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. 2019 Feb;27(2):443-450.
doi: 10.1007/s00520-018-4325-8. Epub 2018 Jun 29.

Positive mental health among cancer survivors: overlap in psychological well-being, personal meaning, and posttraumatic growth

K Holtmaat  1   2 , N van der Spek  1   2   3 , B I Lissenberg-Witte  4 , P Cuijpers  1 , I M Verdonck-de Leeuw  5   6   7
Affiliations

Positive mental health among cancer survivors: overlap in psychological well-being, personal meaning, and posttraumatic growth

K Holtmaat et al. Support Care Cancer. 2019 Feb.

Abstract

Purpose: Positive mental health involves theoretical constructs like psychological well-being, personal meaning, and posttraumatic growth. This study aims to provide empirical insight into possible overlap between these constructs in cancer survivors.

Methods: Within the context of a randomized controlled trial, 170 cancer survivors completed the patient-reported outcome measures (PROMs) Ryff's Scales of Psychological Well-Being (SPWB), Personal Meaning Profile (PMP), and Posttraumatic Growth Inventory (PTGI). Exploratory factor analysis (EFA) on the subscales of these PROMs, as well as structural equation modeling (SEM), was used to explore overlap in these three constructs.

Results: The EFA resulted in a three-factor solution with an insufficient model fit. SEM led to a model with a high estimated correlation (0.87) between SPWB and PMP and lower estimated correlations with PTGI (respectively 0.38 and 0.47). Furthermore, the estimated correlation between the subscales relation with God (PMP) and spiritual change (PTGI) was high (0.92). This model had adequate fit indices (χ2(93) = 144, p = .001, RMSEA = 0.059, CFI = 0.965, TLI = 0.955, SRMR = 0.061).

Conclusions: The constructs psychological well-being and personal meaning overlap to a large extent in cancer survivors. Posttraumatic growth can be seen as a separate construct, as well as religiosity. These findings facilitate researchers to select the appropriate PROM(s) when testing the effect of a psychosocial intervention on positive mental health in cancer survivors.

Relevance: An increasing number of psychosocial intervention trials for cancer survivors use positive mental health outcomes. These constructs are often multifaceted and overlapping. Knowledge of this overlap is important in designing trials, in order to avoid the pitfalls of multiple testing and finding artificially strengthened associations.

Netherlands trial register: NTR3571.

Keywords: Cancer; Meaning; Mental health; Oncology; Patient-reported outcome measures; Survivors.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Model resulting from adding pathways to the null model in which each measurement instrument formed a latent variable, represented by its subscales as manifest variables. Note. N = 161. This figure was created using the R package Lavaan
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