PubMed · 11051896
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J D Banja. Dad.. https://doi.org/10.1016/s1061-9259(99)80077-0
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BACKGROUND: Quality of life (QOL) and mood were prospectively investigated during the first year of treatment among women with gynecologic cancers. Relationships of coping styles to QOL and mood were examined. METHODS: Ninety-eight patients with early stage or regionally advanced gynecologic cancers were recruited. Mood and QOL were assessed at initial clinic visit and at one year, and medical information was abstracted from charts at both time-points. RESULTS: Although decrements in physical, functional, and total well-being were reported at baseline by regionally advanced patients, by one year, all patients reported significant improvements in QOL and mood. There were no differences between early stage and regionally advanced patients in their improvement for these measures. Controlling for medical variables and age, patients who coped using greater acceptance and positive reframing at their initial visits reported better one year QOL; those with continued higher levels of these adaptive coping strategies at one year reported better concurrent functional and emotional well-being. Greater seeking of social support at one year was associated with better concurrent social well-being and doctor-patient relationships. In contrast, disengaged coping at study entry was associated with poorer doctor-patient relationships at one year; continued disengagement at one year was associated with poorer concurrent QOL and greater distress. CONCLUSIONS: During the first year following treatment, QOL and mood improved among both early stage and regionally advanced gynecologic oncology patients. Patients using disengaged coping are particularly at risk for poor QOL and distress.
Traumatic life events, as defined by DSM-IV, are common among persons with severe mental illnesses (SMI) such as schizophrenia. Limited evidence suggests concomitantly high rates of posttraumatic stress disorder (PTSD) in this population. However, conceptual models do not exist for understanding the interactions between trauma, PTSD, and SMI. We propose a model, which is an extension of the stress-vulnerability model, in which PTSD is hypothesized to mediate the negative effects of trauma on the course of SMI. Our model posits that PTSD influences psychiatric disorders both directly, through the effects of specific PTSD symptoms including avoidance, overarousal, and re-experiencing the trauma, and indirectly, through the effects of common correlates of PTSD such as retraumatization, substance abuse, and difficulties with interpersonal relationships. We discuss the evidence supporting this model, and consider several intervening variables that are hypothesized to moderate the proposed relationships between PTSD and SMI, including social support, coping and competence, and antisocial personality disorder. Theoretical and clinical implications of the model are considered, as well as several methodological and nosological issues. We conclude with a brief discussion of directions for future research aimed at evaluating components of the model.