Influence of Posttraumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience

Jee Hye Shin; Hyang Sook So; Eun A Kim

doi:10.7469/KJAN.2017.29.6.657

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Shin, So, and Kim: Influence of Posttraumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience

Original Research

Korean J Adult Nurs 2017;29(6):657-666.

Published online: 18 December 2017

DOI: https://doi.org/10.7469/KJAN.2017.29.6.657

Influence of Posttraumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience

Jee Hye Shin, MSN, RN¹, Hyang Sook So, Ph.D., RN², Eun A Kim, Ph.D., RN^3,

^¹Department of Nursing, Hwasun Chonnam National University Hospital, Hwasun, Korea

^²College of Nursing, Chonnam National University, Gwangju, Korea

^³Department of Nursing, Honam Universtiy, Gwangju, Korea

Corresponding author: Kim, Eun A Department of Nursing, Honam Universtiy, 417 Eodeung-daero, Gwangsan-gu, Gwangju 62399, Korea. Tel: +82-62-940-5551, Fax: +82-62-940-5042, E-mail: umberto@honam.ac.kr

Received 18 September 201718 October 2017 Accepted 18 December 2017

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was performed to identify the mediating effect of resilience in the relationship between post-traumatic stress disorder (PTSD) and quality of life (QoL) among patients with ostomy.

Methods

A cross- sectional survey design was used. A convenience sample of 150 patients with ostomy was recruited from three hospitals located in Gwangju and Chonnam province in Korea. Data were collected by self-report questionnaires and included demographics as well as measures of PTSD, resilience, and QoL. Data were analyzed with descriptive statistics, Pearson correlation coefficients, independent t-test, One-way ANOVA, and linear regression using the SPSS 24.0 program.

Results

There were significant negative relationships between PTSD and QoL (r=-.30, p<.001) and between PTSD and resilience (r=-.57, p<.001). Resilience showed a partial mediating effect (β=.39, p<.001) between PTSD and QoL (Z=-3.12, p<.001).

Conclusion

This study findings suggest the importance of reducing PTSD scores and improving resilience among persons with ostomy which will possibly increase their QoL. Nursing interventions including counseling or education to improve psychological resilience might help better manage PTSD among patients with ostomy.

Keywords: Ostomy, Post-traumatic stress disorders, Psychological resilience, Quality of life

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Table 1.

Differences in Post-traumatic Stress Disorder, Resilience, and Quality of Life by Characteristics of Participants (N=150)

Variables	Categories	n (%) or M± SD	PTSD		Resilience		Quality of life
Variables	Categories	n (%) or M± SD	M± SD	t or F (p) post-hoc	M± SD	t or F (p) post-hoc	M± SD	t or F (p) post-hoc
Gender	Male	87 (58.0)	37.31±16.73	-1.72	2.81±0.64	3.34	5.62±1.40	3.43
Gender	Female	63 (42.0)	41.76±14.75	(.087)	2.47±0.55	(.001)	4.87±1.19	(.001)
Age (year)	＜65	87 (58.0)	36.45±13.18	-2.36	2.76±0.62	2.07	5.65±1.39	3.83
	≥65	63 (42.0)	42.95±18.75	(.020)	2.54±0.61	(.040)	4.82±1.17	(＜.001)
		60.29±10.65
Spouse	Yes	115 (76.7)	39.84±17.05	0.59	2.70±0.64	1.36	5.42±1.37	1.90
Spouse	No	35 (23.3)	38.00±12.21	(.556)	2.54±0.58	(.177)	4.92±1.29	(.060)
Religion	Yes	92 (61.3)	40.22±17.39	1.01	2.67±0.63	0.15	5.45±1.42	1.70
Religion	No	58 (38.7)	37.53±13.58	(.320)	2.66±0.62	(.887)	5.07±1.23	(.092)
Education level	≤ Junior high school ^a	42 (28.0)	39.17±21.11	0.00	2.66±0.63	19.25^†	4.73±1.12	30.83^†
	High school ^b	74 (49.3)	39.22±14.46	(.999)	2.49±0.63	(＜.001)	5.19±1.49	(＜.001)
	≥ College ^c	34 (22.7)	39.12±11.99		3.07±0.37	c＞ a, b	6.27±0.70	c＞ a, b
Occupation	Employed	52 (34.7)	35.25±12.11	-2.47	2.71±0.68	0.61	5.76±1.70	2.68
Occupation	Unemployed	98 (65.3)	41.27±17.46	(.015)	2.64±0.60	(.545)	5.06±1.08	(.009)
Perceived economic status	Middle	106 (70.7)	39.48±14.76	0.32	2.68±0.56	0.38	5.48±1.34	2.51
Perceived economic status	Low	44 (29.3)	38.45±18.92	(.749)	2.64±0.77	(.712)	4.88±1.35	(.013)
Medical expenses burden	Self	113 (75.3)	40.36±16.48	1.59	2.70±0.62	1.22	5.35±1.47	0.93
Medical expenses burden	Family	37 (24.7)	35.57±14.16	(.115)	2.56±0.65	(.223)	5.16±0.98	(.358)
Radiation therapy	Yes	88 (58.7)	38.55±16.31	-1.35	2.67±0.61	0.02	5.42±1.46	1.30
Radiation therapy	No	62 (41.3)	44.12±12.95	(.178)	2.66±0.78	(.983)	5.13±1.21	(.197)
Chemotherapy	Yes	133 (88.7)	36.55±14.76	-2.44	2.68±0.70	0.39	5.46±1.31	4.07
Chemotherapy	No	17 (11.3)	42.92±17.11	(.016)	2.64±0.50	(.693)	4.10±1.20	(＜.001)
Other diseases	Yes	60 (40.0)	41.48±14.95	1.44	2.60±0.70	-1.06	5.09±1.09	-1.58
Other diseases	No	90 (60.0)	37.64±16.61	(.151)	2.71±0.57	(.292)	5.45±1.51	(.117)
Type of stoma	Ileostomy ^a	50 (33.3)	34.80±12.66	3.99^†	2.82±0.65	4.20	5.80±0.95	13.82^†
	Temporary colostomy ^b	58 (38.7)	40.21±17.88	(.022)	2.71±0.51	(.018)	5.35±1.63	(＜.001)
	Permanent colostomy ^c	42 (28.0)	42.98±16.06	c＞ a	2.42±0.68	a＞ c	4.65±1.11	a, b＞ c
Ostomy care done by	Self	77 (51.3)	38.47±12.74	0.18	2.59±0.52	5.37^†	5.21±1.35	1.86
	Spouse	49 (32.7)	40.65±19.56	(.838)	2.91±0.71	(.007)	5.59±1.40	(.160)
	Family	24 (16.0)	39.08±18.03		2.42±0.61	b＞ a, c	5.01±1.26

PTSD=post-traumatic stress disorders; Post-hoc=Games-Howell test;

^† F=Welch analysis of variance.

Table 2.

Level of Post-traumatic Stress Disorder, Resilience, and Quality of Life (N=150)

Variables	M± SD	Min~Max	Range	n (%)
PTSD	39.20±16.07	0~73	0~88
Low risk (≤17)	13.53±3.88	0~16		19 (12.7)
Moderate risk (18~24)	20.75±1.50	19~22		4 (2.7)
High risk (≥25)	43.60±13.11	25~73		127 (84.7)
Resilience	2.67±0.62	1.04~3.64	0~4
Quality of life	5.30±1.37	2.13~8.65	0~10
Nutritional diagnosis/treatment	6.31±1.68	3.00~9.67
Surgical diagnosis/treatment	5.79±1.86	1.50~9.50
Psychological wellbeing	5.36±2.03	1.00~9.17
Social concerns	5.29±1.90	0.67~9.00
Physical well-being	4.89±1.61	1.00~8.20
Body image	4.74±2.17	0.00~9.00

PTSD=post-traumatic stress disorders.

Table 3.

Correlational Relationships among the Variables (N=150)

Variables	Resilience	Quality of life
Variables	r (p)	r (p)
Post-traumatic stress disorder	-.30	-.57
	(＜.001)	(＜.001)
Resilience		.54

(＜.001)

Table 4.

Mediating Effect of Resilience between PTSD and Quality of Life (N=150)

Variables	Step 1 (PTSD → resilience)				Step 2 (PTSD → QoL)				Step 3 (PTSD, resilience → QoL)
Variables	B	β	t	p	B	β	t	p	B	β	t	p
(Constant)	3.25		16.22	＜.001	5.40		14.44	＜.001	2.66		4.67	＜.001
Gender (male)	0.65	.52	5.47	＜.001	-0.00	-.00	-0.01	.990	-0.55	-.20	-2.51	.013
Age (＜65)	0.20	.16	1.78	.075	-0.05	-.02	-0.22	.828	-0.22	-.08	-1.13	.259
Education level (high school)	-0.40	-.32	-2.80	.006	0.64	.23	2.42	.017	0.97	.36	4.00	＜.001
Education level (≥ college)	0.25	.17	1.53	.128	1.53	.47	4.96	＜.001	1.32	.41	4.72	＜.001
Occupation (employed)	-0.41	-.32	-3.77	＜.001	-0.11	-.04	-0.52	.605	0.24	.09	1.26	.210
Perceived economic status (middle)	0.21	.15	2.12	.036	0.33	.11	1.79	.075	0.16	.05	0.92	.361
Chemotherapy (yes)	-0.73	-.37	-4.51	＜.001	0.45	.11	1.48	.141	1.07	.25	3.67	＜.001
Type of stoma (ileostomy)	0.12	.09	0.97	.335	0.62	.22	2.61	.010	0.52	.18	2.42	.017
Type of stoma (temporary colostomy)	0.25	.20	2.34	.021	0.68	.24	3.38	.001	0.47	.17	2.54	.012
PTSD	-0.01	-.28	-4.02	＜.001	-0.05	-.54	-8.89	＜.001	-0.04	-.43	-7.48	＜.001
Resilience									0.84	.39	5.95	＜.001
R²		.413				.570				.658
Adj. R²		.371				.539				.631
F (p)		9.78 (＜.001)				18.45 (＜.001)				24.13 (＜.001)
Sobel test (p)										z=-3.12 (＜.001)

PTSD=post-traumatic stress disorders; QoL=quality of life; Dummy variable=gender (referent: female), age (referent:≥65), education level (referent:≤middle school), occupation (referent: unemployed), perceived economic status (referent: low), chemotherapy (referent: no), type of stoma (referent: Permanent colostomy).

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