The Impact of Social Determinants on Posttraumatic Growth Among Young Adult Childhood Cancer Survivors.

Abstract

Background: Young adult childhood cancer survivors (YA CCSs) may experience posttraumatic growth (PTG), yet little is known about how neighborhood-level social determinants influence PTG. Posttraumatic stress may also shape PTG, but its mediating role in the relationship between neighborhood deprivation and PTG remains unclear.

Objective: To examine associations between neighborhood deprivation and PTG among YA CCSs and determine whether posttraumatic stress mediates these associations.

Methods: This cross-sectional study included 121 YA CCSs. Neighborhood deprivation was measured using the Area Deprivation Index (ADI) and the Environmental Justice Index (EJI). PTG and posttraumatic stress were assessed using the Posttraumatic Growth Inventory and the Impact of Event Scale-Revised. Linear regression examined associations between neighborhood deprivation and PTG. The MEDCURVE macro tested curvilinear mediation.

Results: Participants were mostly non-Hispanic White (71%) with a mean age of 19.4 years. Higher ADI scores were associated with greater PTG (B = 0.36, 95% confidence interval [CI], 0.17-0.55). Total EJI and its Social and Health Vulnerability subscale were positively associated with PTG. Posttraumatic stress curvilinearly mediated the ADI-PTG association, with stronger mediation in less deprived neighborhoods (B = 0.11, 95% CI, 0.02-0.30) and weaker mediation in more deprived neighborhoods (B = 0.07, 95% CI, 0.02-0.17). Similar mediation was observed for the EJI Social Vulnerability subscale.

Conclusions: Greater neighborhood deprivation was associated with higher PTG in YA CCSs. Posttraumatic stress mediated this association, with its influence varying across neighborhood conditions.

Implications for oncology nursing practice: Findings support personalized interventions addressing socioecological environments and psychological determinants.