Study On The Trajectory Of Post-Traumatic Stress Disorder Symptoms In Patients With Gynecological Malignancies

ObjectivesTo explore the level and development track of post-traumatic stress disorder symptoms in patients with gynecological malignant tumors 1 months,3 months and 6months after the first diagnosis of malignant tumors;To analyze the influence of general demographic factors,disease-related factors,and socio-psychological variables on the development of different types of post-traumatic stress disorder symptoms in patients with gynecological malignant tumors,and to find independent factors that can be intervened,so as to provide reference basis for medical professionals to implement effective targeted psychological interventions for clinical patients.MethodsThis study adopts a longitudinal study design,selecting malignant tumor patients who were hospitalized in the gynecology department of three tertiary first-class hospitals in Gansu Province from March 2022 to January 2023 as the research subjects.Using the General Information Questionnaire,Posttraumatic Stress Disorder Screening Scale,Medical Coping Style Questionnaire,Resilience Personality Scale,Generalized Anxiety Scale,Patient Health Questionnaire-9,and Perceived Social Support Scale,a questionnaire survey was conducted on gynecological malignant tumor patients one month after their first diagnosis of malignant tumor.The Posttraumatic Stress Disorder Screening Scale was used to conduct a questionnaire survey on gynecological malignant tumor patients three and six months after their first diagnosis of malignant tumor.After sorting out the data,use SPSS26.0 and Mplus8.3 statistical software to analyze the data and test the level of statisticsα=0.05。The main analysis contents include the description of the basic characteristics of the study object,the development track of post-traumatic stress disorder symptoms and the influencing factors.The data analysis methods include chi-square test,t-test,non-parametric test,latent category growth model,single factor analysis and unordered multi-class logistic regression analysis.Results1.General information:This study initially included 231 patients,and ultimately a total of 201 patients participated in three surveys throughout the entire process,with a loss of follow-up rate of 12.9%.There was no statistically significant difference between 201 patients who completed the follow-up and 30 patients who lost the follow-up in terms of age,number of children born,educational level,monthly income per capita,religious belief,family history,chronic medical history,payment method of medical expenses,type of malignant tumor,treatment method,tumor FIGO stage(P>0.05),it indicates that there is no significant difference in general information between those who have completed follow-up and those who have lost follow-up.2.The level of post-traumatic stress disorder symptoms at three time points:In this study,a total of 201 individuals participated in three complete surveys,with a PCL-5score of(28.12±12.62)for T1(1 month after diagnosis),(23.99±9.53)for T2(3 months after diagnosis),and(18.77±8.48)for T3(6 months after diagnosis;The positive detection rates of PTSD symptoms in patients with T1,T2 and T3 were 30.8%,23.9%and 10.4%respectively.The overall trend was gradually decreasing,indicating that the symptoms of PTSD in patients with gynecological malignancies were gradually relieved over time.3.The development trajectory of post-traumatic stress disorder symptoms:The latent variable growth curve model found that the symptoms of post traumatic stress disorder in patients with gynecological malignant tumors showed a linear downward trend from 1 month after diagnosis to 6 months after diagnosis.There are significant individual differences in the initial state level and descent rate of patients(the estimated variances of the intercept factor and slope factor were 148.420 and 34.220,respectively,P<0.001).4.Potential category analysis results of the development track of PTSD symptoms:based on the potential category growth model,the development track of three potential categories was finally fitted as follows:The first type of development trajectory is the"low risk improvement group",accounting for 58.3%.The characteristic is that the initial PTSS is at a low risk level,showing a slow downward trend overall,with a decline rate of 3.98(mean slope of-3.98,P<0.001);The second type of development trajectory is the"low risk deterioration group",accounting for 10.4%,characterized by a gradual increase from the initial low risk level,with an upward speed of 6.31(mean slope of 6.31,P<0.001);The third type of development trajectory"high-risk improvement group"accounts for 31.3%,characterized by a rapid decline from the initial high-risk level,with a decline rate of 10.47(mean slope of-10.47,P<0.001).5.Univariate analysis:In terms of demography and disease related variables,the number of children born(H=20.193,P<0.001)was significantly different in the distribution of three groups with different development trajectories;In terms of social psychology related variables,there was a statistically significant difference in the scores of coping dimensions,yielding coping dimensions,tenacious personality,anxiety,depression and social support of patients with different development trajectories(P<0.05).6.Random multi-classification logistic regression analysis:Compared with the low-risk improvement group(with the low-risk improvement group as the reference group),the group with higher scores of resilience personality(OR=0.885)and facing coping dimension(OR=0.620)is more likely to develop into a low-risk improvement group,while the group with higher scores of yielding coping dimension(OR=1.866)is more likely to develop into a low-risk malignant group.Compared with the low-risk improvement group(with the low-risk improvement group as the reference group),the high-risk improvement group is more likely to develop into a low-risk improvement group with more children(OR=0.477)and a higher score in the face to face coping dimension(OR=0.691),while the anxiety score is higher(OR=1.589),which is more likely to develop into a high-risk improvement group.Compared with the high-risk improvement group and the low-risk deterioration group(with the low-risk deterioration group as the reference group),the higher the score of the yield coping dimension(OR=0.543),the more likely it is to develop into the low-risk malignant group,and the higher the anxiety score(OR=1.745),the more likely it is to develop into the high-risk improvement group.Mc Fadden R~2=0.472.Conclusions1.The overall score of post-traumatic stress disorder symptoms in patients with gynecological malignant tumors at different stages from the first diagnosis of malignant tumors 1 months,3 months,and 6 months later is in a downward trend.2.There is significant individual heterogeneity in the development of symptoms of post-traumatic stress disorder in patients with gynecological malignant tumors.They can be divided into low-risk improvement group,low-risk malignant group and high-risk improvement group.3.The number of children born,tenacity personality,face to face coping,surrender coping and anxiety can significantly affect the development track categories of patients with different PTSD symptoms.