School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL 33620, USA.
School of Law and Society, University of the Sunshine Coast, Queensland 4558, Australia.
Int J Environ Res Public Health. 2021 Jul 16;18(14):7600. doi: 10.3390/ijerph18147600.
Posttraumatic stress symptoms (PTSS), defined as continued trauma, has been found to negatively impact mental and physical health. Many cancer centers routinely assess level of psychological distress but assessment of symptoms related to PTSS is less routine. Understanding the mechanisms by which psychological distress results in, or influences, PTSS will aid in developing protocols to more effectively identify PTSS in cancer patients.
Survey data were analyzed from intake data at 17 cancer centers across the U.S. Patients reported distress ratings on the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), responded to questions related to intrusive cognitive symptoms of PTSS and provided information about current symptoms and social support systems. Hypotheses were tested using a conditional process model, and paths were provided for direct and indirect effects, including moderation and mediated moderation.
Findings indicated that, while distress scores were influential in the total model, the direct effect of distress on intrusive cognitive symptoms of PTSS was negated by the model's indirect effects. The effects of social support and older age were independent protective factors, and there was a moderation effect that varied across groups. Lastly, physical cancer symptoms as a mediating variable further explained the relationship between psychological distress and intrusive cognitive symptoms of PTSS.
Study results provide evidence for a potential mechanism by which distress relates to intrusive cognitive symptoms of PTSS. Furthermore, findings suggest that older age and social support may be protective factors for certain groups and risk factors for others. This study provides formative data for potential next steps that could lead to improvements in routine psychosocial screenings in cancer treatment settings.
创伤后应激症状（PTSS）被定义为持续的创伤，已被发现对身心健康产生负面影响。许多癌症中心通常会评估心理困扰的程度，但对与 PTSS 相关的症状的评估则不那么常规。了解心理困扰导致或影响 PTSS 的机制将有助于制定更有效地在癌症患者中识别 PTSS 的方案。
对美国 17 个癌症中心的入组数据进行了调查数据分析。患者使用国家综合癌症网络（NCCN）痛苦温度计（DT）报告痛苦评分，回答与创伤后应激症状的侵入性认知症状相关的问题，并提供有关当前症状和社会支持系统的信息。使用条件过程模型检验假设，并提供了直接和间接效应的路径，包括调节和中介调节。
研究结果表明，虽然痛苦评分在总模型中具有影响力，但痛苦对创伤后应激症状的侵入性认知症状的直接影响被模型的间接效应所抵消。社会支持和年龄较大的影响是独立的保护因素，且存在跨群体的调节效应。最后，身体癌症症状作为中介变量进一步解释了心理困扰与创伤后应激症状的侵入性认知症状之间的关系。
研究结果为痛苦与创伤后应激症状的侵入性认知症状之间的关系提供了潜在机制的证据。此外，研究结果表明，年龄较大和社会支持可能是某些群体的保护因素，而对其他群体则是风险因素。本研究为潜在的下一步提供了形成性数据，这可能会导致癌症治疗环境中常规心理社会筛查的改进。
