Posttraumatic growth in women with endometriosis ...

Posttraumatic growth in women with endometriosis – preliminary results Aleksandra Andysz, Anna Najder

Poland The Nofer Institute of Occupational Medicine Department of Health and Work Psychology XIV Conference of European Society for Traumatic Stress Studies Trauma in Changing Societies: Social Contexts and Clinical Practice 10-13 June 2015, Vilnius

The project  „Is There a Positive Aspect of Living with Endometriosis? Research on Determinants of Posttraumatic Growth in Diagnosed Women”  Cross-sectional, multicenter study  Anonymous, self-assessed questionnaires  Recruitment - gynecological wards; Polish association of patients with endometriosis  Status - ongoing (anticipated end of data collection December 2015)

Presentation topics  Short characteristic of endometriosis  How many women with endometriosis experience PTG?  What is the characteristic of the phenomenon in the group of patients with endometriosis?  What are the differences between women with endometriosis who experienced and who do not experience PTG?

Endometriosis  Chronic, incurable, recurrent female disease of unknown etiology (10% of women at reproductive age)  Pathophysiology - the presence of endometrium cells outside the uterus  The effects – chronic inflammations, adhesions, anatomical distortions, pain, infertility  „Life shaped with pain” (dysmenorrhea, dyspareunia, dyschezia, dysuria) source: www.readingacupuncture.com

MeasureS  Polish version of Posttraumatic Growth Inventory  Self-perception (Cronbach’s α=0.94)  Relating to Others (α=0.92)  Appreciation of Life (α=0.85)  Spiritual Change (α=0.71)  Demographic and disease-related questionnaire

THE STUDY SAMPLE

Demographic characteristic PLACE OF RESIDENCE Big city

54%

Medium city

21%

Small city

13%

Country

12%

source: www.expatst.com

source: www.aeg-edu.com

source: www.huffingtonpost.com

LEVEL OF EDUCATION INCOME

Basic vocational

3%

College

21%

Not enough for basic needs

2%

High school

76%

Enough only for basic needs

18%

Enough for current needs

35%

CHILDREN Yes

46%

Enough to allow to save some money

34%

No

54%

High enough to live without financial limitations

11%

Demographic characteristic

AGE AGE AT FIRST SYMPTOMS OCCURENCE DIAGNOSTIC DELAY YEARS AFTER DIAGNOSIS

Source:http://upload.wikimedia.org/wikipedia/commons/7/7b/Woman_outside_Sepulchre-1.jpg; http://pixabay.com/static/uploads/photo/2014/08/30/16/43/woman-431658_640.jpg

N

Mean (SD)

Min-Max

116 105 100 122

32.3 (5.6) 22.8 (6.6) 6.2 (6.4) 3.9 (3.9)

20-49 12-48 0-26 0-21

Disease-related characteristic BASIS OF DIAGNOSIS Operation (laproscopy, laparotomy)

29%

USG

19%

Clinical symptoms and USG

18%

Clinical symptoms

15%

Clinical symptoms, USG, operation

9%

Clinical symptoms and operation

7%

USG and operation

4%

STAGE OF ENDOMETRIOSIS (only operated women; N=91) 1

6%

2

12%

3

14%

4

22%

Unknown

46%

Operations M=2 (1-6)

Symptoms AND CONSEQUENCES during last year 100% 15

18

23

80%

44

48

61

63

64

49 68

60% 40%

86

82

77 57

20%

52

39

37

36

51 32

0%

yes

no

Low PTG vs average/high PTG p=0.013

POSTTRAUMATIC GROWTH IN WOMEN WITH ENDOMETRIOSIS

Prevalence of PTG (%) PTG

43%

low

medium

high

Women with endometriosis

57

15

28

Breast cancer survivors [9]

34

23

43

Patients after myocardial infarction [10]

60

26

13

ptgi across different samples (total score) 100

80

60

40

20

0 child loss child lossphysical and HIV; N=112 death of a close endometriosis mothers; N=49 fathers; N=18 sexual assault; [3] person; N=74 (N=127) [1] [1] N=100 [2] [4]

infertility; N=121 [5]

advanced breast cancer; N=100 [6]

infertility; N=182 [7]

severe MVA; N=82 [8]

PtGi across different samples (subscales) 5 4

3.70 3.08

3.21 3.31

3

3.20 2.74

3.14 2.69

2

2.80

2.70 2.46

2.53

2.43 1.80

1.74 1.37

1 0 Appreciation of Life

Relating to Others

Self-Perception

Spitiruality

endometriosis; N=127 breast cancer; N=47 [9] myocardial infarction; N=53 [10] death of a close person; N=74 [4]

Areas of the biggest changes

(average and high ptg; ≥75% of the respondents)

Appreciating each day (AL)

6

94

An appreciation for the value of my own life (AL) 2 9 Having compassion for others (RO) 2 4

89 9

85

Knowing that I can count on people in times of trouble 1 6 (RO)

13

80

I discovered that I'm stronger than I thought I was (SP) 1 4

17

78

A sense of closeness with others (RO)

11

I'm more likely to try to change things which need 22 changing (SP) I'm able to do better things with my life (SP) 3 4 0 no change

very small and small change

13

76

20

76

17 20 average change

76 40

60

80

big and very big change

100

COMPARISONS

Comparison of the demographic and disease-related characteristics 40 32.6 31.8 30

23.4

21.8

20

10

9.0 9.8

6.5 5.8

3.5 4.7

0

years since first symptoms

years of diagnostic delay low PTG

years since diagnosis

age at first symptoms occurence

average/high PTG

age at the date of survey

severity of the endometriosis (only operated women; N=91) 100%

38

80%

55 60%

26 40%

18 15

20%

0%

14

7

17

7

4 average/high PTG

low PTG 1

2

3

4

unknown

Is endometriosis your the biggest health problem? (N=124)

100%

80%

29

27

60%

40%

71

73

low PTG

average/high PTG

20%

0%

no yes

Did your attitude towards maternity change since diagnosis? (N=120)

100%

80%

60%

47 70 p=0.009

40%

53 20%

30

0% low PTG

yes

average/high PTG

no

…but what is the direction of this change?

Conclusions  

   

The percentage of women with endometriosis who experience PTG was smaller than in BCS but larger than in patients after MI Objective, time-related variables did not differ women who did not experience and who experienced PTG (Is time irrelevant to the PTG in endometriosis?) Objective, medical variable such as stage of endometriosis was comparable in both groups (Is severity of the disease irrelevant to PTG in endometriosis?) Patients with greater PTG experienced more symptoms during past year (Is painfulness of the endometriosis relevant to PTG process?) The biggest changes were conected with life appreciation, the lowest with the spirituality Changes in attitude towards maternity should be deeply studied in this group

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