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Relation of Psychological Vulnerability Factors to Posttraumatic Stress Disorder Symptomatology in Bone Marrow Transplant Recipients

From the Departments of Psychology (M.R.W., P.B.J.) and Internal Medicine (K.K.F.), University of South Florida; and the Psychosocial Oncology Program (M.R.W., P.B.J.) and the Blood and Marrow Transplant Program (K.K.F.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Address reprint requests to: Paul B. Jacobsen, PhD, Psychosocial Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, MOD3-PSY, 12902 Magnolia Dr., Tampa, FL 33612. Email: jacobsen{at}moffitt.usf.edu

OBJECTIVE: Prior research suggests that the diagnosis and treatment of cancer can result in the development of symptoms of posttraumatic stress disorder (PTSD). Based on Lazarus and Folkman’s model of stress, the current study examined whether trauma appraisals, coping, social support, and social constraint were associated with the severity of PTSD symptoms in cancer patients who had undergone bone marrow transplantation (BMT).

METHODS: Participants were 23 males and 79 females treated with BMT an average of 20 months previously (range = 3–62 months). Past and current psychiatric diagnoses were assessed through a structured clinical interview. PTSD symptomatology and other psychological variables were assessed using standardized self-report measures.

RESULTS: Results indicated that 5% of participants met diagnostic criteria for current PTSD. Participants reported an average of three to four symptoms of PTSD (range = 0–16). Univariate analyses confirmed predictions that increased PTSD symptomatology would be associated with more negative appraisals of the BMT experience, greater use of avoidance-based coping strategies, lower levels of social support, and greater social constraint (p < .05). Regression analyses indicated that each of these variables accounted for significant (p < .05) variability in PTSD symptomatology above and beyond relevant demographic and medical variables.

CONCLUSIONS: Results of the present study confirm and extend prior research regarding the prevalence of PTSD and PTSD symptoms among patients treated for cancer. In addition, the study identified a set of theoretically derived psychological characteristics that seem to place patients at risk for greater PTSD symptomatology after BMT.

Key Words: posttraumatic stress disorder • cancer • bone marrow transplantation.

Abbreviations: BMT = bone marrow transplantation; DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders, third edition, revised; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; PCL-C = PTSD Checklist–Civilian Version; PTSD = posttraumatic stress disorder; SCID = Structured Clinical Interview for DSM-III-R; SCID-I/NP = Structured Clinical Interview for DSM-IV Disorders, Non-Patient Version.

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