Commentary: Posttraumatic Growth Following Pediatric Solid Organ Transplantation: Making Meaning Out of the Gift of Life.
Commentary: Posttraumatic Growth Following Pediatric Solid Organ Transplantation: Making Meaning Out of the Gift of Life.
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评论：儿科实体器官移植后的创伤后成长：让生命的礼物变得有意义。
DOI：
10.1093/jpepsy/jsac060
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发表时间：
2022
影响因子：
3.6
通讯作者：
Cousino,MelissaK
中科院分区：
文献类型：
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作者：
Rea,KellyE;Cousino,MelissaK
许多儿科心理学研究都集中在缺陷或风险模型上，例如注意到患有医学疾病的儿童会经历适应不良的结果（Hilliard et al.，2015年）。然而，越来越多的人认识到，儿童和家庭可能表现出适应性或比预期更好的结果，尽管面临管理严重医学状况的挑战，例如实体器官移植（SOT; Hilliard et al.，2015年）。因此，了解促进复原力和积极调整的因素，包括创伤后成长（PTG）至关重要。PTG是一种积极的变化（例如，自我或目的感的转变），由经历创伤事件后的重要人际或内心过程引起（Tedeschi & Calhoun，1996）。虽然最常在儿科肿瘤学中进行研究，但PTG的过程可能在儿科SOT中也很明显，这是由于器官衰竭的生命威胁性质和移植后功能的增加。虽然PTG已在成人SOT样品中得到证实（Gangeri等人，2018年; Pérez-San-Gregorio等人，2017）和儿科肾移植受者的母亲（Mantulak & Cadell，2018），没有已知的研究检查了儿科SOT受者的PTG。Triplett及其同事（本期）通过检查儿童和年轻人SOT接受者（7-21岁）及其照顾者是否经历PTG以及与这种增长相关的因素来填补这一空白。这项研究的优势包括种族和民族多样化的样本，探索整个发展，高参与率，并纳入儿童和照顾者的观点。大多数参与者在儿童，年轻的成年人，和照顾者群体表示中度到高度的PTG。使用统计学显著性和效应量与更高水平的PTG相关的因素包括西班牙裔种族（护理人员报告统计学显著性），黑人种族（年轻人报告统计学显著性）和宗教信仰和应对（护理人员报告统计学显著性）。也有显着的，积极的关系之间的照顾者和青年报告PTG。这项研究强调了儿科SOT中基于力量的方法，尽管需要研究来告知干预措施，包括理解宗教应对的作用，使用经验证的措施，机构合作以增加样本量，以及SOT中PTG的纵向探索。（本期）表明宗教信仰或应对PTG的作用，与其他儿科人群一致的发现，包括进行干细胞移植的儿童的看护者（Beckmann等，2021; Chardon等人，2021年）。未来的研究需要了解与这种关系相关的过程，考虑到PTG在那些有组织和没有组织的宗教信仰但可能支持精神或存在变化的人中的可能性（Tedeschi等人，2017年）。以多种方式评估宗教虔诚度和灵性是必要的，以进一步了解与PTG的关联，因为在本研究中，报告宗教信仰的青年并不总是报告使用宗教应对，但PTG的水平仍然很高（Triplett等人，本期）。这实际上可以通过详细说明照顾者和青年PTG发展的模型来了解
Much of pediatric psychology research has focused on deficit or risk models, such that children with medical conditions are noted to experience maladaptive outcomes (Hilliard et al., 2015). However, it is increasingly recognized that children and families may demonstrate adaptive or better than expected outcomes, despite challenges managing serious medical conditions, such as solid organ transplantation (SOT; Hilliard et al., 2015). Thus, it is critical to understand factors promoting resilience and positive adjustment, including posttraumatic growth (PTG). PTG is a positive change (eg, transformed sense of self or purpose) resulting from significant inter-or intrapersonal processes after experiencing a traumatic event (Tedeschi & Calhoun, 1996). While most frequently studied in pediatric oncology, processes of PTG are likely also apparent in pediatric SOT, owing to the lifethreatening nature of organ failure and increases in functioning following transplant. While PTG has been demonstrated in adult SOT samples (Gangeri et al., 2018; P érez-San-Gregorio et al., 2017) and among mothers of pediatric kidney transplant recipients (Mantulak & Cadell, 2018), no known studies have examined PTG among pediatric SOT recipients. Triplett and colleagues (this issue) fill this gap by examining whether children and young adults SOT recipients (ages 7–21 years) and their caregivers experience PTG and what factors relate to this growth. Strengths of this study include a racially and ethnically diverse sample, exploration across development, high participation rate, and incorporation of child and caregiver perspectives. Most participants across child, young adult, and caregiver groups indicated medium to high levels of PTG. Factors associated with greater levels of PTG using both statistical significance and effect sizes included Hispanic ethnicity (caregiver report statistically significant), Black race (young adult report statistically significant), and religious affiliation and coping (caregiver report statistically significant). There were also significant, positive relationships between caregiver and youth-reported PTG. This study underscores strength-based approaches within pediatric SOT, though research is needed to inform interventions, including understanding the role of religious coping, use of validated measures, institutional collaborations to increase sample size, and longitudinal exploration of PTG in SOT.Triplett and colleagues (this issue) suggest a role of religious affiliation or coping in PTG, findings that are aligned with other pediatric populations, including caregivers of children undergoing stem cell transplantation (Beckmann et al., 2021; Chardon et al., 2021). Future research is needed to understand processes associated with this relationship, given the possibility of PTG in those with and without organized religious affiliation but who may endorse spiritual or existential change (Tedeschi et al., 2017). Assessment of religiosity and spirituality in multiple ways is warranted to further understand associations with PTG, as in the present study, youth reporting religious affiliation were not always reporting use of religious coping, yet high levels of PTG remained (Triplett et al., this issue). This may practically be informed by models detailing the development of PTG among caregivers and youth