Sintomatología de estrés postraumático en pacientes con cáncer de mama e identificación de posibles factores de riesgo.

Due to changes in the definition of trauma in the DSM-IV highlighting the subjective characteristics of trauma-, and the consideration of a life threatening illness as a potential traumatic experience able to trigger PTSD, the psychological reactions to trauma can be understood from the perspective of acute and posttraumatic stress disorder. Moreover, a number of studies have tried to identify a profile of predictive variables of posttraumatic stress sympthomatology in cancer patients. The main objective in this work is to evaluate the presence and evolution of traumatic stress sympthomatology (ASD and PTSD) along the process of diagnosis and treatment of breast cancer, and to identify risk factors that can contribute to the emergence of this type of symthoms. In this study we evaluated longitudinally traumatic symthomatology in 175 women with breast cancert stages I to III- along the different phases of the illness process: uncertainty, surgery, diagnostic confirmation, treatment, end of treatment and follow-up. The main results of this work showed that acute and posttraumatic stress responses are common in breast cancer patients. The first stages of the illness process are the most stressful situation that provokes major psychological impact in women evaluated in this research. ASD prevalence rates fell from 17% in uncertainty phase to 8% at the end of treatment. PTSD prevalence remained relatively constant through treatment phase (27.4%), end of treatment (24%) and follow-up (22.9%). Moreover, psychological risk profile of developing PTSD characterizes by high levels of ASD sympthomatology in uncertainty phase, by unexpression of negative emotions and asertive or dominant behaviors, and by a trend to show dissociative experiences as a stable pattern. Different analysis showed that acute stress sympthomatology is the stronger simple predictor of PTSD sympthoms in this study. Finally, we found a cut-off point in the questionnaire used to evaluate ASD (SASRQ), that allowed us to identify more easily those women with elevated ASD sympthoms, and able to predict in a precise form subsequent PTSD sympthomatolgy. The results of this work are useful in order to implement screening protocols and psychotherapeutic interventions for prevention of PTSD in breast cancer patients.