Evidence for a curvilinear relationship between posttraumatic growth and posttrauma depression and PTSD in assault survivors

Post-traumatic growth in mental health recovery: qualitative study of narratives

OBJECTIVES

Post-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems.

DESIGN

Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.

SETTING

England.

PARTICIPANTS

Participants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British.

RESULTS

Components of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process.

CONCLUSIONS

Post-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery.

TRIAL REGISTRATION NUMBER

ISRCTN11152837.

Are Pediatric Critical Personnel Satisfied With Their Lives? Prediction of Satisfaction With Life From Burnout, Posttraumatic Stress, and Posttraumatic Growth, and Comparison With Noncritical Pediatric Staff

OBJECTIVES

Staff in PICUs shows high burnout, posttraumatic stress disorder symptoms, and posttraumatic growth levels. However, their levels of satisfaction with life and how positive and negative posttrauma outcomes relate to each other and contribute to predict satisfaction with life remain unknown. Thus, we attempted to explore these aspects and to compare the findings with data from pediatric professionals working in noncritical units.

DESIGN

This is an observational multicentric, cross-sectional study.

SETTING

The PICU of nine hospitals in Spain, and other pediatric units in the same hospitals.

SUBJECTS

Two hundred ninety-eight PICU workers (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in noncritical pediatric units (53 physicians, 104 nurses, and 32 nursing assistants).

INTERVENTION

Participants completed the Maslach Burnout Inventory, the Trauma Screening Questionnaire, the Posttraumatic Growth Inventory, and the Satisfaction With Life Scale.

MEASUREMENTS AND MAIN RESULTS

Of PICU staff, 16.4% were very satisfied with their lives, 34.2% were satisfied, 34.6% showed average satisfaction with life, and 14.8% were below average. No differences were found between PICU and non-PICU workers. Women reported lower satisfaction with life than men, and physicians reported higher satisfaction with life than other professional groups. The correlation between posttraumatic stress disorder and posttraumatic growth was low, but significant and positive. According to the path analysis with latent variables, 20% of the variance satisfaction with life could be predicted from burnout, posttraumatic stress disorder symptoms, and posttraumatic growth. Higher distress was inversely associated to satisfaction with life, whereas posttraumatic growth contributed to higher satisfaction with life.

CONCLUSIONS

Posttraumatic growth can moderate the negative effect of traumatic work-related experiences in satisfaction with life. PICU and non-PICU workers were equally satisfied with their lives. Positive and negative impact of work-related potentially traumatic events can coexist in the same person. Interventions aimed at reducing distress and fostering posttraumatic growth could impact in an improvement in pediatric health professionals' satisfaction with life.

Disaster Communication, Posttraumatic Stress, and Posttraumatic Growth following Hurricane Matthew

Disaster survivors may experience a range of mental health reactions that can include posttraumatic stress (PTS) and posttraumatic growth (PTG). The current study examines the associations between citizen disaster communication, PTS, and PTG among individuals in North Carolina communities impacted by Hurricane Matthew, approximately six weeks following the event. Participants who communicated more frequently following the hurricane exhibited more PTS and PTG. Communication activities focused on connecting with loved ones and cognitively restructuring the disaster experience were associated with PTS and PTG, whereas communication activities confirming disaster reports and assisting with disaster recovery were associated solely with PTG. Results illustrate the need for robust disaster communication ecologies to facilitate public disaster mental health response and coordination.

Psychological status of nursing survivors in China and its associated factors: 6 years after the 2008 Sichuan earthquake

PURPOSE

Nursing survivors are often not only the victims but also the rescuers in a disaster. Severe natural disasters can cause them long-term psychological impact. This study aimed to investigate the psychological status of nursing survivors and its associated factors 6 years after the severe earthquake that occurred in Wenchuan, Sichuan, on May 12, 2008.

METHODS

The study used a cross-sectional design. A total of 597 nurses who survived the earthquake and took care of victims were recruited about 6 years after the disaster. They completed a self-report questionnaire assessing information about demographics, earthquake-related characteristics, psychological status, posttraumatic stress disorder, and posttraumatic growth and resilience.

RESULTS

The mean score on the Symptom Checklist-90-Revised (SCL-90-R) was (123.56±41.26). Of symptoms indicated by the SCL-90-R, obsessive-compulsive dimension had the highest score (1.62±0.62). The psychological status of nursing survivors differed with the title, monthly per capita household income, financial loss, health status, residential satisfaction, and satisfaction with leaders and colleagues. Severe financial loss and poor health status were significant factors of psychological distress. In addition, psychological status was negatively related to posttraumatic stress disorder and posttraumatic growth, and positively related to resilience.

CONCLUSION

Nursing survivors had a relatively normal level of psychological status 6 years after the 2008 Sichuan earthquake. However, psychological symptoms such as obsessive-compulsive patterns still remained. Interventions focusing on the improvement of financial subsidies and physical health may be particularly useful in reducing psychological problems after the disaster.

Mediating Roles of Gratitude and Social Support in the Relation Between Survivor Guilt and Posttraumatic Stress Disorder, Posttraumatic Growth Among Adolescents After the Ya'an Earthquake

Objective: This study aims to examine the mediating roles of gratitude and social support in the relationship between survivor guilt and posttraumatic stress disorder (PTSD) as well as the relationship between survivor guilt and posttraumatic growth (PTG). Methods: The current study used self-report questionnaires to investigate 706 adolescent survivors of Lushan county three and a half years after the Ya'an earthquake. The structural equation model was used to evaluate the relations between survivor guilt, gratitude and social support in PTSD and PTG. Results: The results indicated that survivor guilt had a positive effect on both PTSD and PTG. Gratitude partly mediated the relation between survivor guilt and both PTSD and PTG; social support partly mediated the relation between survivor guilt and PTG but not PTSD as well as the relation between gratitude and PTG. Conclusion: Survivor guilt has a double-edged sword effect. Survivor guilt affects PTSD and PTG through gratitude, and it could affect PTG but not PTSD through social support. Gratitude decreases PTSD and increases PTG, whereas social support only increases PTG.

The Relationship Between Posttraumatic Stress Disorder Symptoms and Posttraumatic Growth Among HIV-Infected Men Who Have Sex With Men in Beijing, China: The Mediating Roles of Coping Strategies

The traumatic experience of contracting and living with HIV/AIDS may produce a myriad of mental health problems, especially posttraumatic stress disorder (PTSD) symptoms, and conversely, bring posttraumatic growth (PTG), that is, positive changes resulting from a struggle with trauma. The growing body of research into the relationship between PTSD symptoms and PTG has produced mixed results. In addition, some research has suggested that psychosocial and cognitive factors may mediate the development of PTG after trauma exposure. Specifically, individuals experience fewer psychological symptoms and better mental health when adaptive coping strategies align with stressors; however, little research is available on the relationship and the mediating effect of coping strategies on the link of PTSD symptoms and PTG among HIV-infected men who have sex with men (MSM) in China. The aims of the current study were to investigate the relationship between PTSD symptoms and PTG as well as the potential mediating effects of coping strategies through which PTSD symptoms contributes to PTG among this vulnerable population. One hundred and forty HIV-positive MSM were recruited from the Beijing Center for Disease Prevention and Control and were asked to complete a battery of self-administered questionnaires, covering sociodemographic and HIV-related characteristics, coping strategies (i.e., problem-solving, seeking social support, self-blame, and wishful thinking), PTSD symptoms, and PTG. Results showed that, after controlling for sociodemographic and HIV-related variables, a negative linear relationship was found between PTSD symptoms and PTG. In addition, problem-solving and self-blame played significant mediating roles in the association between PTSD symptoms and PTG. The mediating effects of seeking social support and engaging in wishful thinking on the PTSD symptoms and PTD link were, however, non-significant. The present study contributes to an understanding of the association between PTSD symptoms and PTG and underscores the mediators through which individuals gain growth from traumatic experience in the context of HIV infection in Beijing, China. Given these findings, the future efforts at psychological intervention should differentiate and target various types of coping strategies, especially focusing on enhancing problem-solving skills and decreasing self-blame, in response to the promotion of positive growth among HIV-infected MSM.

The Duality of Human Experience: Perspectives From Psychosocial Adaptation to Chronic Illness and Disability—Empirical Observations and Conceptual Issues

The authors examine the current views on the duality of the human experience as portrayed within the process of coping with traumatic life events. Emphasis is placed on those views associated with the onset or diagnosis of chronic illnesses and disabilities (CID). In a companion article, the authors reviewed experiential dualities focusing on (a) modes of psychosocial adaptation to CID, such as coping versus succumbing, disabled and nondisabled selves; (b) models of denial; and (c) models of personal growth following adversity and traumatic events, such as the onset or diagnosis of CID. Discussion then focused on the dualities espoused by the latter models, which typically dichotomize human functioning following traumatic experiences. In the present article, the authors discuss (a) the main factors, considered by the various theoretical models, that have been found to exert influence on the genuineness of personal growth, with a special emphasis on post-CID psychological growth; (b) pertinent empirical findings that, directly and indirectly, address the perceived dualities of personal growth in the context of psychosocial adaptation to CID; and (c) theoretical and research implications associated with the study of the dual nature of post-CID growth, including recommendations for investigating the veracity of this reported personal growth.

Examining posttraumatic growth and mental health difficulties in the aftermath of Hurricane Sandy

OBJECTIVE

Hurricane Sandy continues to affect the mental health of New York residents. This study examined associations between Posttraumatic Growth (PTG) and mental health difficulties (MHD) including symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD).

METHOD

Participants (N = 1,356) recruited from the New York metropolitan area completed questionnaires regarding their PTG, demographics, MHD, and hurricane experiences. A weighted least squares regression assessed the association between MHD and PTG. A post hoc analysis determined whether anxiety or depression moderated the effect of PTSD on PTG.

RESULTS

All MHD were crudely associated with greater PTG. After adjustment, an increased PTSD score was significantly associated with a 0.20 unit increase in PTG (t = 6.05, p < .001); this did not hold for depression or anxiety symptoms. Higher PTG was associated with being non-White (B = 5.90, t = 6.49, p < .001), Hispanic (B = 3.38, t = 2.89, p = .004), a smoker (B = 3.18, t = 3.28, p = .001), and greater Hurricane Sandy exposure (t = 7.11, p < .001). The positive association between PTSD symptoms and PTG was weaker among participants with probable depression.

CONCLUSION

Results suggest that participants with higher PTSD symptoms were more likely to grow from the impact of the storm, indicating resilience. Highly exposed participants were more likely to experience PTG. A decrease in PTG was found among those with both PTSD and depression symptoms. The development and implementation of interventions fostering PTG could be beneficial in clinical disaster response work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Benefit finding and well-being in older adults: The utility of the General Benefit Finding Scale

The research aim was to test the General Benefit Finding Scale (GBFS) in a cross-sectional survey of adults aged 55 years and older and to assess to what extent it relates to mental well-being, perceived social support, health and personality. Participants (n=341) completed a questionnaire which included demographic questions, the GBFS, and measures of mental well-being, perceived social support, activity levels, and personality. Benefit finding was higher in older adults and correlated positively with mental well-being and perceived support. The impact of the psychosocial factors investigated on benefit finding levels was small (9.2%) with mental well-being, sex and agreeableness being significant predictors. The study provides additional support for the use of the GBFS and suggests that perceived social support, particularly from friends, is especially important for older adults.

Social Support, Dysfunctional Coping, and Community Reintegration as Predictors of PTSD Among Human Trafficking Survivors

Human trafficking exerts psychological effects on survivors that persist after intervention, and even after community reintegration. Effects include anxiety, depression, alienation, disorientation, aggression, suicidal ideation, attention deficit, and posttraumatic stress disorder (PTSD). Community supports and coping mechanisms may mitigate these effects. The report presented here is part of a long-term program of research to develop and test evidence-informed mental health and human capacity-building intervention programs for women and girls who are victims of trafficking. Structural equation modeling was used to assess a conditional process model (moderated mediation) of the effect of social support, coping, and community reintegration on PTSD among n = 144 girls and women. Participants received psychosocial intervention at a residential care facility for trafficking survivors. Results indicate model fit was excellent. Results indicate community reintegration indirectly influenced PTSD through its effect on perceived social support. Survivors who reported more difficulty reintegrating back into the community perceived less social support than those that reported easier community reintegration, and trafficking survivors who perceived less social support indicated more PTSD. Survivors with more PTSD symptoms tended to report using more dysfunctional coping mechanisms.

A Salutogenic Perspective on Adverse Experiences

Abstract. Research has predominantly focused on the negative effects of adversity on health and well-being. However, the salutogenic perspective suggests that adversity may not always be detrimental ( Antonovsky, 1996 ). In fact, under certain circumstances, adversity may have the potential for positive outcomes, such as increased resilience and thriving ( Carver, 1998 ; Rutter, 1987 ). The “steeling effect” suggests that past experiences of adversity may increase resistance to later adversities. It proposes that moderate adversity may facilitate more adaptive functioning than no adversity or high levels of adversity ( Rutter, 2006 , 2012 ). The relationship between adversity and health may be optimally assessed using curvilinear models, yet the majority of previous studies have examined linear associations ( Masten & Cicchetti, 2016 ). It is therefore the aim of this review to determine whether moderate adversity is associated with more adaptive functioning when compared to no and high levels of adversity. Practical implications and future research are also discussed.

Challenges Associated With the Civilian Reintegration of Soldiers With Chronic PTSD: A New Approach Integrating Psychological Resources and Values in Action Reappropriation

Background: In light of the psychological changes in an individual suffering from chronic Posttraumatic Stress Disorder (PTSD), questions are being raised in order to understand and facilitate recovery and a return to work. This is particularly challenging for soldiers suffering from chronic PTSD, who are often young individuals suffering from moral conflicts. A French military rehabilitation program proposes the broadening of the relationships between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with chronic PTSD. The aim of the study was to evaluate (i) the psychological resources which remain sustainable for these trauma exposed soldiers according to their PTSD symptoms, (ii) the dynamics of resource reappropriation after the military rehabilitation program, which focuses on values in action (VIA) as character strengths, and (iii) how these resources and their reappropriation facilitate civilian professional reintegration. Method: We conducted a prospective study with 56 trauma exposed soldiers with a clinical diagnosis of chronic PTSD. PTSD severity and psychological resources (optimism, mindfulness, well-being, motivation, self-esteem, and VIA) were assessed before and after the rehabilitation program. After the identification of resource profiles, we analyzed the impact of the program on resource levels and successful reintegration into a civilian job. Results: 3 profiles were identified based on the psychological resources of the soldiers. Profiles 1, 2, and 3 differed in terms of clinical severity (PCL5). Profile 1 exhibited both the highest level of resources and the lowest clinical severity of PTSD but did not modify its resources after the intervention program when compared to profile 3. Profile 3 was characterized by the lowest level of resources, the highest clinical severity of PTSD and the highest reappropriation in all VIAs. This profile was associated with the highest rate of reintegration success 1 year after the intervention. Conclusions: This paper aims to broaden the relationship between recovery and reintegration by incorporating approaches from the field of positive psychology for soldiers with PTSD. VIA appears to be an important factor for reintegration. Our results highlight the importance of taking into account the existing needs of the patient and the optimization of the modalities of individual, collective, and institutional rehabilitation for patients suffering from PTSD in order to better understand the dynamics of the recovery process of a chronically afflicted individual.

Posttraumatic growth in a heterogeneous sample of traumatically injured patients 1 year postinjury

OBJECTIVE

Posttraumatic growth (PTG) describes positive change resulting from challenging life events. The current study examined factors associated with PTG in traumatically injured patients 1 year postinjury.

METHOD

Participants (N = 221) in this prospective cohort study included adults admitted to a Level I trauma center. Over half the participants (60%) were male, with a mean age of 47. Participants completed baseline measures during hospitalization. PTG was assessed at 12-month follow-up.

RESULTS

Greater PTG was associated with minority race/ethnicity, lower income, automotive collision, and premorbid psychological disorder other than depression or posttraumatic stress (PTS). These variables are also known to predict PTS in trauma patients. Analysis confirmed that greater PTS at follow-up was associated with more growth.

CONCLUSION

Participants with the most growth also experienced the most distress. This finding demonstrates the importance of implementing psychological screening and intervention for trauma patients in the acute care setting to reduce PTS and facilitate growth.

Quantitative and Qualitative Evaluations of the Enhanced Logo-autobiography Program for Korean-American Women

This study extends Bernstein et al.'s (2016) investigation of the effects of the Enhanced Logo-autobiography Program on Korean-American women's depressive symptoms, coping strategies, purpose in life, and posttraumatic growth by analyzing quantitative and qualitative data. This study's participants significantly improved on quantitative measures of depression, coping strategies, purpose in life, and post-traumatic growth at eight weeks post-intervention and follow-up. The qualitative content analysis revealed 17 themes with five essential themes. The program's activity to promote purpose in life through posttraumatic growth facilitated participants' recovery from traumatic experiences. Standardized guidelines are needed to conduct this program in Korean community centers.

Trajectories of posttraumatic growth among US military veterans: a 4-year nationally representative, prospective cohort study

OBJECTIVE

This study examined the nature and determinants of predominant trajectories of posttraumatic growth (PTG) over time.

METHOD

Using data from a prospective, nationally representative survey of 2718 US veterans assessed in 2011, 2013, and 2015, we used latent growth mixture modeling to identify PTG trajectories, and to examine key determinants of PTG trajectories from a comprehensive set of sociodemographic, military, health, and psychosocial variables.

RESULTS

Three PTG trajectories were identified, labeled as Low and Decreasing PTG (74.0%), Consistently Moderate PTG (12.0%), and High and Increasing PTG (14.0%). Greater severity of posttraumatic stress disorder symptoms, specifically re-experiencing and avoidance symptoms, at baseline predicted Consistently Moderate and High and Increasing PTG trajectories. Compared to the Low and Decreasing PTG trajectory, the High and Increasing PTG trajectory scored higher on baseline measures of gratitude, purpose in life, Spirituality, and social support.

CONCLUSION

Posttraumatic growth is a dynamic process with divergent trajectories. Developing interventions that target certain psychosocial factors may help trauma survivors maintain PTG over time.

Relation between parental psychopathology and posttraumatic growth after a child's admission to intensive care: Two faces of the same coin?

OBJECTIVES

Confronted with the potentially traumatic experience of a child's admission to a paediatric intensive care unit, parents may experience psychopathological post-trauma symptoms as well as posttraumatic growth. The aim of this cross-sectional study was to explore the relation between psychopathology symptoms, namely, posttraumatic stress disorder), anxiety and depression, as well as post traumatic growth in parents following their child's hospitalisation in a paediatric intensive care unit.

METHODS

Six months after their child's discharge, 143 parents completed the questionnaire, which assessed post traumatic growth (Posttraumatic Growth Inventory), post traumatic stress disorder (Davidson Trauma Scale), depression and anxiety (Hospital Anxiety and Depression Scale).

RESULTS

Of the 143 parents, 23.1% reported symptoms of post traumatic stress disorder, 21% reported symptoms of moderate to severe anxiety, 9.1% reported symptoms of moderate to severe depression and 37.1% reported at least a medium degree of post traumatic growth. There was a moderate, direct association between post traumatic stress disorder, depression and anxiety with post traumatic growth. Higher scores in anxiety, depression and post traumatic stress disorder were associated with higher levels of post traumatic growth, contradicting the notion of an inverted U-shaped relationship between psychopathology symptoms and post traumatic growth.

CONCLUSIONS

Given that positive and negative outcomes after a child's critical admission tend to co-occur, it is surmised that parents who indicate post traumatic growth do not deny the difficulties. While not negating the negative impact on the mental health of a parent with a child admitted to intensive care, including the assessment of post traumatic growth as an outcome following this event has important implications for research and clinical practice.

The Experience of Trauma Resulting From the Loss of a Child and Posttraumatic Growth-The Mediating Role of Coping Strategies (Loss of a Child, PTG, and Coping)

The aim of the study was to determine the mediating role of coping strategies in the relationship between intensity of trauma resulting from the loss of a child and posttraumatic growth (PTG). The study included a group of 76 persons who regarded the loss of a child as a traumatic event. The majority (55.3%) of respondents were women. The age of the participants ranged from 18 to 62 years (M = 35.88; SD = 9.52). A visual scale to measure intensity of trauma was used, and the Polish versions of the Posttraumatic Growth Inventory and Coping Inventory (Brief-Cope). The subjects revealed PTG, primarily in terms of appreciating of life and relating to others. Seeking social support, both emotional and instrumental, plays a mediating role between the intensity of trauma and PTG. Encouraging people who have experienced trauma to seek social support may not only enable adaptation to the situation but also contribute to the occurrence of PTG.

The Associations of Complicated Grief, Depression, Posttraumatic Growth, and Hope Among Bereaved Youth

Research on the association between complicated grief (CG), hope, and posttraumatic growth (PTG) among bereaved youth is limited. Measures of CG, depression, hope, and PTG were completed by 85 youth (aged 7–18 years). Results indicated a strong positive relationship between CG and depressive symptoms, an inverse relationship between hope and depressive symptoms, and a moderate positive relationship between hope and PTG. There was no significant association between CG and hope or between CG and PTG. Higher levels of CG and lower levels of hope independently predicted greater depressive symptoms, but PTG did not. Results have implications for assessing positive outcomes in bereaved youth.

Posttraumatic growth is related to subjective well-being of aid workers exposed to cumulative trauma in Palestine

The present study examined how stress reactions after traumatic events influence subjective well-being (SWB) via the indirect effect of posttraumatic growth (PTG) in two samples of Palestinian professional helpers from the Gaza Strip and West Bank ( n = 201). Using the General Health Questionnaire (GHQ-12) as a dependent measure of well-being, and PTGI-10, PANAS-20, WHO-5 BREF, and IES-13 questionnaires as independent variables, structural equation modelling (SEM) was used to examine whether: (a) cumulative trauma was negatively and directly related to subjective well-being; (b) levels of trauma were positively and directly related to posttraumatic growth; and (c) PTG was positively and directly related to subjective well-being. The findings suggest that posttraumatic growth contributes to mitigating and buffering (on the order of approximately 10%) the effect of trauma on subjective well-being. PTG seems to be a resource that can help aid workers deal with the consequences of stressful life events. Clinical implications and directions for supervision and training are discussed.

Social support, stress coping strategies, resilience and posttraumatic growth in a Polish sample of HIV-infected individuals: results of a 1 year longitudinal study

This study investigated the level of posttraumatic growth (PTG) and its association with the level of social support, stress coping strategies and resilience among a people living with HIV (PLWH) in a 1 year longitudinal study. We also controlled for age, HIV infection duration and the presence of posttraumatic stress symptoms (PTSS). From the 290 participants, initially eligible for the study, 110 patients were recruited for the first assessment and 73 patients participated in a follow-up assessment. Participants filled out following psychometric tools: the Posttraumatic Growth Inventory (PTGI), the Berlin Social Support Scales (BSSS), the Mini-COPE Inventory, the Resiliency Assessment Scale (SPP-25) and the PTSD-F questionnaire. Received support and resilience were positively, whereas return to religion as coping strategy was negatively related to the PTG. Clinicians and researchers need to focus on potentially positive consequences of HIV infection, i.e. PTG, and factors that might promote it among PLWH.

Correlation Between Posttraumatic Growth and Posttraumatic Stress Disorder Symptoms Based on Pearson Correlation Coefficient: A Meta-Analysis

The literature on posttraumatic growth (PTG) is burgeoning, with the inconsistencies in the literature of the relationship between PTG and posttraumatic stress disorder (PTSD) symptoms becoming a focal point of attention. Thus, this meta-analysis aims to explore the relationship between PTG and PTSD symptoms through the Pearson correlation coefficient. A systematic search of the literature from January 1996 to November 2015 was completed. We retrieved reports on 63 studies that involved 26,951 patients. The weighted correlation coefficient revealed an effect size of 0.22 with a 95% confidence interval of 0.18 to 0.25. Meta-analysis provides evidence that PTG may be positively correlated with PTSD symptoms and that this correlation may be modified by age, trauma type, and time since trauma. Accordingly, people with high levels of PTG should not be ignored, but rather, they should continue to receive help to alleviate their PTSD symptoms.

Posttraumatic Symptoms, Quality of Life, and Survival among Lung Cancer Patients

PURPOSE

This longitudinal study characterized psychological adjustment in a sample of lung cancer patients by examining the occurrence of posttraumatic stress and growth and their relationships with mental and physical health quality of life and survival over time.

METHODS

Two waves of consecutive cohort samples, totaling 115 participants diagnosed with lung cancer, were identified from outpatient oncology clinics. Of these, 93 consented and completed the first of three assessments, and 57 completed the study. Prevalence of posttraumatic stress symptoms (PTSD Checklist) and posttraumatic growth (Posttraumatic Growth Inventory) were assessed and used to predict physical and mental health components of quality of life (Short Form 36) and survival.

RESULTS

Patients reported both negative and positive psychological sequelae, with prevalence of estimated PTSD ranging from 5-16% at each assessment as determined by symptom and cut-off methods. Posttraumatic stress and growth were positively related, but were differentially associated with outcomes. More posttraumatic stress predicted lower mental health quality of life, whereas more posttraumatic growth predicted better physical health quality of life and longer survival. These relationships persisted after accounting for disease variables and attrition due to death or illness.

CONCLUSIONS

These findings highlight the importance of using longitudinal designs to identify relationships between stress and resilience factors in predicting outcomes.

A Systematic Review of Posttraumatic Growth in Survivors of Interpersonal Violence in Adulthood

This review critically evaluates the literature on posttraumatic growth in survivors of interpersonal violence, integrating the findings from 12 quantitative and 4 qualitative studies. The following databases were searched using predetermined terms: AMED, EMBASE, MEDLINE, PsycINFO, BNI, CINAHL, and Web of Knowledge. The review's findings suggest that the mean prevalence of growth in interpersonal violence survivors is around 71% (range 58-99%). The highest level of growth was consistently experienced in the "appreciation of life" domain. However, survivors reported growth in the four remaining domains: "personal strength," "new possibilities," "experience of relationships with others," and "outlook on life." The nature of the relationship between growth and distress was inconsistent across studies. A combination of pretrauma, peritrauma, and posttrauma variables were found to be related to the degree of growth survivors experienced. Methodological weaknesses of the quantitative studies included the predominant use of retrospective, cross-sectional, correlational designs, discrepancy in the measurement of growth, insufficient sample sizes for power calculations in five studies and limited external validity. Qualitative findings were limited by sampling methods, insufficient information about interview schedules, the lack of credibility checks, and evidence of reflexivity demonstrated by some studies. Implications for practice, policy, and future research are discussed.

Moderate Depression Promotes Posttraumatic Growth (Ptg): A Young Population Survey 2 Years after the 2009 L'Aquila Earthquake

Background:

Earthquakes can result in a range of psychopathology and in negative and positive consequences for survivors.

Objective:

To examine the association between clinical aftereffects (anxiety and depressive symptoms) and post-traumatic growth (PTG) among young survivors of the 2009 L’Aquila earthquake, Italy.

Method:

316 young earthquake survivors enrolled in the University of L’Aquila were evaluated two years after the natural disaster. Participants completed three main questionnaires, including Patient Health Questionnaire-9 items (PHQ-9), Self-Rating Anxiety Scale (SAS), and Posttraumatic Growth Inventory (PTGI).

Results:

59.6% of the student sample showed different levels of depression, whereas 13.3% reported anxiety symptoms. In both clinical dimensions (anxiety and depression), gender differences were found: female gender was confirmed risk factor for a clinical post-traumatic response. Personal PTG, demonstrated by 18% of the L’Aquila youths included in our sample, was predicted by moderate levels of depression (O.R. 2.7). In our model, gender, age, and anxiety did not show any predictive value.

Conclusion:

In a post-traumatic setting, the development of individual cognitive strategies is crucial, whereas after a natural disaster, paradoxically, a moderate depressive condition and the related distress could promote the drive to overcome the psychological consequences of the traumatic event.

The Characteristics of Emotional Response of Post-traumatic Stress Disorder and Post-traumatic Growth among Chinese Adults Exposed to an Explosion Incident

Purpose

Post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) are two different outcomes that may occur after experiencing traumatic events. Meanwhile, the traumatic exposure level and emotion response played an important role in the process. The present study first evaluated the relationship between PTSD, PTG, and traumatic exposure level and then compared the characteristics of emotional response through response time of the affective priming paradigm.

Methods

For the purpose of evaluating the relationship between PTSD, PTG, and trauma exposure level, a sample of 2,395 participants completed measures of posttraumatic stress disorder Checklist-Civilian Version (PCL-C), Post-traumatic Growth Inventory (PTGI) and a trauma exposure-related survey, and Pearson’s correlation analysis for the scales were conducted. In order to compare the characteristics of emotional response between PTSD and PTG, we randomly selected 90 participants and divided them into groups of PTSD, PTG, and control according the scores of PCL-C and PTGI, then the 90 participants were asked to do the affective priming task and the response time was recorded, at last analysis of variance was employed to analyze the data.

Results

The results indicated that PTSD was not correlated with PTG. It was positively correlated with the traumatic exposure level, but PTG was not observed in this phenomenon. Finally, the data of response time showed that PTSD required more time to do the priming task and PTG demonstrated no difference compared to the control group.

Conclusion

Combined with previous research findings, the relationship between PTSD and PTG may depend on the type and severity of the trauma, the exposure level, and other such parameters. In terms of positive outcome of trauma PTG displayed no changes of emotional performance from the perspective of behavior. The preliminary results suggested that PTG was more related to a self-reported or self-experienced state.

What Determines Posttraumatic Stress and Growth Following Various Traumatic Events? A Study in a Turkish Community Sample

This study aimed to examine the roles of personality traits, traumatic event types, coping, rumination, and social support in explaining posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in a representative community sample of 498 Turkish adults. The results of 2 multiple regression analyses showed that PTS was associated with neuroticism, experiencing events involving intentional/assaultive violence, intrusive and deliberate rumination, and fatalistic coping. In contrast, PTG was related to conscientiousness, openness to experience, injury/shocking and sudden-death type of events, deliberate rumination, problem-solving coping, and perceived social support. When all variables were entered into the equation, almost two thirds of the variability (R² = .64) in the severity of PTS and more than one third of the variability (R² = .40) in PTG was explained. The findings can aid in the development of psychosocial support programs for individuals experiencing traumatic events.

Posttraumatic growth and depreciation six years after the 2004 tsunami

Background: Posttraumatic growth (PTG) has been reported after various types of potentially traumatic events, as a part of the personal recovery process among survivors. Even negative changes in survivors' life view, known as posttraumatic depreciation (PTD), have been identified as an additional aspect in the personal recovery processes. Objective: To examine how the type of exposure experienced by survivors of a natural disaster, the 2004 Southeast Asia tsunami, influenced self-reported PTG and PTD six years later (T2). Additionally, the study examined the relations between psychological distress and posttraumatic stress symptoms (PTSS) 14 months after the disaster (T1), to PTG and PTD, respectively at T2. Finally, the study examined whether psychological distress and PTSS (T1) could have a mediating effect on PTG and PTD at T2. Method: The participants were 848 tsunami survivors living in Stockholm, Sweden who responded to a questionnaire at 14 months (T1) and six years (T2) after the tsunami. The material was analysed using linear regression and pathway analysis. PTG and PTD were measured on separate scales. Results: The type of exposure was significant related to both PTG and PTD six years later (T2). Those experiencing a combination of various types of exposure (including threat to life and bereavement) reported higher scores for both PTG and PTD. There were significant positive correlations between PTSS at T1 and PTG /PTD at T2, and somewhat lower correlations between psychological distress at T1 and PTG/PTD at T2. Both PTSS and psychological distress at T1 were significant mediating variables for both PTG and PTD at T2. Conclusions: Studying survivors' various types of exposure and subsequent changed view of life - both PTG and PTD - resulted in a broadened understanding of the complexity of reactions and the recovery process among survivors.

Age at cancer diagnosis, non-O blood group and asparaginase therapy are independently associated with deep venous thrombosis in pediatric oncology patients: A risk model

INTRODUCTION

Pediatric oncology patients are at increased risk for deep venous thrombosis (DVT). Determining the sub-population of children at increased DVT risk is critical for optimum clinical management. Therefore, the aim of the current study was to identify clinical risk factors for DVT which are easily identifiable at cancer diagnosis.

MATERIALS AND METHODS

A Canadian multicenter case control study in survivors of childhood cancer. Survivors who had DVT (Cases) while being treated for pediatric cancer where matched by center with a minimum of two survivors who did not experience DVT (Controls). Clinical information including age at diagnosis, type of cancer and chemotherapy were collected. Genotyping of blood group was done by single nucleotide polymorphisms analysis.

RESULTS

218 subjects were recruited at 4 Canadian pediatric centers. Multivariable analysis demonstrated 3 significant variables (reported as Odds Ratio (OR), (95% CI), p value): age at diagnosis p<0.001, non-O blood group OR 2.6 (1.3-5.2) p=0.005 and asparaginase treatment OR 2.4 (1.2-4.8) p=0.011. In order to optimise clinical utility, we reanalysed the study data with age at diagnosis categorised into four subgroups 0-≤2years, >2-≤7years, >7≤10years, >10years. A significant association with DVT were seen in children 0-≤2years (OR 3.1 (1.1-8.3) p=0.026) and >10years (OR 3.8, 1.7-8.5 p=0.001). Significant associations with DVT remained for non-O blood group, OR 2.2 (1.2-4.4) p=0.016 and asparaginase treatment, OR 2.1 (1.1-4.0) p=0.027. The value for the clinical risk model receiver operating characteristics curve was 0.67.

CONCLUSIONS

We have shown 3 independent risk factors for DVT in childhood cancer.

Gender differences in posttraumatic stress symptoms and the level of posttraumatic growth among a Polish sample of HIV-positive individuals

The main goal of the current study was to investigate gender differences in the relationship between the level of posttraumatic stress symptoms (PTSSs) and the intensity of posttraumatic growth (PTG), treated as the explained variable, among a Polish sample of HIV-positive individuals (n = 250) while controlling for participants' ages and time since HIV diagnosis. The level of PTG was measured using the Polish adaptation of the Posttraumatic Growth Inventory. The level of PTSSs was assessed using the PTSD Factorial Version Inventory. HIV-positive women scored higher for some PTSSs (intrusion/arousal) and for a particular PTG dimension (spiritual change). In addition, the PTSSs that occurred were negatively related to the PTG level but only among HIV-positive women. Given the important health-related benefits associated with PTG among HIV-positive people, it is vital to shape competencies for effective growth promotion among these individuals, taking into account gender differences within this phenomenon.

Relationships Between Latent Factors of Posttraumatic Stress Disorder and Posttraumatic Growth

In the present study, we examined posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) responses among a nonclinical sample of 202 participants. Instruments included the PTSD Checklist for the DSM-5 (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) and Posttraumatic Growth Inventory. Confirmatory factor analysis demonstrated the most support for the 6-factor DSM-5 PTSD model and 5-factor PTG model, previously supported in the literature. Canonical correlation analysis evidenced a strong relationship between PTSD and PTG subscales. Path analysis results demonstrated that PTSD's re-experiencing subscale was related to PTG's appreciation for life subscale. Posttraumatic stress disorder's avoidance was related to PTG's personal strength subscale. We also tested curvilinear relationships between PTSD and PTG subscales. Results and implications are discussed in the context of the constructs of PTSD and PTG.

Perceived social support, hopefulness, and emotional regulations as mediators of the relationship between enacted stigma and post-traumatic growth among children affected by parental HIV/AIDS in rural China

Some previous studies have revealed a negative impact of enacted stigma on post-traumatic growth (PTG) of children affected by HIV/AIDS, but little is known about protective psychological factors that can mitigate the effect of enacted stigma on children's PTG. This study aims to examine the mediating effects of perceived social support, hopefulness, and emotional regulation on the relationship between enacted stigma and PTG among HIV-affected children. Cross-sectional data were collected from 790 children affected by parental HIV (382 girls, 408 boys) aged 6-17 years in 2012 in rural central China. Multiple regression was conducted to test the mediation model. The study found that the experience of enacted stigma had a negative effect on PTG among children affected by HIV/AIDS. Emotional regulation together with hopefulness and perceived social support mediated the impact of enacted stigma on PTG. Perceived social support, hopefulness, and emotional regulation offer multiple levels of protection that can mitigate the impact of enacted stigma on PTG. Results suggest that future psychological intervention programs should seek strategies to reduce the stigmatizing experience of these children and promote children's level of PTG, and health professionals should also emphasize the development of these protective psychological factors.

Stressful Life Events and Predictors of Post-traumatic Growth among High-Risk Early Emerging Adults

Stressful life events (SLEs) may elicit positive psychosocial change among youth, referred to as Post-traumatic Growth (PTG). We assessed types of SLEs experienced, degree to which participants reported PTG, and variables predicting PTG across 24 months among a sample of high risk, ethnically diverse early emerging adults. Participants were recruited from alternative high schools (n = 564; mean age=16.8; 65% Hispanic). Multi-level regression models were constructed to examine the impact of environmental (SLE quantity, severity) and personal factors (hedonic ability, perceived stress, developmental stage, future time orientation) on a composite score of PTG. The majority of participants reported positive changes resulted from their most life-altering SLE of the past two years. Predictors of PTG included fewer SLEs, less general stress, having a future time perspective, and greater identification with the developmental stage of Emerging Adulthood. Findings suggest intervention targets to foster positive adaptation among early emerging adults who experience frequent SLEs.

LONGITUDINAL COURSE OF POSTTRAUMATIC GROWTH AMONG U.S. MILITARY VETERANS: RESULTS FROM THE NATIONAL HEALTH AND RESILIENCE IN VETERANS STUDY

BACKGROUND

Posttraumatic growth (PTG) is increasingly recognized as an important psychosocial phenomenon, but few studies have evaluated the longitudinal course of PTG. This study identified courses of PTG over a 2-year period in a contemporary, nationally representative sample of U.S. military veterans, and examined sociodemographic, military, trauma, medical, and psychosocial predictors of PTG course.

METHODS

Data were based on a Web-based survey of a nationally representative sample of 1,838 U.S. veterans who reported at least one potentially traumatic event and provided data at two time points (October-December 2011 and September-October 2013).

RESULTS

Five different courses of PTG were identified--Consistently Low (33.6%), Moderately Declining (19.4%), Increasing PTG (16.8%), Dramatically Declining (15.7%), and Consistently High (14.5%). More than half (59.4%) of veterans who reported at least "moderate" PTG maintained that level of PTG 2 years later. Posttraumatic stress disorder symptoms, medical conditions, purpose in life, altruism, gratitude, religiosity, and an active reading lifestyle predicted maintenance or increase in PTG.

CONCLUSIONS

PTG has a heterogeneous course and is not only common, but can persist over time especially in the presence of posttraumatic stress and certain psychosocial factors. Clinicians and researchers should consider the personal growth that can result from trauma and help trauma survivors find ways to maintain this growth over time.