(PS2-D86) Posttraumatic Stress, Alexithymia, and Demoralization as Predictors of Posttraumatic Growth in Chinese Breast Cancer Patients During COVID-19: A Cross-sectional Study

In response to the adjustments made in the medical care field to manage the overcapacity caused by the global COVID-19 outbreak (Mirandola et al., 2022), individuals with pre-existing life-threatening health conditions such as cancer have been reportedly experiencing increasing levels of psychological distress due to delays in timely diagnosis and treatment, concerns of contracting the coronavirus, and quarantine restrictions (Momenimovahed et al., 2021). This has led to worsening of their health conditions and adverse effects on their mental health. Recent studies have shown that common mental health risks associated with COVID-19 in cancer patients are depression, anxiety, PTSD, and hostility (Wang et al., 2020). For cancer populations during the pandemic period, their fear of getting infected could add to the current cancer condition, which represents a traumatic experience (Romeo et al., 2020).

Nevertheless, an unexpected positive outcome named posttraumatic growth (PTG) can also be observed among cancer survivors, both before and during the pandemic (Casellas-Grau et al., 2017; Marziliano et al., 2020; Soelch et al., 2019). Individuals who experience PTG usually present an appreciation of life, intimate relationships with others, a sense of personal strength, recognition of new possibilities, and religious/spiritual change (Tedeschi & Calhoun, 1996). Evidence suggests that PTG is highly related to post-traumatic stress (PTS), yet the direction of the association remains controversial (Casellas-Grau et al., 2017; Marziliano et al., 2020; Xia, 2017).

Other predictors indicating psychological distress such as demoralization and alexithymia (inability to identify or describe one's emotions; Nemiah, 1976) have been positively related to PTS (Frewen et al., 2008; Kohn, 2013; Liu et al., 2023), but their individual relationships with PTG remain unknown. The current cross-sectional study recruited breast cancer patients by cluster sampling from March to May 2022 in Liaoning Cancer Hospital, China. 301 valid responses regarding PTS, alexithymia, and demoralization were analyzed with a hierarchical regression analysis. Demographics such as time since diagnosis, cancer stage, and recurrence were also included.

The overall model was significant, and the predictors accounted for 21.8% of the variance in PTG (R2 = .218, F(6, 294) = 13.68, p < .001). Alexithymia accounted for a significant percentage of the variance in PTG (ΔR2 = .089, F(1, 295) = 29.44, p < .001), as did demoralization (ΔR2= .108, F(1, 294) = 40.46, p < .001). Demoralization (β = -.42, p < .001) and alexithymia (β = -.24, p < .001) were negatively related to PTG, whereas PTS (b = .40, p < .001) was positively related to PTG.

Demoralization and alexithymia were demonstrated to be highly relevant to the development of PTG, which provides a new perspective for further investigation into the underlying mechanism of positive psychological changes among cancer populations.