Kelada L, Roziner I, Dahabre R, Bentley G, Poikonen-Saksela P, Mazzocco K, Sousa B, Pat-Horenczyk R
School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel.
Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, Randwick, Australia.
Psychooncology. 2025 Apr;34(4):e70126. doi: 10.1002/pon.70126.
Research suggests that posttraumatic stress symptoms (PTSS) after a breast cancer (BC) diagnosis may lead to posttraumatic growth (PTG). Further prospective research is needed to confirm this, and to examine whether modifiable factors mediate the relationship. This study aimed to prospectively determine whether PTSS predicts PTG, and whether social support and cognitive emotion regulation mediate the relationship between PTSS and PTG among women with BC.
In this study, 489 women from four countries (Finland, Israel, Italy, Portugal) with BC completed questionnaires at diagnosis (M0), and 6-months (M6), 9-months (M9), 15-months (M15), and 18-months (M18) post-diagnosis. Questionnaires included the Posttraumatic Growth Inventory, PTSD Checklist for DSM-5, Cognitive Emotion Regulation Questionnaire, modified Medical Outcomes Study Social Support Survey, and sociodemographic questions. We used serial mediation to determine whether the relationship between PTSS (M6) and PTG (M18) was mediated by social support (M9) and positive cognitive emotion regulation (M15), controlling for age.
PTSS (M6) (B = 0.18, 95%CI = 0.07, 0.28), social support (M9) (B = 1.71, 95%CI = 0.30, 3.14) and positive cognitive emotion regulation (M15) (B = 3.34, 95%CI = 1.76, 4.92) all directly predicted PTG (M18). The serial mediation was significant with a very small effect size: PTSS negatively predicted social support which positively predicted positive cognitive emotion regulation which positively predicted PTG (effect = -0.013, 95%CI = -0.02, -0.005).
Our study adds support for a prospective, positive relationship between PTSS and PTG among women with BC, and shows that this relationship may be mediated by social support and cognitive emotion regulation. Further research is needed to inform interventions to promote PTG.
研究表明，乳腺癌（BC）诊断后的创伤后应激症状（PTSS）可能会导致创伤后成长（PTG）。需要进一步的前瞻性研究来证实这一点，并研究可改变因素是否介导了这种关系。本研究旨在前瞻性地确定PTSS是否能预测PTG，以及社会支持和认知情绪调节是否介导了BC女性中PTSS与PTG之间的关系。
在本研究中，来自四个国家（芬兰、以色列、意大利、葡萄牙）的489名BC女性在诊断时（M0）、诊断后6个月（M6）、9个月（M9）、15个月（M15）和18个月（M18）完成了问卷调查。问卷包括创伤后成长量表、DSM-5创伤后应激障碍检查表、认知情绪调节问卷、改良的医学结局研究社会支持调查以及社会人口学问题。我们使用系列中介分析来确定PTSS（M6）与PTG（M18）之间的关系是否由社会支持（M9）和积极认知情绪调节（M15）介导，并控制年龄因素。
PTSS（M6）（B = 0.18，95%CI = 0.07，0.28）、社会支持（M9）（B = 1.71，95%CI = 0.30，3.14）和积极认知情绪调节（M15）（B = 3.34，95%CI = 1.76，4.92）均直接预测了PTG（M18）。系列中介分析具有显著性，效应量非常小：PTSS对社会支持有负向预测作用，社会支持对积极认知情绪调节有正向预测作用，积极认知情绪调节对PTG有正向预测作用（效应 = -0.013，95%CI = -0.02，-0.005）。
我们的研究支持了BC女性中PTSS与PTG之间存在前瞻性的正向关系，并表明这种关系可能由社会支持和认知情绪调节介导。需要进一步的研究来为促进PTG的干预措施提供依据。
