A Prospective Multi-National Study of Posttraumatic Stress and Posttraumatic Growth Among Women With Breast Cancer: A Serial Mediation Analysis

Objective: Research suggests that posttraumatic stress symptoms (PTSS) after a breast cancer (BC) diagnosis may lead to posttraumatic growth (PTG). Further prospective research is needed to confirm this, and to examine whether modifiable factors mediate the relationship. This study aimed to prospectively determine whether PTSS predicts PTG, and whether social support and cognitive emotion regulation mediate the relationship between PTSS and PTG among women with BC. Methods: In this study, 489 women from four countries (Finland, Israel, Italy, Portugal) with BC completed questionnaires at diagnosis (M0), and 6-months (M6), 9-months (M9), 15-months (M15), and 18-months (M18) post-diagnosis. Questionnaires included the Posttraumatic Growth Inventory, PTSD Checklist for DSM-5, Cognitive Emotion Regulation Questionnaire, modified Medical Outcomes Study Social Support Survey, and sociodemographic questions. We used serial mediation to determine whether the relationship between PTSS (M6) and PTG (M18) was mediated by social support (M9) and positive cognitive emotion regulation (M15), controlling for age. Results: PTSS (M6) (B = 0.18, 95%CI = 0.07, 0.28), social support (M9) (B = 1.71, 95%CI = 0.30, 3.14) and positive cognitive emotion regulation (M15) (B = 3.34, 95%CI = 1.76, 4.92) all directly predicted PTG (M18). The serial mediation was significant with a very small effect size: PTSS negatively predicted social support which positively predicted positive cognitive emotion regulation which positively predicted PTG (effect = −0.013, 95%CI = −0.02, −0.005). Conclusions: Our study adds support for a prospective, positive relationship between PTSS and PTG among women with BC, and shows that this relationship may be mediated by social support and cognitive emotion regulation. Further research is needed to inform interventions to promote PTG.