乳癌患者之反芻反應風格對其術後憂鬱與創傷後壓力症狀之預測

Rumination Predicting Depression and PTSD Symptoms in Postoperative Breast Cancer Patients

獲知罹患威脅生命重大疾病（如癌症）的診斷及接受醫療的歷程可視為一創傷事件。過去研究指出，反芻反應風格與壓力事件後的憂鬱與創傷後壓力症狀有關。然而，對反芻反應風格與癌症患者身心症狀之關聯性的瞭解仍相當有限。因此，本研究目的在於檢驗反芻反應風格對接受手術後的乳癌患者之憂鬱與創傷後壓力症狀的預測力。本研究之研究對象為244位乳癌術後患者，由醫師轉介自願參與本研究。簽署同意書後，參與者填寫包括中文反應風格量表短版、中文症狀檢劾量表短版及創傷後心理症狀指標量表短版等量表。研究結果顯示，反應風格分別能顯著預測乳癌術後病人之憂鬱與創傷後壓力症狀，其中反芻反應風格與憂鬱和創傷後壓力症狀之增加有關；而分心反應風格則與憂鬱和創傷後壓力症狀之減輕有關。反芻反應風格對創傷後壓力症狀具獨特之預測力。最後，本文討論反芻反應風格影響創傷後壓力症狀病程之可能機制與臨床應用。

Life-threatening illness (e.g. cancer) is recognized as a traumatic stressful event. Cancer patients who receive medical treatment may present some notable psychological complaints, such as depressive and posttraumatic stress symptoms. Thus, factors associated with these psychiatric symptoms may play an important role in the adjustment and recovery of the postoperative cancer patients. Empirical researches suggest rumination as a powerful predictor of the maintenance of depressive and PTSD symptoms in response to stress. However, the relationship between rumination and PTSD symptoms in cancer patients has been little understood in the western literature or examined in Taiwan. Therefore, the first purpose of the present study was to investigate the relationship among rumination, depression, and PTSD symptoms in postoperative breast cancer patients. This study also sought to examine the ability of rumination in predicting depression and PTSD symptoms. Specifically, ruminative response style was hypothesized to predict depressive and PTSD severity in postoperative cancer patients. In addition, rumination was assumed to have a unique contribution to the prediction of PTSD severity, controlling for current level of depressive severity. Two hundred and forty four postoperative breast cancer female outpatients recruited from National Taiwan University Hospital volunteered to participate in this study. The measures included the Symptom CheckList- 90-Revised short form, Post Traumatic Stress Reaction Index- short form, and Chinese Response Style Questionnaire- short form. The results showed that, as predicted, response style could both significantly predict depression and PTSD severity in postoperative breast cancer patients. Hierarchical regression analysis revealed that, after demographical variables and depression severity were controlled, ruminative response style had a unique contribution to the prediction of PTSD severity. The findings of this study suggest that rumination may play an important role in the development and maintenance of PTSD symptoms in cancer patients. It is speculated that ruminating traumatic experiences may trigger intrusive traumatic memories and affect the cognitive reconstruction of traumatic events. Ruminative responses may also interfere with instrumental behaviors such as seeking care and reducing problem solving ability thus so to result in exacerbation of PTSD. Finally, it will be helpful to replicate this study in patients with different types of cancers. Moreover, future studies can adopt different research paradigms, such as prospective design, to establish the causal relationship of rumination and PTSD symptoms.