| ObjectivesThe aim of this study was to describe the psychological trajectories of post-traumatic growth(PTG)in women with fetal abnormalities requiring pregnancy termination,and to investigate the current level of PTG as well as related psychological variables;establish and implement the expressive writing intervention(EWI),and discuss the effectiveness of EWI on PTG and related variables,improve and optimize the EWI for women with fetal abnormalities,so as to enrich their psychological resources,promote the establishment of better coping mechanism of women,and to promote relevant psychological intervention for this vulnerable population.MethodsThe study was divided into two main parts.The first part: Study on the psychological trajectories and current status of PTG in women with fetal abnormalities requiring requiring pregnancy termination: 1.The qualitative interview of women with fetal abnormalities: the current study described the psychological trajectories of PTG to understand emotional changes of women fromknowing the diagnosis of fetal abnormalities to 1 month after discharge through interviewing 20 women.2.Using demographic questionnaires,Impact of Event Scale-Revised(IES-R),Connor-Davidson Resilience Scale 10(CD-RISC-10)and Chinese-Posttraumatic Growth Inventory(C-PTGI)investigated 219 women with fetal abnormalities requiring pregnancy termination,so as to understand the level of Post-Traumatic Stress Disorder(PTSD)symptoms,resilience and PTG.The second part: The efficacy of EWI for women with fetal abnormalities requiring pregnancy termination: 1.Employing randomized controlled trial(RCT)to explore the effectiveness of EWI for women.Using random number table to recruit 100 women,50 women were in the control group and 50 were in the intervention group.Participants in the intervention group received 3 times EW intervention during their hospitalization.IES-R,CD-RISC10 and C-PTGI were given to women before the EWI,immediately after intervention and 1 month after EWI.Independent-samples T test and repeated measures were applied to analyzed data.2.Interviews were conducted in women who participated three times in EWI to investigate the effectiveness and applicability of EWI and women's experiences during the process.During the process,EWI was optimized to provide a basis for the formulation of psychological intervention strategies and the promotion of psychological rehabilitation for those women.Results1 ? Five themes and 15 sub themes that reflected psychological changes from knowing the diagnosis to 1 month after discharge were revealed in the psychological trajectories: the 1)traumatic response,2)ruminant meditation,3)memorial,4)positive coping and 5)post-traumatic growth(PTG)stages.The quantitative survey showed that the total scores of PTSD was “26.09±14.16” and that of CD-RISC-10 was “24.37±6.49”.The level of C-PTGI was “58.45±14.24”,basically at the middle level.While the highest dimension was appreciation of life(3.27±0.73),followed by personal strength(3.15±0.81),relating to others(2.90±0.95),new possibilities(2.86±0.93)and self-changes(2.31±0.71).A negative correlation between PTSD and resilience was found.There was a positive relationship between PTG and resilience as well as PTSD and PTG.2?The results of RCT:44 women in the EWI group and 37 women in the control group finished three times questionnaire assessments.There was no significant differences between the two group before participating the EWI.(1)PTG :Independent-samples T test was employed.The results showed that at the end of the EWI,EWI had significant effects on total scores of C-PTGI,appreciation of life,new possibilities and self-change(P<0.05);In 1 month after EWI assessment,the effects of EWI were significant on total scores of C-PTGI,new possibilities and self-change(P<0.05).Repeated measures showed the interaction of EWI and the time factor had a significant effect on total scores of C-PTGI,appreciation of life,personal strength,new possibilities and self-change(P < 0.05).(2)PTSD: Independent-samples T test was employed.The results showed that at the end of the EWI,significant differences were found between two groups on total scores of IES-R,intrusive symptoms and avoidance(P < 0.05);In 1 month after EWI assessment,there was no significant differences between two groups on the total scores of IES-R and its three sub-scale scores(P >0.05).The scores of IES-R and its three dimensions in the EWI group were lower than the control group.Repeated measures showed the interaction of EWI and the time factor had no significant effect on total scores of IER-S and its three sub-scale scores(P>0.05).(3)Resilience: Independent-samples T test was employed.The results showed that there was no significant difference between the EWI group and the control group(P>0.05);In 1 month after EWI assessment,no significant difference was found between the two groups(P>0.05).The total scores of EWI group were slightly higher than that in control group.There were 4 themes and 12 sub themes generated from the interview of women participated in the EWI.The results showed that EW could facilitate rationaland systems thinking,shifting perspectives,emotional catharsis,adjusting coping strategies and improving emotional health;Challenges in clinical practice were lack of understanding and Stigma surrounding fetal abnormality;Suggestions for improvement were adding external psychological support and increasing continuity;Future directions for development were wider clinical application,spreading to families and choosing electronic EW.Conclusion(1)Qualitative interviews in this study explored the PTG psychological trajectories of women with fetal abnormalities,which provided a basis for formulating a targeted EWI during hospitalization.Medical personnel should provide targeted nursing measures according to the psychological characteristics of each stage to promote women's physical and mental rehabilitation.The results of quantitative survey showed that PTG among this population was basically at middle level;Resilience could negatively relieve PTSD and positively promote PTG.(2)The evaluation of the effectiveness of EWI showed that at the end of intervention,EWI could relieve the symptoms of PTSD and facilitate PTG;EWI was still beneficial to PTG in 1 month after EWI,while it had no significant effect on PTSD in 1 month after EWI.Additionally,EWI has no effect on improving resilience.Women with fetal abnormalities were willing to engage in EWI and they could benefit from this intervention.Therefore,EWI is helpful to improve PTG level and improve PTSD to some extent,which has certain clinical value.In the future,the efficacy of EWI can be improved by combining EWI with other psychological interventions,improving the continuity and changing the form of this intervention. |
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