Post-traumatic Growth among Stroke Patients: Impact of Hope, Meaning in Life, and Social Support

Young-Ju Jeong; Hee Sun Kim

doi:10.7475/kjan.2019.31.6.605

Journal List > Korean J Adult Nurs > v.31(6) > 1139712

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Jeong and Kim: Post-traumatic Growth among Stroke Patients: Impact of Hope, Meaning in Life, and Social Support

Original Article

Korean J Adult Nurs 2019;31(6):605-617.

Published online: 21 December 2019

DOI: https://doi.org/10.7475/kjan.2019.31.6.605

Post-traumatic Growth among Stroke Patients: Impact of Hope, Meaning in Life, and Social Support

Young-Ju Jeong¹, Hee Sun Kim^2,

¹Ph.D., Candidate, Graduate School, College of Nursing, Chonbuk National University, Jeonju, Korea

²Associate Professor, College of Nursing · Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea

Corresponding author: Kim, Hee Sun https://orcid.org/0000-0002-7698-8794 College of Nursing, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea. Tel: +82-63-270-3124, Fax: +82-63-270-4478, E-mail: joha0219@jbnu.ac.kr

Received 25 September 201912 November 2019 Accepted 25 November 2019

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 explored the level of Post-Traumatic Growth (PTG) in stroke patients receiving rehabilitation treatment and identified the effects of hope, meaning in life, and social support on PTG.

Methods

A sample of 165 participants was surveyed in a cross-sectional study. Data were collected from January 17, 2018 to April 9, 2018 using self-report structured questionnaires and analyzed using descriptive statistics and hierarchical regression analysis with SPSS/WIN 24.0 program.

Results

The mean score for PTG in stroke patients was 2.82±1.14(range 0~5). Living with family(t=-2.37, p=.019), having a religion (t=2.91 p=.004), higher income(F=8.94, p<.001), shorter period in stroke diagnosis(≤6 month) (F=3.88, p=.010), having no speech defect (t=-2.24, p=.026), and good functional status (F=3.99, p=.020) were associated with higher PTG. The higher levels of hope(r=.73, p<.001), higher meaning in life (r=.64, p<.001), and higher social support (r=.49, p<.001) were related to higher PTG. Hierarchical regression analysis showed that hope(β=.43, p<.001), meaning in life(β=.25, p=.001), and social support (β=.12, p=.044) were effective factors of PTG in stroke patients. These variables accounted for 42%p of the variance in PTG(F=20.52, p<.001).

Conclusion

The study provides insights into how hope, meaning in life, and social support promote PTG in stroke patients. To increase PTG in stroke patients receiving rehabilitation treatment, health care providers should consider developing intervention programs to help increase hope, meaning in life, and social support.

Keywords: Stroke, Posttraumatic growth, Patients

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Table 1.

General Characteristics of Participants and Differences in Post-traumatic Growth according to General Characteristics of Participants (N=165)

Characteristics	Categories	n (%)	Mean± SD (range)	Post-traumatic growth
Characteristics	Categories	n (%)	Mean± SD (range)	Mean± SD	t or F (p) Scheffé
Gender	Men	93 (56.4)		2.78±1.11	-0.44
Gender	Women	72 (43.6)		2.86±1.17	(.663)
Age (year)	50	21 (12.7)	61.33±9.54	2.37±1.12	2.24
	50~＜60	50 (30.3)	(37~79)	2.96±0.97	(.086)
	60~＜70	63 (38.2)		2.98±1.17
	≥70	31 (18.8)		2.58±1.25
Living status	Alone	50 (30.3)		2.51±1.24	-2.37
Living status	With family	115 (69.7)		2.96±1.06	(.019)
Primary caregiver	Spouse	61 (37.0)		2.99±1.13	1.57
	Family except for spouse	35 (21.2)		2.67±1.08	(.199)
	Personal care attendants	34 (20.6)		2.95±1.05
	Self	35 (21.2)		2.54±1.24
Religion	Yes	84 (50.9)		3.07±1.02	2.91
Religion	No	81 (49.1)		2.56±1.20	(.004)
Education	High school	69 (41.8)		2.83±1.23	0.06
Education	≥ High school	96 (58.2)		2.81±1.07	(.952)
Occupation	Yes	24 (14.5)		3.18±1.02	1.68
Occupation	No	141 (85.5)		2.76±1.15	(.095)
Monthly income (10,000 won)	100 ^a	60 (36.4)		2.41±1.25	8.94
	100~＜300 ^b	70 (42.4)		2.92±1.05	(＜.001)
	≥300 ^c	35 (21.2)		3.32±0.84	a＜ c
Stroke type	Infarction	117 (70.9)		2.85±1.16	0.56
Stroke type	Hemorrhage	48 (29.1)		2.74±1.08	(.580)
Period in stroke diagnosis (month)	≤6 ^a	21 (12.7)	23.51±15.74	3.57±0.91	3.88
	7~12 ^b	32 (19.4)	(4~73)	2.74±1.07	(.010)
	13~36 ^c	82 (49.7)		2.75±1.10	a＞ b, c, d
	≥37 ^d	30 (18.2)		2.56±1.26
Number of attack	1	142 (86.1)		2.85±1.16	0.92
Number of attack	≥2	23 (13.9)		2.62±0.99	(.359)
Parethesia site	None	38 (23.0)		2.81±1.14	0.13
	Right	51 (30.9)		2.76±1.10	(.942)
	Left	70 (42.5)		2.88±1.19
	Both	6 (3.6)		2.71±1.06
Speech defect	Yes	37 (22.4)		2.45±1.16	-2.24
Speech defect	No	128 (77.6)		2.92±1.11	(.026)
Comorbidity	0	17 (10.3)	1.43±0.93	2.50±1.14	-1.22
Comorbidity	≥1	148 (89.7)	(0~5)	2.86±1.13	(.223)
Functional status	Poor ^a	60 (36.4)		2.53±1.22	3.99
	Moderate ^b	84 (50.9)		2.91±1.05	(.020)
	Good ^c	21 (12.7)		3.26±1.03	a＜ c

SD=standard deviation.

Table 2.

The Level of Post-traumatic Growth, Hope, Meaning in Life, and Social Support (N=165)

Variables	Categories	Mean± SD	Min~Max
Post-traumatic growth (range 0~5)	Total	2.82±1.14	0.13~5.00
	Changed perception of self	2.77±1.25	0~5
	Relating to others	3.09±1.23	0~5
	New possibilities	2.64±1.28	0~5
	Spiritual change	2.54±1.61	0~5
Hope (range 1~4)	Total	2.69±0.64	1~4
	Pathway thinking	2.76±0.69	1~4
	Agency thinking	2.61±0.67	1~4
Meaning in life (range 1~7)	Total	4.28±1.25	1~7
	Presence of meaning	4.30±1.29	1~7
	Search for meaning	4.26±1.34	1~7
Social support (range 1~5)	Total	3.49±0.81	1.17~5.00
	Family support	4.02±1.03	1~5
	Friends support	3.14±1.07	1~5
	Medical staff support	3.31±1.05	1~5

SD=standard deviation.

Table 3.

Correlation among Post-traumatic Growth, Hope, Meaning in Life, and Social Support (N=165)

Variables	Hope	Meaning in life	Social support
	Hope	Meaning in life	Total	Family	Friends	Medical staff
	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Post-traumatic growth	.73 (＜.001)	.64 (＜.001)	.49 (＜.001)	.46 (＜.001)	.36 (＜.001)	.30 (＜.001)
Changed perception of self	.77 (＜.001)	.69 (＜.001)	.49 (＜.001)	.47 (＜.001)	.39 (＜.001)	.29 (＜.001)
Relating to others	.61 (＜.001)	.52 (＜.001)	.51 (＜.001)	.51 (＜.001)	.36 (＜.001)	.32 (＜.001)
New possibilities	.65 (＜.001)	.57 (＜.001)	.30 (＜.001)	.26 (.001)	.30 (＜.001)	.14 (.075)
Spiritual change	.38 (＜.001)	.32 (＜.001)	.25 (.001)	.21 (.007)	.11 (.151)	.27 (.001)
Hope	1
Meaning in life	.70 (＜.001)	1
Social support	.49 (＜.001)	.41 (＜.001)	1

Table 4.

Effects of Hope, Meaning in Life, Social Support on Post-traumatic Growth (N=165)

Variables	Model 1					Model 2
Variables	B	SE	β	t (p)	95% CI	B	SE	β	t (p)	95% CI
(Constant)	1.91	0.27		7.15 (＜.001)	1.38~2.44	-1.17	0.32		-3.68 (＜.001)	-1.80~-0.54
Living status (reference: alone)	0.12	0.21	.05	0.57 (.573)	-0.29~0.52	0.10	0.14	.04	0.70(.485)	-0.18~0.39
Religion (reference: no)	0.40	0.16	.18	2.47 (.015)	0.08~0.72	0.25	0.11	.11	2.18(.031)	0.02~0.48
Monthly income (100~＜300) (reference: ＜100)	0.44	0.21	.19	2.14 (.034)	0.03~0.86	0.08	0.15	.03	0.50(.618)	-0.22~0.37
Monthly income (≥300) (reference: ＜100)	0.76	0.25	.27	3.09 (.002)	0.27~1.24	0.23	0.18	.08	1.31(.194)	-0.12~0.58
Period in stroke diagnosis (≤6 month) (reference: ≥37 month)	0.80	0.29	.24	2.71 (.008)	0.22~1.38	0.68	0.21	.20	3.29(.001)	0.27~1.09
Period in stroke diagnosis (7~12 month) (reference: ≥37 month)	0.00	0.27	.00	0.00 (.997)	-0.53~0.53	0.23	0.19	.08	1.24(.216)	-0.14~0.61
Period in stroke diagnosis (13~36 month) (reference: ≥37 month)	0.05	0.22	.02	0.22 (.828)	-0.39~0.49	0.08	0.16	.04	0.53(.596)	-0.22~0.39
Speech defect (reference: no)	-0.33	0.20	-.12	-1.61 (.109)	-0.73~0.07	-0.18	0.14	-.07	-1.29 (.200)	-0.46~0.10
Functional status (moderate) (reference: poor)	0.30	0.18	.13	1.65 (.101)	-0.06~0.65	-0.01	0.13	-.01	-0.08 (.933)	-0.26~0.24
Functional status (good) (reference: poor)	0.55	0.27	.16	2.03 (.044)	0.02~1.09	-0.02	0.20	-.01	-0.10 (.922)	-0.41~0.37
Hope						0.76	0.13	.43	5.69(＜.001)	0.50~1.03
Meaning in life						0.23	0.07	.25	3.45(.001)	0.10~0.35
Social support						0.17	0.08	.12	2.03(.044)	0.00~0.33
Adjusted R²				.19					.61
△ Adjusted R² (p)								.42 (＜.001)
F (p)			4.87 (＜.001)					20.52 (＜.001)

Durbin-Watson=1.99, Kolmogorov-Smirnov (Z=0.61, p=.846), Breusch-Pagan (x²=18.25, p=.148).

B=unstandardized estimates; SE=standardized error; β=standardized estimates; CI=confidence interval.

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