Marta Scrignaro

The combined contribution of social support and coping strategies in predicting post-traumatic growth: a longitudinal study on cancer patients.

Objectives: The aim of this study is to investigate the role of social support and coping strategies in enhancing post‐traumatic growth (PTG) in cancer patients. The study focused on both avoidance and approaching coping and on four distinct types of social support: (a) perceived availability, (b) actual received, (c) satisfaction with received support, and (d) the competence of caregiver to satisfy the patients basic psychological needs of autonomy, competence, and relatedness.

Identity formation in Italian emerging adults: A cluster-analytic approach and associations with psychosocial functioning

The present study examined identity formation in Italian emerging adults using an integrative identity model including commitment making, identification with commitment, exploration in depth, exploration in breadth, and ruminative exploration. Participants were 1,130 university students, aged 18–30 years. In line with previous research, results indicated that, by means of cluster analysis, six identity statuses could be derived: achievement, foreclosure, moratorium, diffused diffusion, carefree diffusion, and undifferentiated. Each of these identity statuses exhibited a distinct profile in terms of self-esteem, anxiety, depression, and need satisfaction. Suggestions for future research and limitations are discussed.

Italian validation of the Purpose In Life (PIL) test and the Seeking Of Noetic Goals (SONG) test in a population of cancer patients

ObjectiveThe first instruments developed to evaluate specific logotherapeutic dimensions were the Purpose In Life (PIL) and the Seeking Of Noetic Goals (SONG) tests, designed to reflect Frankls concepts of, respectively, meaning in life attainment and will to meaning. This study aims to perform the Italian cultural adaptation and the psychometric validation of the PIL and SONG questionnaires.MethodsWe administered the PIL and SONG, culturally adapted into the Italian language, to 266 cancer patients. The psychometric validation appraised construct validity, internal consistency, test–retest reliability, known-group validity, and convergent validity of the two questionnaires with respect to one another.ResultsThe factorial analysis indicates that the original single-factor solution can be maintained for both instruments (proportion of variance explained by the first factor 77% and 71% for the PIL and SONG, respectively). The results show excellent internal consistency (Cronbachs alpha of 0.91 for the PIL and 0.90 for the SONG) and test-retest reliability (intraclass correlation coefficient of 0.92 for the PIL and 0.81 for the SONG). As expected, males, believers, patients nearer to the diagnosis, and patients not undergoing psychological therapy have higher PIL and lower SONG scores, while expectations for age were not confirmed. The average level for the PIL was 107.3, while for the SONG, it was 66.1, and a negative correlation (−0.47) between PIL and SONG scores indicates good convergent validity of the two instruments.ConclusionItalian versions of the PIL and SONG are adequate and reliable self-report instruments for evaluating purpose in life and the motivation to find purpose for cancer patient populations.

Social Support and Adherence to Treatment in Hypertensive Patients: A Meta-Analysis

BackgroundIt is important to examine factors associated with patient adherence to hypertension control strategies.PurposeA meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients.MethodsJournal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review.ResultsFindings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses.ConclusionsFunctional social support, but not structural social support, was associated with adherence in hypertensive patients.

Seeking and experiencing meaning: exploring the role of meaning in promoting mental adjustment and eudaimonic well-being in cancer patients.

OBJECTIVE The present study is the result of theory-driven research investigating the role of the search for and presence of meaning in enhancing both mental adjustment and eudaimonic well-being in cancer patients. METHOD A cross-sectional study involved 266 cancer patients currently in the treatment and management phase of their illness. Data were collected by a written questionnaire. The search for meaning was assessed with the Seeking of Noetic Goals Test, and the presence of meaning was assessed using the Purpose in Life Test. Mental adjustment to a cancer diagnosis was assessed by two subscales of the Italian version of the Mini-Mental Adjustment to Cancer Scale, and eudaimonic well-being was assessed with the Psychological Well-Being Scale. Correlation and mediation analyses based on five thousand bootstrapping samples were performed. RESULTS The mediation analyses showed that the presence of meaning totally or partially mediated the effect of the search for meaning on both mental adjustment and eudaimonic well-being. Further correlation analyses showed a high negative correlation between eudaimonic well-being and hopelessness. SIGNIFICANCE OF RESULTS Our results appear relevant from both the theoretical and clinical points of view. They support a deeper understanding of the combined contribution of the search for and presence of meaning in promoting well-being in cancer patients. Simultaneously, they are consistent with suggestions from recent studies on the clinical psychology of posttraumatic growth and emphasize the relevance of eudaimonic well-being as a protective factor for hopelessness.

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators.

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome

BackgroundResearch has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome.MethodsTwo hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35–75; SD = 7.98). Patients’ needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran’s Q Test were performed to test differences in variables of interest over time.ResultsResults showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time.ConclusionThe present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients’ information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care.

Studying Predictors of Posttraumatic Growth in Cancer Patients

Coherently, with the Organismic valuing theory of growth, the research firstly intended to verify the effectiveness of the pattern of accommodative versus assimilative strategies in predicting posttraumatic growth and, secondly, to verify the effectiveness of autonomy-supportive posttrauma social environment (i.e., caregiver) in predicting accommodative versus assimilative strategies in a group of mixed cancer patients. A structured questionnaire was offered to 150 cancer patients prevalently diagnosed with Stage 1 or Stage 2 breast cancer or gastro-enteric cancer (M = 52 years old; SD = 7.70), an average of 35-month postdiagnosis, using the Posttraumatic Growth Inventory, the Brief Cope, the Impact Scale and the Impact of Event Scale, the Need Satisfaction in Relationship Scale. The accommodative strategy of coping strongly positively correlates with posttraumatic growth (PTG). On the contrary, assimilative strategy weakly correlates with PTG. Furthermore, a model of the pattern of accommodative processes was tested by path analysis. The model was significant and accounted for high amount of variance symptoms of intrusion that started up the process toward growth, predicting the impact of the event on identity of patients that in turn channeled the ruminative process toward an approach strategy of coping. The approach coping strategy was the reliable direct predictor of PTG. No other predictors of growth correlate significantly with autonomy-supportive stile of caring. The quality of personal struggle with the new reality of trauma is the key variable in determining the extent to which posttraumatic growth occurs. On the contrary, the role of the autonomy-supportive social context is unclear.

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs). Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs. Main outcome measures: Intensity and frequency of PA. Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).

A Longitudinal Investigation of Posttraumatic Growth and Quality of Life in Liver Transplant Recipients

Background: What does it mean to adjust to a liver transplant? Quality of life research has offered an impairment model, defining adjustment as the absence of diagnosed psychological disorder or of limitations in physical functioning. Recently emerging research on posttraumatic growth testifies the prevalence of positive life changes following the life-threatening illnesses. The present study aimed to verify the presence of the posttraumatic growth process in liver transplant patients and its relationship with traditional quality of life. Methods: The research was a longitudinally descriptive study. A sample of 233 liver transplant patients were assessed with the Posttraumatic Growth Inventory and the Functional Assessment of Chronic Illness Therapy General. Results: Over 50% of patients showed moderate-high levels in all dimensions of the Posttraumatic Growth Inventory. Further posttraumatic growth is correlated with the functional and social dimensions of quality of life construct and not with physical and emotional functioning. Conclusion: These results confirmed that posttraumatic growth is related to a different definition of well-being than the one traditionally used in the assessment of quality of life. Adjustment to liver transplant is a complex and systemic process, which requires a multidisciplinary approach to be able to support and encourages adaptation through all the needed functional elements. An interesting perspective is offered by the narrative medicine approach, that highlighted the importance to pay specific attention to the words and expression used by patients related to changes in life and not only to traditional words reporting physical status.