Trajectory And Influencing Factors Of Post-traumatic Growth In Patients With Gynecologic Cancer And Their Spouses

Objective:Firstly,to explore the specific longitudinal trajectories of post-traumatic growth(PTG)in patients with gynecologic cancer and their spouses at different time points within one year after diagnosis,and compare the subgroup characteristics of different trajectories.Secondly,to explore the influencing factors of PTG in patients with gynecologic cancer and their spouses at individual level.Thirdly,to investigate the relationships between relevant factors with PTG with Actor-Partner Interdependence Model(APIM).Methods:1.Using longitudinal study design,409 patients with gynecologic cancer and their spouses were followed up for 4 times in one year.All participants finished the general information questionnaire and Chinese-Posttraumatic Growth Inventory at baseline(within one month after diagnosis,T1),and finished Chinese-Posttraumatic Growth Inventory again at 3 months(T2),6 months(T3),and 12 months(T4)after diagnosis.The data were analyzed by SPSS22.0 and Mplus8.3 statistical analysis software,and Growth Mixture Modeling(GMM)was used to explore the trajectories of posttraumatic growth of patients and their spouses,and chi-square test,analysis of variance or nonparametric test was used to compare the subgroup characteristics of different trajectories.2.Using cross-sectional study design,a total of 400 patients with gynecologic cancer and their spouses diagnosed within one year were recruited.All participants completed the general information questionnaire,Chinese-Posttraumatic Growth Inventory(C-PTGI),Internality,Powerful others,and Chance Scale(IPC),Event Related Rumination Inventory(ERRI),Simplified Coping Style Questionnaire(SCSQ),and the Distress Disclosure Index(DDI).The data were analyzed by SPSS22.0,Py Caret 2.3 platform based on Python,and Mplus8.3 software.Univariate analysis,multiple linear regression analysis,Automated Machine Learning(Auto ML)algorithms and APIM were used for data analysis.Results:1.Three trajectories of PTG of patients were identified using GMM:high stable,decay,and low increasing group.The patients in high stable group(N=138)had a stable high PTG score within one year;the patients in the decay group(N=78)had a moderate PTG score at baseline,and then decreased gradually;the patients in the low increasing group(N=193)had a lower PTG score at baseline,and then gradually increased.General characteristics such as years of marriage,educational level of the patients and spouses,the place of residence,per capita monthly income of the household,medical insurance type,et al.influenced the trajectories of patients’PTG significantly.2.Three trajectories of PTG of spouses were identified using GMM:middle increasing,decay,and low stable group.The spouses in middle increasing group(N=175)had a moderate PTG score at baseline,and then gradually increased;the spouses in the decay group(N=35)had a moderate PTG score at baseline,and then decreased gradually;the spouses in the low stable group(N=199)had a lower PTG score within one year.General characteristics such as age of the patients,years of marriage,educational level of the patients and spouses,the place of residence,the occupational status of the patients,per capita monthly income of the household,et al.influenced the trajectories of spouses’PTG significantly.3.Multiple linear regression model showed that 71.9%of the variance in PTG of patients was explained by positive coping,internal control in locus of control,distress disclosure index,deliberate rumination,invasive rumination,subjective perception of the severity of the disease,and place of residence(adjusted R~2=0.719).4.Based on the results of Auto ML,the order of importance of influencing factors of PTG of patients various among patients with different educational level,place of residence,per capita monthly income of the household,perception of the severity of the disease,and place of residence.5.Multiple linear regression model showed that 69.8%of the variance in PTG of spouses was explained by positive coping,distress disclosure index,deliberate rumination,invasive rumination,internal control in locus of control,time of diagnosis,and years of marriage(adjusted R~2=0.698).6.Based on the results of Auto ML,the order of importance of influencing factors of PTG of spouses various among spouses with different years of marriage,educational level,per capita monthly income of the household,time of diagnosis,whether they have children,and whether they have experienced other stressful events in recent six months.7.The results of APIM showed that the actor effect was significant for both patients and spouses between positive coping and PTG,and positive coping had a stronger actor effect on PTG for patients than for spouses.The partner effect was significant for spouses between positive coping and PTG.8.The results of APIM showed that the actor effect was significant for both patients and spouses between deliberate rumination and PTG,and the actor effects of deliberate rumination on PTG was similar for the patients and the spouses.The partner effect was significant for spouses between deliberate rumination and PTG.9.The results of APIM showed that the actor effect was significant for patients between invasive rumination and PTG.10.The results of APIM showed that the actor effect was significant for both patients and spouses between internal control in locus of control and PTG,and the actor effects of internal control in locus of control on PTG was similar for the patients and the spouses.The partner effect was significant for patients between internal control in locus of control and PTG.11.The results of APIM showed that the actor effect was significant for both patients and spouses between the distress disclosure index and PTG,and the actor effects of the distress disclosure index on PTG was similar for the patients and the spouses.The partner effect was significant for both patients and spouses between the distress disclosure index and PTG,and the partner effect was the distress disclosure index on PTG was similar for the patients and the spouses.Conclusion:1.Three trajectories of PTG of patients were identified:high stable,decay,and low increasing group.Patients with different PTG trajectories have different subgroup characteristics.2.Three trajectories of PTG of spouses were identified:middle increasing,decay,and low stable group.Spouses with different PTG trajectories have different subgroup characteristics.3.At the individual level,positive coping,internal control in locus of control,distress disclosure index,deliberate rumination,invasive rumination,subjective perception of the severity of the disease and place of residence are the influencing factors of patients’PTG.4.There are differences in the importance of influencing factors of PTG among patients with different educational level,place of residence,per capita monthly income of the household,perception of the severity of the disease,and place of residence.5.At the individual level,positive coping,distress disclosure index,deliberate rumination,invasive rumination,internal control in locus of control,time of diagnosis,and years of marriage are the influencing factors of spouses’PTG.6.There are differences in the importance of influencing factors of PTG among spouses with different years of marriage,educational level,per capita monthly income of the household,time of diagnosis,whether they have children,and whether they have experienced other stressful events in recent six months.7.From the perspective of dyadic relationship,positive coping,deliberate rumination,internal control in locus of control,and the distress disclosure index can affect their own PTG.Invasive rumination of patients can affect their own PTG.Positive coping,deliberate rumination,and distress disclosure index of the patients can affect their spouses’PTG.Internal control in locus of control and distress exposure index of the spouses can affect the patients’PTG.