Posttraumatic stress and posttraumatic growth among low-income mothers who survived Hurricane Katrina

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.

Life after Hurricane Katrina: The Resilience in Survivors of Katrina (RISK) Project

This article presents an overview of the findings to date of the Resilience in Survivors of Katrina (RISK) Project, a longitudinal study of 1,019 young, predominantly female and African American community college students who were surveyed a year before Hurricane Katrina in New Orleans and then two to three times afterward. This study combines a multidisciplinary, multimethod approach to understanding the immediate and long-term effects of the Katrina disaster on physical and mental health, economic and social functioning, and neighborhood attainment. I discuss what we can learn from the rare inclusion of predisaster data and our unusual ability to follow participants for years after the disaster. I argue that it is important to follow the recovery of individuals and communities as well as the recovery of the city, as these are often not the same, especially in Katrina where a large proportion of the city never returned.

Meaning and Posttraumatic Growth Among Survivors of the September 2013 Colorado Floods

In the wake of significant adversity, a range of recovery outcomes are possible, from prolonged distress to minimal effects on functioning and even psychological growth. Finding meaning in one's life is thought to facilitate optimal recovery from such adversity. Research on psychological growth and recovery often focuses on the daily hassles or significant traumas of convenience samples or on people's psychological recovery from medical illness. A small body of research is developing to test theories of growth among survivors of natural disasters. The present study of 57 survivors of the 2013 Colorado floods tested the incremental relations between posttraumatic growth (PTG) and dimensions of meaning in life, vitality, and perceived social support. The most consistent relations observed were among the one dimension of meaning-search for meaning-perceived social support, and PTG. Despite the limitations of this study, we conclude that search for meaning in life may be an important part of recovery from natural disasters, floods being one example.

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.

Posttraumatic stress disorder and posttraumatic growth coexistence and the risk factors in Wenchuan earthquake survivors

Various studies have assessed the negative and/or positive changes in the aftermath of traumatic events. Yet few of these have addressed the factors associated with the coexistence of both negative and positive changes after a devastating earthquake. The aim of this study is to assess the relationship between the negative and positive changes and elucidate the risk factors of such changes one year after Wenchuan earthquake. A total of 2080 survivors from 19 counties participated in a self-report questionnaire survey which included the posttraumatic stress disorder (PTSD) Check list-Civilian, the posttraumatic growth PTG Inventory (PTGI). The prevalence of PTSD and moderate PTG was found to be 40.1% (95% CI [37.9% 42.3%]) and 51.1% (95% CI [48.9% 53.3%]). The PTSD and moderate PTG coexistence was 19.6% (95% CI [17.8% 21.4%]). PTSD symptom severity was significantly positively associated with the PTG score. Middle aged groups (31-40 and 41-50 years old, OR=2.323, 95% CI [1.059, 5.095] and OR=2.410, 95% CI [1.090, 5.329] respectively), those with lower income levels (OR=8.019, 95% CI [2.421, 26.558]), those living in temporary house (OR=1.946, 95% CI [1.280, 2.956]), and those who had had less social support (OR=1.109, 95% CI [1.076, 1.143]) had a significantly higher possibility for the presence of PTSD and moderate PTG coexistence. The results indicated the widespread positive changes in earthquake survivors. Better income levels and living conditions and higher social support were suggested to promote PTG in those with PTSD.

Meaning Making in the Context of Disasters

OBJECTIVE

Understanding the factors underlying adaptive psychological responses and recovery after disasters has important implications for intervention and prevention efforts. To date, little attention has been paid to successful coping processes in recovering from natural and technological disasters. This article takes a meaning making perspective to explicate how survivors successfully adapt after disasters.

METHOD

Relevant literature is reviewed to illustrate the process of adaptation and resilience after disasters.

RESULTS

Studies to date suggest both survivors' global meaning, particularly their religiousness and sense of meaning, and their appraisals and meaning making after the disaster are important influences on their postdisaster resilience. Meanings made in the form of changes in global beliefs and perceived growth have been reported and shown to have inconsistent relations with adjustment.

CONCLUSIONS

Although much more research is needed, current literature suggests that meaning making processes are central to recovery and resilience after a range of disasters.

Exposure to war traumatic experiences, post-traumatic stress disorder and post-traumatic growth among nurses in Gaza

ACCESSIBLE SUMMARY

What is known on the subject? This study builds on existing research on war-related factors that may affect health-care staff by particularly focusing on trauma exposure in both professional and everyday life, as well as on correlates of later positive psychological changes. What this paper adds to existing knowledge? It shows that one in five nursing staff working in Gaza experienced post-traumatic stress symptoms within the clinical range, 2 years after an incursion on Gaza and after being exposed to substantial trauma during this period. Participants appeared to develop a variety of post-traumatic growth responses following trauma exposure. Although nurses experienced traumatic events both as civilians and in their health-care capacity, personal exposure was strongly associated with PTSD symptoms. What are the implications for practice? Support to nursing and other health-care professionals in war situations should entail different levels, remain available well after an acute conflict, and take into consideration both personal and practice-related traumatic events. Mental health nursing practitioners can play a pivotal role in this.

AIM

To establish the association between war traumatic experiences, post-traumatic stress disorder (PTSD) symptoms and post-traumatic growth among nurses in the Gaza Strip, 2 years after an incursion on Gaza, and during a period of ongoing trauma exposure. This study builds on existing evidence by considering exposure to personal and work-related traumatic events, and on factors associated with later positive psychological adaptation.

METHODS

The sample consisted of 274 randomly selected nurses in Gaza who completed the Gaza Traumatic Events Checklist, PTSD Checklist, and Posttraumatic Growth Inventory.

RESULTS

Of the nurses, 19.7% reported full PTSD. There was a significant relationship between traumatic events and PTSD scores; as well as between community-related traumatic events and post-traumatic growth. Participants reported a range of traumatic events, but PTSD and post-traumatic growth scores were more strongly associated with community rather than work-related traumas.

DISCUSSION

Nursing professionals experienced high levels of distress 2 years following an acute period of conflict, both as civilians and in their health-care capacity.

IMPLICATIONS FOR PRACTICE

There is need for different levels of support for health-care staff in war-affected areas. Mental health nursing professionals have a central role in training, counselling and support to other health-care colleagues.

A Longitudinal Investigation of the Relationship between Posttraumatic Stress Symptoms and Posttraumatic Growth in a Cohort of Israeli Jews and Palestinians during Ongoing Violence

Objectives

Meta-analytic evidence based on cross-sectional investigations between posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD) demonstrates that the two concepts are positively related and that ethnic minorities report greater PTG. Few longitudinal studies have quantified this relationship so the evidence is limited regarding the potential benefit PTG may have on post-traumatic adjustment and whether differences between ethnic groups exist.

Methods

The current study attempts to fill a substantial gap in the literature by exploring the relationship between PTG and PTSD symptom clusters longitudinally using a nationally representative cohort of 1613 Israelis and Palestinian Citizens of Israel (PCI) interviewed via telephone on three measurement occasions during one year. Latent cross-lagged structural models estimated the relationship between PTG and each PTSD symptom cluster, derived from confirmatory factor analysis, representing latent and statistically invariant PTSD symptom factors, best representing PTSD for both ethnic groups.

Results

PTG was not associated with less PTSD symptom severity in any of the four PTSD clusters, for Jews and PCI. In contrast, PTSD symptom severity assessed earlier was related to later reported PTG in both groups.

Conclusions

This study demonstrates that PTSD symptoms contribute to greater reported PTG, but that PTG does not provide a salutatory benefit by reducing symptoms of PTSD.

Perceptions of distress and positive consequences following exposure to a major disaster amongst a well-studied cohort

OBJECTIVES

Research on the impact of natural disasters on health and well-being faces several methodological challenges, including: sampling issues; exposure assessment; and outcome measurement. The present study used a comprehensive measure of disaster exposure to assess relationships between exposure to the Canterbury (New Zealand) Earthquakes of 2010-2011 and both: (a) self-reported distress and (b) positive outcomes; and also investigated gender differences in reports.

METHODS

Data were gathered from the Christchurch Health and Development Study, a 35-year longitudinal study. The study examined data from 495 individuals exposed to the Canterbury Earthquakes for who complete data on exposure and reactions to the earthquakes at age 35 were available.

RESULTS

Participants with higher levels of exposure to the earthquakes reported significantly (p<0.0001) higher levels of distress due to fear, death and injury, and disruption caused by the earthquakes. Higher levels of exposure to the earthquakes were also associated with significantly (p<0.0001) higher levels of reporting positive consequences following the earthquakes. Women reported significantly (p<0.0001) greater distress than men and significantly (p<0.001) greater positive consequences.

CONCLUSIONS

Higher levels of exposure to disaster were associated with higher levels of distress, but also with higher levels of self-reported positive outcomes, with females reporting higher levels of both positive and negative outcomes. The findings highlight the need for comprehensive assessment of disaster exposure, to consider gender and other group differences in reactions to disaster exposure, and for studies of disasters to examine both positive and negative consequences.

Posttraumatic growth, depression and posttraumatic stress in relation to quality of life in tsunami survivors: a longitudinal study

Background

Quality of life (QoL) may often be reduced in survivors of a natural disaster. This paper investigated how posttraumatic growth (PTG), depression and posttraumatic stress interact and independently predict QoL in a longitudinal study of disaster survivors.

Methods

A total of 58 Norwegian adults who were present in Khao Lak, Thailand at the time of the 2004 Southeast Asia Tsunami completed self-report questionnaires 2 and 6 years after the disaster. The participants reported symptoms of depression and posttraumatic stress as well as PTG and QoL. Multiple mixed effects regression analyses were used to determine the independent effects of PTG, depression and posttraumatic stress on QoL measured 2 and 6 years after the disaster.

Results

Posttraumatic stress and depression were negatively related to QoL. PTG was not significantly related to QoL in a bivariate analysis. However, considerable interaction effects were found. Six years after the tsunami, high levels of posttraumatic stress were related to lower QoL in those participants with low levels of PTG, whereas lower levels of depression were related to higher QoL in those participants with high levels of PTG.

Conclusions

Posttraumatic stress and depression are negatively associated with QoL after a natural disaster. PTG may serve as a moderating factor in this relationship.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-014-0202-4) contains supplementary material, which is available to authorized users.

Posttraumatic growth in the aftermath of a disaster: looking for the role of gender

In the past 10 years, the literature on disasters and mental health has shifted from a focus on psychopathology, to an interest in documenting manifestations of resilience in the face of mass trauma. The Jin et al. study, published in this issue of the Journal, examines gender differences in the relationship between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in the aftermath of the Wenchuan Earthquake in China. The study suggests that the coping response to PTSD may differ between males and females, and raises interesting questions about the types of factors that contribute to the manifestation of high versus low PTG given high levels of PTSD. At the same time, this type of study highlights the need to investigate the long-term impact and meaning of PTG, and to examine whether it reflects an adaptive process with long-term benefits in the face of traumatic exposures, or an illusory type of posttraumatic response.

Interaction between genetic variants and exposure to Hurricane Katrina on post-traumatic stress and post-traumatic growth: a prospective analysis of low income adults

BACKGROUND

There is considerable variation in psychological reactions to natural disasters, with responses ranging from relatively mild and transitory symptoms to severe and persistent posttraumatic stress (PTS). Some survivors also report post-traumatic growth (PTG), or positive psychological changes due to the experience and processing of the disaster and its aftermath. Gene-environment interaction (GxE) studies could offer new insight into the factors underlying variability in post-disaster psychological responses. However, few studies have explored GxE in a disaster context.

METHODS

We examined whether ten common variants in seven genes (BDNF, CACNA1C, CRHR1, FKBP5, OXTR, RGS2, SLC6A4) modified associations between Hurricane Katrina exposure and PTS and PTG. Data were from a prospective study of 205 low-income non-Hispanic Black parents residing in New Orleans prior to and following Hurricane Katrina.

RESULTS

We found a significant association (after correction) between RGS2 (rs4606; p=0.0044) and PTG, which was mainly driven by a cross-over GxE (p=0.006), rather than a main genetic effect (p=0.071). The G (minor allele) was associated with lower PTG scores for low levels of Hurricane exposure and higher PTG scores for moderate and high levels of exposure. We also found a nominally significant association between variation in FKBP5 (rs1306780, p=0.0113) and PTG, though this result did not survive correction for multiple testing.

LIMITATIONS

Although the inclusion of low-income non-Hispanic Black parents allowed us to examine GxE among a highly vulnerable group, our findings may not generalize to other populations or groups experiencing other natural disasters. Moreover, not all participants invited to participate in the genetic study provided saliva.

CONCLUSIONS

To our knowledge, this is the first study to identify GxE in the context of post-traumatic growth. Future studies are needed to clarify the role of GxE in PTS and PTG and post-disaster psychological responses, especially among vulnerable populations.