeschi RG, Calhoun LG, Cann A. Correlates of posttraumatic growth in survivors of intimate partner violence. J Trauma Stress 2006; 19(6): 895–903.
- 19Weinrib AZ, Rothrock NE, Johnsen EL, Lutgendorf SK. The assessment and validity of stress-related growth in a community-based sample. J Consult Clin Psychol 2006; 74(5): 851–858.
- 20Frazier PA, Kaler ME. Assessing the validity of self-reported stress-related growth. J Consult Clin Psychol 2006; 74(5): 859–869.
- 21Smith SG, Cook SL. Are reports of posttraumatic growth positively biased? J Trauma Stress 2004; 17(4): 353–358.
- 22Linley PA, Joseph S. Positive change following trauma and adversity: a review. J Trauma Stress 2004; 17(1): 11–21.
- 23Stanton AL, Bower JE, Low CA. Posttraumatic growth after cancer. In: Handbook of Posttraumatic Growth: Research and Practice, LG Calhoun, RG Tedeschi (eds.). Erlbaum: Mahwah, NJ, 2006.
- 24Taylor SE, Lichtman RR, Wood JV. Attributions, beliefs about control, and adjustment to breast cancer. J Pers Soc Psychol 1984; 46(3): 489–502.
- 25Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road and the emerald city: benefit-finding, positive reappraisal coping, and posttraumatic growth in women with early-stage breast cancer. Health Psychol 2003; 22: 487–497.
- 26Wasserman AL, Thompson EI, Wilimas JA, Fairclough DL. The psychological status of survivors of childhood/adolescent Hodgkin's disease. Am J Dis Child 1987; 141(6): 626–631.
- 27Kinsinger DP, Penedo FJ, Antoni MH, Dahn JR, Lechner S, Schneiderman N. Psychosocial and sociodemographic correlates of benefit-finding in men treated for localized prostate cancer. Psycho-Oncology 2006; 15(11): 954–961.
- 28Rieker PP, Fitzgerald EM, Kalish LA et al. Psychosocial factors, curative therapies, and behavioral outcomes. A comparison of testis cancer survivors and a control group of healthy men. Cancer 1989; 64(11): 2399–2407.
10.1002/1097-0142(19891201)64:11<2399::AID-CNCR2820641134>3.0.CO;2-P CAS PubMed Web of Science® Google Scholar
- 29Widows MR, Jacobsen PB, Booth-Jones M, Fields KK. Predictors of posttraumatic growth following bone marrow transplantation for cancer. Health Psychol 2005; 24(3): 266–273.
- 30Fromm K, Andrykowski MA, Hunt J. Positive and negative psychosocial sequelae of bone marrow transplantation: implications for quality of life assessment. J Behav Med 1996; 19(3): 221–240.
- 31Cordova MJ, Cunningham LLC, Carlson CR, Andrykowski MA. Posttraumatic growth following breast cancer: a controlled comparison study. Health Psychol 2001; 20: 176–185.
- 32Petrie KJ, Buick DL, Weinman J, Booth RJ. Positive effects of illness reported by myocardial infarction and breast cancer patients. J Psychosom Res 1999; 47(6): 537–543.
- 33Hodges LJ, Humphris GM, Macfarlane G. A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med 2005; 60(1): 1–12.
- 34Akizuki N, Akechi T, Nakanishi T et al. Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Cancer 2003; 97(10): 2605–2613.
- 35Manne S, Ostroff J, Winkel G, Goldstein L, Fox K, Grana G. Posttraumatic growth after breast cancer: patient, partner, and couple perspectives. Psychosom Med 2004; 66(3): 442–454.
- 36Weiss T. Correlates of posttraumatic growth in husbands of breast cancer survivors. Psycho-Oncology 2004; 13(4): 260–268.
- 37Schulz U, Mohamed NE. Turning the tide: benefit finding after cancer surgery. Soc Sci Med 2004; 59(3): 653–662.
- 38Antoni MH, Lehman JM, Kilbourn KM et al. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 2001; 20(1): 20–32.
- 39Lechner SC, Zakowski SG, Antoni MH, Greenhawt M, Block K, Block P. Do sociodemographic and disease-related variables influence benefit-finding in cancer patients? Psycho-Oncology 2003; 12(5): 491–499.
- 40Dunigan JT, Carr BI, Steel JL. Posttraumatic growth, immunity and survival in patients with hepatoma. Dig Dis Sci 2007; 52(9): 2452–2459.
- 41Jaarsma TA, Pool G, Sanderman R, Ranchor AV. Psychometric properties of the Dutch version of the posttraumatic growth inventory among cancer patients. Psycho-Oncology 2006; 15(10): 911–920.
- 42Bellizzi KM. Expressions of generativity and posttraumatic growth in adult cancer survivors. Int J Aging Hum Dev 2004; 58(4): 267–287.
- 43Zwahlen D, Hagenbuch N, Carley MI, Recklitis CJ, Buchi S. Screening cancer patients' families with the distress thermometer (DT): a validation study. Psycho-Oncology 2008; 17(10): 959–966.
- 44Maercker A, Langner R. Persönliche Reifung durch Belastungen und Traumata: Ein Vergleich zweier Fragebogen zur Erfassung selbstwahrgenommener Reifung nach traumatischen Erlebnissen (Stress-related personal growth: validation of German versions of two questionnaires). Diagnostica 2001;( 47): 153–162.
- 45 R Development Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria, 2007.
10.1111/j.1462-2920.2006.01017.x Google Scholar
- 46Hogg RW, Craig A, McKean JW. Introduction to Mathematical Statistics. Prentice-Hall: Upper Saddle River, NJ, 2004.
- 47Cohen J. Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ, 1988.
10.1046/j.1526-4610.2001.111006343.x Google Scholar
- 48Hagedoorn M, Sanderman R, Bolks HN, Tuinstra J, Coyne JC. Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull 2008; 134(1): 1–30.
- 49Groves RM. Nonresponse rates and nonresponse bias in household surveys. Public Opin Q 2006; 70(5 Special Issue): 646–675.