Predictors of posttraumatic stress symptoms in childhood cancer survivors
Predictors of posttraumatic stress symptoms in childhood cancer survivors
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DOI：
10.1542/peds.100.6.958
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发表时间：
1997-12-01
期刊：
影响因子：
8
通讯作者：
Meadows, A
中科院分区：
文献类型：
--
作者：
Stuber, ML;Kazak, AE;Meadows, A
客观的。儿童癌症的诊断和治疗是一种极其紧张的经历，心理后遗症可能在治疗结束后持续多年。本研究调查了一般性焦虑、治疗强度、治疗后遗症以及生命威胁和治疗强度的主观评价对后来的创伤后应激症状（如侵入性记忆、回避和过度警觉）的相对贡献。方法。 186 名年龄在 8 岁至 20 岁、停止治疗超过 1 年的儿童癌症幸存者及其父母完成了调查问卷。治疗的医疗后遗症和治疗强度由儿科肿瘤学家评定。结果。持续性创伤后应激症状的重要、独立预测因素包括：1）幸存者在治疗时对生命威胁的回顾性主观评价，以及幸存者对治疗“艰难”或“可怕”的体验程度； 2）孩子的一般焦虑程度； 3）其他压力经历史； 4) 自治疗终止以来的时间（负相关）； 5）女性； 6) 家庭和社会支持。母亲对治疗和生命威胁的看法会导致幸存者的焦虑和主观评价，但不会独立地导致创伤后应激症状。结论。创伤后应激障碍的症状似乎随着时间的推移而减轻，但在儿童癌症幸存者中却持续存在。除了时间和性别之外，创伤后应激症状的预测因子主要是主观因素（如束缚、焦虑和主观评价），而不是治疗和医疗后遗症的客观应激源。
Objective. The diagnosis and treatment of childhood cancer are extremely stressful experiences, with psychological sequelae which can persist many years after the end of treatment. This study investigated the relative contributions of general anxiety, treatment intensity, medical sequelae of treatment, and the subjective appraisal of life threat and treatment intensity to later posttraumatic stress symptoms, such as intrusive memories, avoidance, and hypervigilance.Method. One hundred eighty-six childhood cancer survivors ages 8 through 20 years, off of treatment for more than 1 year, and their parents completed questionnaires. Medical sequelae of treatment and intensity of treatment were rated by a pediatric oncologist.Results. Significant, independent predictors of persistent posttraumatic stress symptoms included: 1) the survivor's retrospective subjective appraisal of life threat at the time of treatment, and the degree to which the survivor experienced the treatment as ''hard'' or ''scary''; 2) the child's general level of anxiety; 3) history of other stressful experiences; 4) time since the termination of treatment (negative association); 5) female gender; and 6) family and social support. Mother's perception of treatment and life threat contributed to anxiety and subjective appraisal for the survivor, but did not independently contribute to posttraumatic stress symptoms.Conclusions. Symptoms of posttraumatic stress seem to decrease with time, but are persistent in a subset of childhood cancer survivors. Other than time and gender, the predictors of posttraumatic stress symptoms are primarily subjective factors tie, anxiety and subjective appraisal) rather than objective stressors of treatment and medical sequelae.