Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-30T17:24:36Z No. of bitstreams: 1 DIS_JULIA_LUIZA_SCHAFER_PARCIAL.pdf: 1950516 bytes, checksum: d087e3b380f5026a78af786f693a37b3 (MD5) / Made available in DSpace on 2017-06-30T17:24:36Z (GMT). No. of bitstreams: 1 DIS_JULIA_LUIZA_SCHAFER_PARCIAL.pdf: 1950516 bytes, checksum: d087e3b380f5026a78af786f693a37b3 (MD5) Previous issue date: 2017-03-08 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Introdu??o: A literatura sugere que respostas emocionais est?o associadas ao desenvolvimento e manuten??o de sintomas do Transtorno de Estresse P?s-Traum?tico (TEPT). A capacidade de influenciar a experi?ncia e express?o emocional, conhecida como regula??o emocional (RE), pode ser cr?tica ao lidar com n?veis significativos de estresse. Especificamente, a RE atrav?s de cogni??es, ou pensamentos (ou seja, Regula??o Emocional Cognitiva, REC), ajuda os indiv?duos a manter o controle sobre sua experi?ncia emocional durante, ou depois de serem expostos a eventos estressores, ou traum?ticos. O Question?rio de Regula??o Emocional Cognitiva (CERQ), foi desenvolvido para medir nove diferentes estrat?gias de REC que se referem ? maneira consciente e atencional de lidar com eventos de vida amea?adores, ou negativos. Objetivos: Os objetivos gerais desta disserta??o foram desenvolver e investigar as evid?ncias de validade da vers?o brasileira do CERQ (Estudo 1) e investigar a rela??o entre a exposi??o a traumas, estrat?gias cognitivas de RE, afeto e Sintomas de Estresse P?s-Traum?tico (SEPT) atrav?s de um modelo de media??o dupla (Estudo 2). M?todo: Uma amostra de 445 estudantes universit?rios completou um Question?rio S?cio-Demogr?fico, a Life of Events Checklist (LEC-5), a vers?o brasileira do CERQ, a Positive and Negative Affect Schedule (PANAS) e a Posttraumatic Symptoms Checklist (PCL-5) em uma plataforma de pesquisa on-line. Para o Estudo 1, o processo de adapta??o da vers?o brasileira do CERQ incluiu tradu??o, retro-tradu??o, avalia??o de ju?zes e teste em 30 participantes da popula??o-alvo. As evid?ncias de validade de construto foram avaliadas atrav?s de an?lise fatorial confirmat?ria, da consist?ncia interna atrav?s dos alfas de Cronbach e de correla??es com as vari?veis afetivas mensuradas pelo PANAS. Para o Estudo 2 foram realizadas an?lises preliminares de correla??o e de regress?o linear m?ltipla para investigar associa??es entre tipo de trauma, estrat?gias cognitivas de regula??o emocional, afeto e severidade de SEPT. Em seguida, um modelo com rumina??o e afeto negativo como mediadores do efeito da exposi??o ao trauma les?o moral causada por outros sobre os SEPT foi testado usando o macro PROCESS para o SPSS. Resultados: As an?lises de validade mostraram que a estrutura original do CERQ possui boa validade fatorial na amostra e alta confiabilidade, com ? de Cronbach variando entre .71 e .88. An?lises preliminares de associa??o entre tipo de trauma, estrat?gias de regula??o emocional cognitiva, afeto e SEPT mostraram que o tipo de trauma de les?o moral causada por outros, rumina??o e afeto negativo s?o preditores significativos da gravidade de SEPT. Ao testar o modelo de media??o dupla, os resultados sugerem que a rumina??o ? um mediador forte e independente entre o tipo de trauma de les?o moral causada por outros e SEPT, enquanto afeto negativo ? um mediador apenas quando a rumina??o est? presente no modelo. Discuss?o: Nossos resultados indicam que a vers?o brasileira do CERQ ? uma ferramenta v?lida e confi?vel para avaliar as estrat?gias cognitivas de regula??o emocional e que os indiv?duos expostos ao tipo de trauma de les?o moral causada pelos outros utilizam rumina??o como uma estrat?gia de regula??o emocional cognitiva com mais frequ?ncia. O uso aumentado dessa estrat?gia amplifica os n?veis de afeto negativo que acaba levando a n?veis mais elevados de SEPT. Em geral, esses resultados podem influenciar pesquisas e auxiliar no desenvolvimento e melhoria de interven??es cognitivas para indiv?duos expostos a eventos traum?ticos. / Background: Literature suggests that emotional responses are associated to the development and maintenance of Posttraumatic Stress Disorder (PTSD) symptoms. The ability to influence emotional experience and expression, known as emotion regulation (ER), can be critical when dealing with significant levels of stress. Specifically, ER through cognitions, or thoughts (i.e. Cognitive Emotion Regulation; CER), helps individuals to maintain control over their emotional experience during, or after being exposed to stressful, or traumatic events. The Cognitive Emotion Regulation Questionnaire (CERQ) was developed to measure nine different CER strategies that refer to the conscious and attentional way people deal with threatening, or negative life events. Objectives: Therefore, the general purposes of this thesis were to develop and evaluate validity evidences of the Brazilian version of the CERQ (Study 1) and to investigate the relationship between trauma exposure, cognitive emotion regulation strategies, affect and Posttraumatic Stress Symptoms (PTSS) testing for a double mediation model (Study2). Method: A sample of 445 university students completed a Socio-Demographic Questionnaire, the Life of Events Checklist (LEC-5), the Brazilian version of the CERQ, the Positive and Negative Affect Schedule (PANAS) and the Posttraumatic Symptoms Checklist (PCL-5) on an on-line research platform. For Study 1, adaptation process of the Brazilian version of the CERQ included translation, backtranslation, expert committee?s evaluation, and testing on 30 participants from the target population. Validity evidence was assessed through confirmatory factor analysis, internal consistency through the Cronbach?s alpha analysis, and correlations with the affective variables measured by the PANAS. For Study 2, preliminary correlation and multiple linear regression analyses were conducted to investigate associations among trauma type exposure, cognitive emotion regulation strategies, affect and PTSS severity. Next, a model positing rumination and negative affect as double mediators of the effect of trauma type of moral injury by others on PTSS was tested using the PROCESS macro for SPSS. Results: Validity analyses showed that the original structure of the CERQ has good factorial validity in the sample and high reliabilities, with Cronbach?s ? ranging between .71 and .88. Preliminary analyses of the association among trauma type, cognitive emotion regulation strategies, affect and PTSS showed that trauma type of moral injury, rumination and negative affect were significant predictors of PTSS severity. When testing for the double mediation model, results suggested that rumination is a strong and independent mediator between trauma type moral injury by others and PTSS, while negative affect is a mediator only when rumination is also included. Discussion: Our results indicate that the Brazilian version of the CERQ is a valid and reliable tool for assessing cognitive emotion regulation strategies, and that individuals who are exposed to trauma type of moral injury by others engage more frequently in rumination as a cognitive emotion regulation strategy, which in turn amplifies levels of negative effect that ends up leading to higher levels of PTSS. Overall, these results can influence further researches and aid the development and improvement of cognitive treatment interventions for individuals exposed to traumatic events.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.