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Psychother Psychosom Med Psychol 2003; 53(3/4): 191-201
DOI: 10.1055/s-2003-38005
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Traumatische und psychosoziale Belastungen bei Patienten mit akuter Tumorerkrankung

Traumatic and Psychosocial Distress in Patients with Acute TumorsGuido  Flatten1 , Saskia  Jünger1 , Stefan  Gunkel2 , Jaswant  Singh1 , Ernst  Petzold1
  • 1Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsklinikum der RWTH Aachen (Direktor: Univ.-Prof. Dr. E. R. Petzold)
  • 2Klinik für Psychiatrie und Psychotherapie im Klinikum Hannover
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Publikationsverlauf

Eingegangen: 14. Dezember 2001

Angenommen: 7. Juni 2002

Publikationsdatum:
20. März 2003 (online)

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Zusammenfassung

Eine Krebsdiagnose bedeutet für die Betroffenen die Konfrontation mit einer lebensbedrohlichen Erkrankung und kann daher als traumatisches Erlebnis aufgefasst werden. Erschwert wird dieser Umstand dadurch, dass eine Krebserkrankung zumeist kein einmaliges Ereignis, sondern ein anhaltender Stressor ist. Ziel der vorliegenden Studie war a) die Untersuchung der psychotraumatischen und komorbiden Belastung von Tumorpatienten akut und im Verlauf, b) die Erhebung möglicher protektiver Faktoren sowie c) die Identifikation von Risikofaktoren für die Entwicklung einer posttraumatischen Stressreaktion (PTSR) nach Tumordiagnose. Die Stichprobe bestand aus 46 Patienten, die sich wegen einer neu aufgetretenen Tumorerkrankung aus diagnostischen oder therapeutischen Gründen einer chirurgischen Behandlung unterziehen mussten. Untersucht wurden die posttraumatische Belastung, dissoziative Reaktionen, Angst, Depressivität, kognitiv-emotionale Belastung, soziale Unterstützung sowie Krankheitsverarbeitung. Mehr als 25 % der Patienten wies akut (T1) und nahezu 40 % vier Monate später (T2) eine klinisch relevante PTSR auf. Bei Frauen trat PTSR deutlich häufiger auf, vor allem in der Katamnese. Ein systematischer Zusammenhang zwischen der Art des Tumors zu T1 und dem Auftreten einer PTSR zu T2 konnte nicht festgestellt werden. Patienten mit PTSR zu T2 zeigten in der Akutphase höhere Werte für Angst und Depressivität. Als wichtigste Prädiktoren für die Entwicklung klinisch bedeutsamer posttraumatischer Symptome in der 4-Monats-Katamnese ergaben sich die Zugehörigkeit zum weiblichen Geschlecht, der PTSR-Befund zu T1 sowie erhöhte Depressivitätswerte. Die Ergebnisse bestätigen die klinische Relevanz psychotraumatischer Screeninguntersuchungen bei Patienten mit akuten Krebserkrankungen sowohl für diagnostische als auch therapeutische Fragestellungen.

Abstract

For patients, being diagnosed with cancer means being confronted with a life-threatening illness and can thus be considered a traumatic experience. This situation is compounded by the fact that having cancer is usually not an isolated event but is generally a long-term stressor. The aim of the present study was a) the assessment of psychotraumatic and comorbid distress in tumor patients both in the acute stage (T1) and over time (T2), b) the identification of possible protective factors, and c) the identification of risk factors for the development of a posttraumatic stress reaction (PTSR) following the diagnosis of a tumor. The sample consisted of 46 patients who had to undergo surgical treatment for a newly developed tumor for either diagnostic or therapeutic purposes. The following psychosocial factors were examined: posttraumatic stress, dissociative reactions, anxiety, depression, cognitive-emotional distress, social support and processing the illness. More than 25 % of the patients demonstrated signs of a clinically relevant PTSR at the acute stage (T1) and almost 40 % did so four months later (T2). Significantly more women showed a PTSR at both points of measurement, but particularly at follow-up. No significant relationship could be found between the type of the tumor at T1 and the emergence of a PTSR at T2. Patients with PTSR at T2 showed higher scores for anxiety and depression. The most important predictors for the development of clinically relevant posttraumatic symptoms at the four-month follow-up examination were female sex, PTSR at T1 as well as elevated levels of depression. The results indicate the clinical relevance of psychotraumatic screening examinations in patients with acute cancer illnesses both for diagnostic as well as therapeutic investigations.

Key words

Acute cancer - Posttraumatic stress - Anxiety - Depression - Predictors

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Dr. med. Guido Flatten

Klinik für Psychosomatik und Psychotherapeutische Medizin · Universitätsklinikum der RWTH Aachen

Pauwelsstraße 30

52074 Aachen

eMail: GFlatten@ukaachen.de