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Influence of Post-traumatic 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., RN3
Korean Journal of Adult Nursing 2017;29(6):657-666.
Published online: December 18, 2017

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: September 18, 2017   • Accepted: December 18, 2017

© 2017 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Ostomy; Post-traumatic stress disorders; Psychological resilience; Quality of life
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
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
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
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
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
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
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
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
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
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
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
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)
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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    Influence of Post-traumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience
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    DOI: https://doi.org/10.7475/kjan.2017.29.6.657
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    Influence of Post-traumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience
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    DOI: https://doi.org/10.7475/kjan.2017.29.6.657
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    Influence of Post-traumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience
    Influence of Post-traumatic Stress Disorders on Quality of Life among Patients with Ostomy: Focused on the Mediating Effect of Resilience

    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
    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
    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
    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
    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
    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
    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
    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
    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
    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
    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.

    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.

    Correlational Relationships among the Variables (N=150)

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

    (＜.001)

    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)
    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).
    Table 1. Differences in Post-traumatic Stress Disorder, Resilience, and Quality of Life by Characteristics of Participants (N=150)

    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)

    PTSD=post-traumatic stress disorders.

    Table 3. Correlational Relationships among the Variables (N=150)

    (＜.001)

    Table 4. Mediating Effect of Resilience between PTSD and Quality of Life (N=150)

    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).

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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