Rumination, post-traumatic growth, and distress: structural equation modelling with cancer survivors
Morris, BA and Shakespeare-Finch, J, Rumination, post-traumatic growth, and distress: structural equation modelling with cancer survivors, Psycho-Oncology, 20, (11) pp. 1176-1183. ISSN 1057-9249 (2011) [Refereed Article]
Objective: Theoretical models of post-traumatic growth (PTG) have been derived in the general
trauma literature to describe the post-trauma experience that facilitates the perception of
positive life changes. To develop a statistical model identifying factors that are associated
with PTG, structural equation modelling (SEM) was used in the current study to assess
the relationships between perception of diagnosis severity, rumination, social support, distress,
Method: A statistical model of PTG was tested in a sample of participants diagnosed with a
variety of cancers (N5313).
Results: An initial principal components analysis of the measure used to assess rumination
revealed three components: intrusive rumination, deliberate rumination of benefits, and life
purpose rumination. SEM results indicated that the model fit the data well and that 30% of the
variance in PTG was explained by the variables. Trauma severity was directly related to distress,
but not to PTG. Deliberately ruminating on benefits and social support were directly related to
PTG. Life purpose rumination and intrusive rumination were associated with distress.
Conclusions: The model showed that in addition to having unique correlating factors, distress
was not related to PTG, thereby providing support for the notion that these are discrete
constructs in the post-diagnosis experience. The statistical model provides support that postdiagnosis
experience is simultaneously shaped by positive and negative life changes and that
one or the other outcome may be prevalent or may occur concurrently. As such, an implication
for practice is the need for supportive care that is holistic in nature.