This article was downloaded by: [New York University] On: 03 June 2015, At: 11:54 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Psychology, Health & Medicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/cphm20
Coping and posttraumatic growth in women with limb amputations a
a
a
Lauren A. Stutts , Sarah E. Bills , Savannah R. Erwin & Jessica J. a
Good a
Psychology, Davidson College, Post Box 7136, Davidson, NC 28035, USA Published online: 09 Feb 2015.
Click for updates To cite this article: Lauren A. Stutts, Sarah E. Bills, Savannah R. Erwin & Jessica J. Good (2015): Coping and posttraumatic growth in women with limb amputations, Psychology, Health & Medicine, DOI: 10.1080/13548506.2015.1009379 To link to this article: http://dx.doi.org/10.1080/13548506.2015.1009379
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [New York University] at 11:54 03 June 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Psychology, Health & Medicine, 2015 http://dx.doi.org/10.1080/13548506.2015.1009379
Coping and posttraumatic growth in women with limb amputations Lauren A. Stutts*, Sarah E. Bills, Savannah R. Erwin and Jessica J. Good Psychology, Davidson College, Post Box 7136, Davidson, NC 28035, USA
Downloaded by [New York University] at 11:54 03 June 2015
(Received 29 August 2014; accepted 15 January 2015) While ample research has examined the psychological experiences of men with limb amputations, minimal research has examined the psychological experiences of women with limb amputations. The present study utilizes a qualitative design to examine coping and posttraumatic growth in women with limb amputations. Thirty women completed the posttraumatic growth inventory (PTGI) and provided open-ended responses about coping, social support, discrimination, support groups, and acceptance. Interpretative phenomenological analysis was used to discern emergent and superordinate themes in qualitative responses. Superordinate themes included social support (friendships/family and community), self-beliefs, resources, physical complications, spirituality, specific strategies, and acceptance. Concerns related specifically to participants’ gender identity included appearance and motherhood. Overall, women reported moderate-to-high PTGI scores. The current findings address a void in the literature by illuminating the unique perspective of women with amputations. Future research should use quantitative methodology to expand on our research findings, as well as assess interventions to assist women adjusting to limb loss. Keywords: posttraumatic growth; coping; women; limb amputations
The prevalence of individuals with a limb amputation was approximately 1.6 million in 2005 and is projected to double to 3.6 million by 2050 (Ziegler-Graham, MacKenzie, Ephraim, Travison, & Brookmeyer, 2008). Women with amputations comprise approximately one third of that total number. The focus of this paper is how women with amputations cope with limb loss and perceive posttraumatic growth (PTG) after an amputation. There are myriad ways in which individuals psychologically cope with limb loss. Oaksford, Frude, and Cuddihy (2005) found that individuals used five main coping strategies post amputation: psychological escapes, support seeking, humor, cognitive appraisal, and practical coping. These strategies relate positively to successful coping, whereas experiencing discrimination and self-stigma contribute to difficulty adjusting to limb loss (Rybarczyk, Nicholas, & Nyenhuis, 1997). Women’s reactions to disease/injury have been examined across many medical populations. For example, White, Hunter, and Holttum (2007) found that women who experienced a myocardial infarction used cognitive reframing, optimism, and social support as primary strategies. Similarly, a study on women with spinal cord injuries found that positive reappraisal and social support are common coping strategies (Lequerica, Forchheimer, Tate, Roller, & Toussaint, 2008). *Corresponding author. Email: [email protected] © 2015 Taylor & Francis
Downloaded by [New York University] at 11:54 03 June 2015
2
L.A. Stutts et al.
Regarding women with amputations, researchers have studied women’s reactions to mastectomy (i.e. breast amputation) and found that women tend to cope with activecognitive, active-behavioral, and/or avoidance coping (Bartmann & Roberto, 1996). Although it appears to have not been explored empirically, having a mastectomy is likely a qualitatively different experience than having limb loss because breasts are a defining characteristic of womanhood. Only a few studies we are aware of have examined women with limb amputations (Elnitsky, Latlief, Andrews, Adams-Koss, & Phillips, 2012). Previous quantitative studies have highlighted potential gender differences that are worthy of future study (Kashani, Frank, Kashani, Wonderlich, & Reid, 1983). For example, Demet, Martinet, Guillemin, Paysant, and Andre (2003) found that men with amputations reported higher health-related quality of life in the areas of physical disability, energy, emotional reactions, and social isolation compared to women. Coping can contribute to multiple outcomes, such as trauma-related stress, depression, or more positive outcomes. PTG has become an increasingly common outcome to examine empirically in populations with medical stressors (Hefferon, Grealy, & Mutrie, 2009). PTG is defined as self-perceived positive psychological change following a challenging experience (Tedeschi & Calhoun, 2004). A meta-analysis on gender differences across all populations (not solely medical) found that women self-report a greater level of PTG than men (Vishnevsky, Cann, Calhoun, Tedeschi, & Demakis, 2010). Zwahlen, Hagenbuch, Carley, Jenewein, and Buchi (2010) found that women with cancer reported more PTG than men; however, research has not specifically investigated PTG in women with amputations. The present study examines the experience of a limb amputation from the female perspective. Due to the dearth of research on women with amputations, a qualitative approach was most appropriate. This design enabled us to obtain a richer collection of data, and voice the unique experiences of these women through direct quotations. Our main research goal was to examine coping strategies, perceptions of social support, experiences with discrimination, attendance in support groups, reported level of acceptance of limb loss, and perceived PTG in women with amputations. This information allows us to understand the female experience and raise potential areas of intervention.
Method Participants Thirty women served as participants in the present study. The average age was 50.0 years old (SD = 14.77), with a range from 23 to 81 years. The majority of our sample (28 participants) identified as white/Caucasian, and two participants identified as African-American. Table 1 contains other demographic details. The number of participants included in the study was based on the principle of saturation; the average qualitative study also tends to have 20–30 participants (Dworkin, 2012). Twenty-seven women reported having a single amputation: Below-the-knee = 14 (46.7%), above-the-knee = 11(36.7%), and upper limb = 2(6.7%). Two women had bilateral arm amputations and one woman had bilateral above-the-knee amputations. The reasons reported for the amputation included the following: amputations secondary to illness/surgery = 18(60%), due to a motor vehicle accident = 9(30%), were congenital = 2(6.7%), and due to electrocution = 1(3.3%). The mean time since amputation was 12.53 years (SD = 13.55), with a range from 0 (less than a year) to 41 years.
Psychology, Health & Medicine Table 1.
Demographic variables of sampled women with amputations (N = 30).
Demographic variable
Downloaded by [New York University] at 11:54 03 June 2015
3
Living situation With spouse With domestic partner With parent(s) With children(s) Independent Education status High school or GED Some college Associate’s degree Bachelor’s degree Some graduate work Master’s degree or higher Employment status Full-time Part-time Homemaker Retired Unable to work Household income level Under $15,000 $15,000–
Psychology, Health & Medicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/cphm20
Coping and posttraumatic growth in women with limb amputations a
a
a
Lauren A. Stutts , Sarah E. Bills , Savannah R. Erwin & Jessica J. a
Good a
Psychology, Davidson College, Post Box 7136, Davidson, NC 28035, USA Published online: 09 Feb 2015.
Click for updates To cite this article: Lauren A. Stutts, Sarah E. Bills, Savannah R. Erwin & Jessica J. Good (2015): Coping and posttraumatic growth in women with limb amputations, Psychology, Health & Medicine, DOI: 10.1080/13548506.2015.1009379 To link to this article: http://dx.doi.org/10.1080/13548506.2015.1009379
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [New York University] at 11:54 03 June 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Psychology, Health & Medicine, 2015 http://dx.doi.org/10.1080/13548506.2015.1009379
Coping and posttraumatic growth in women with limb amputations Lauren A. Stutts*, Sarah E. Bills, Savannah R. Erwin and Jessica J. Good Psychology, Davidson College, Post Box 7136, Davidson, NC 28035, USA
Downloaded by [New York University] at 11:54 03 June 2015
(Received 29 August 2014; accepted 15 January 2015) While ample research has examined the psychological experiences of men with limb amputations, minimal research has examined the psychological experiences of women with limb amputations. The present study utilizes a qualitative design to examine coping and posttraumatic growth in women with limb amputations. Thirty women completed the posttraumatic growth inventory (PTGI) and provided open-ended responses about coping, social support, discrimination, support groups, and acceptance. Interpretative phenomenological analysis was used to discern emergent and superordinate themes in qualitative responses. Superordinate themes included social support (friendships/family and community), self-beliefs, resources, physical complications, spirituality, specific strategies, and acceptance. Concerns related specifically to participants’ gender identity included appearance and motherhood. Overall, women reported moderate-to-high PTGI scores. The current findings address a void in the literature by illuminating the unique perspective of women with amputations. Future research should use quantitative methodology to expand on our research findings, as well as assess interventions to assist women adjusting to limb loss. Keywords: posttraumatic growth; coping; women; limb amputations
The prevalence of individuals with a limb amputation was approximately 1.6 million in 2005 and is projected to double to 3.6 million by 2050 (Ziegler-Graham, MacKenzie, Ephraim, Travison, & Brookmeyer, 2008). Women with amputations comprise approximately one third of that total number. The focus of this paper is how women with amputations cope with limb loss and perceive posttraumatic growth (PTG) after an amputation. There are myriad ways in which individuals psychologically cope with limb loss. Oaksford, Frude, and Cuddihy (2005) found that individuals used five main coping strategies post amputation: psychological escapes, support seeking, humor, cognitive appraisal, and practical coping. These strategies relate positively to successful coping, whereas experiencing discrimination and self-stigma contribute to difficulty adjusting to limb loss (Rybarczyk, Nicholas, & Nyenhuis, 1997). Women’s reactions to disease/injury have been examined across many medical populations. For example, White, Hunter, and Holttum (2007) found that women who experienced a myocardial infarction used cognitive reframing, optimism, and social support as primary strategies. Similarly, a study on women with spinal cord injuries found that positive reappraisal and social support are common coping strategies (Lequerica, Forchheimer, Tate, Roller, & Toussaint, 2008). *Corresponding author. Email: [email protected] © 2015 Taylor & Francis
Downloaded by [New York University] at 11:54 03 June 2015
2
L.A. Stutts et al.
Regarding women with amputations, researchers have studied women’s reactions to mastectomy (i.e. breast amputation) and found that women tend to cope with activecognitive, active-behavioral, and/or avoidance coping (Bartmann & Roberto, 1996). Although it appears to have not been explored empirically, having a mastectomy is likely a qualitatively different experience than having limb loss because breasts are a defining characteristic of womanhood. Only a few studies we are aware of have examined women with limb amputations (Elnitsky, Latlief, Andrews, Adams-Koss, & Phillips, 2012). Previous quantitative studies have highlighted potential gender differences that are worthy of future study (Kashani, Frank, Kashani, Wonderlich, & Reid, 1983). For example, Demet, Martinet, Guillemin, Paysant, and Andre (2003) found that men with amputations reported higher health-related quality of life in the areas of physical disability, energy, emotional reactions, and social isolation compared to women. Coping can contribute to multiple outcomes, such as trauma-related stress, depression, or more positive outcomes. PTG has become an increasingly common outcome to examine empirically in populations with medical stressors (Hefferon, Grealy, & Mutrie, 2009). PTG is defined as self-perceived positive psychological change following a challenging experience (Tedeschi & Calhoun, 2004). A meta-analysis on gender differences across all populations (not solely medical) found that women self-report a greater level of PTG than men (Vishnevsky, Cann, Calhoun, Tedeschi, & Demakis, 2010). Zwahlen, Hagenbuch, Carley, Jenewein, and Buchi (2010) found that women with cancer reported more PTG than men; however, research has not specifically investigated PTG in women with amputations. The present study examines the experience of a limb amputation from the female perspective. Due to the dearth of research on women with amputations, a qualitative approach was most appropriate. This design enabled us to obtain a richer collection of data, and voice the unique experiences of these women through direct quotations. Our main research goal was to examine coping strategies, perceptions of social support, experiences with discrimination, attendance in support groups, reported level of acceptance of limb loss, and perceived PTG in women with amputations. This information allows us to understand the female experience and raise potential areas of intervention.
Method Participants Thirty women served as participants in the present study. The average age was 50.0 years old (SD = 14.77), with a range from 23 to 81 years. The majority of our sample (28 participants) identified as white/Caucasian, and two participants identified as African-American. Table 1 contains other demographic details. The number of participants included in the study was based on the principle of saturation; the average qualitative study also tends to have 20–30 participants (Dworkin, 2012). Twenty-seven women reported having a single amputation: Below-the-knee = 14 (46.7%), above-the-knee = 11(36.7%), and upper limb = 2(6.7%). Two women had bilateral arm amputations and one woman had bilateral above-the-knee amputations. The reasons reported for the amputation included the following: amputations secondary to illness/surgery = 18(60%), due to a motor vehicle accident = 9(30%), were congenital = 2(6.7%), and due to electrocution = 1(3.3%). The mean time since amputation was 12.53 years (SD = 13.55), with a range from 0 (less than a year) to 41 years.
Psychology, Health & Medicine Table 1.
Demographic variables of sampled women with amputations (N = 30).
Demographic variable
Downloaded by [New York University] at 11:54 03 June 2015
3
Living situation With spouse With domestic partner With parent(s) With children(s) Independent Education status High school or GED Some college Associate’s degree Bachelor’s degree Some graduate work Master’s degree or higher Employment status Full-time Part-time Homemaker Retired Unable to work Household income level Under $15,000 $15,000–
