Factors associated with posttraumatic growth among parents of children with cancer

Cognitive processing, resilience, and family functioning as contributors to posttraumatic growth in family caregivers of patients with Alzheimer's disease

OBJECTIVES

The present study examined the existence of posttraumatic growth (PTG) and its association with cognitive processing, resilience, and family functioning in family caregivers of patients with Alzheimer's disease (AD).

METHOD

Family caregivers (N = 114) were surveyed using measures of cognitive processing, resilience, family functioning, and PTG. Data were analyzed using descriptive statistics, Pearson correlations, and multiple regression analyses.

RESULTS

The average PTG score in the sample was 48.6 (SD = 18.7; range 14-105). Race, education level, severity of the patient's AD, cognitive processing, resilience, and family functioning explained 25.8% of the variance in PTG (F [9, 95] = 5.025, p < 0.001). Race was significantly correlated with PTG; specifically, non-White caregivers reported higher PTG than White caregivers (p < 0.05). When controlling for race and education level, mild AD, intrusive rumination, and family satisfaction were significant predictors of PTG (p < 0.05). However, deliberate rumination, resilience, and family communication were not significant predictors PTG (p > 0.05).

CONCLUSION

These findings provide insight into factors that may influence the development of PTG in family caregivers of patients with AD. Results may inform intervention strategies to mitigate the negative consequences of caregiving and promote PTG in this caregiver population.

Predictors of Moderate-High Posttraumatic Growth in Parents of Children With Cancer: A Cross-sectional Study

BACKGROUND

Parents of children with cancer may experience posttraumatic growth (PTG). In clinical practice, this parental enhancement is more likely to be seen with a moderate-high PTG.

OBJECTIVE

The aim of this study was to determine the moderate-high PTG prevalence of parents of children diagnosed with cancer at least 6 months and to investigate its relationship with hope, social support, and patient-parent characteristics.

METHODS

This cross-sectional study was conducted with the parents of children with cancer admitted to the pediatric hematology-oncology unit using the Parent-Child Characteristic Questionnaire, Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support and Dispositional Hope Scale. Univariate and multivariate logistic regression analyses were performed to investigate the variables associated with moderate-high PTG.

RESULTS

One hundred one parents were enrolled in this study, and the prevalence of the moderate-high PTG was 79.2%. There was a statistically significant difference between moderate-high PTG and children's age (P = .037). Multivariate logistic regression analysis showed that social support from significant others (odds ratio = 1.138, 95% confidence interval = 1.030-1.257, P = .011) was a predictor of moderate-high PTG.

CONCLUSIONS

Moderate-high PTG is common among parents of children diagnosed with cancer. Perceived social support from healthcare professionals and other patient parents is a predictive factor.

IMPLICATIONS FOR PRACTICE

Interventions that encourage the support of health professionals and interaction with the parents of other patients, such as peer counseling, group-based interventions, and expanding the social support network, seem to be clinically promising in helping parents to improve from the cancer experience.

Illness cognition and associated socio-demographic and clinical factors in parents of children with leukemia

PURPOSE

Illness cognition is an important mediator between psychological and behavioral adjustment and the quality of life for patients and their caregivers. Evidence related to illness cognition among parents of children with leukemia is limited. The purpose of this study is to explore the illness cognition status and associated factors in parents of children with leukemia.

METHODS

A cross-sectional survey was conducted with the parents of 335 children with leukemia from three general children's hospitals in China from January to December 2022. A parents' version of the illness cognition questionnaire was used to collect data. This included three subscales: helplessness, acceptance, and perceived benefits.

RESULTS

The mean scores of helplessness, acceptance and perceived benefits of parents regarding their children's disease were 15.56 (4.60), 16.25 (4.41), and 19.96 (3.69) respectively. The multiple regression model indicated seven factors associated with the parents' illness cognition (adjusted R [2] ranged from 0.182 to 0.134): four socio-demographic factors (parent's age, role, education level, and family income) and three clinical factors (length of time spent each day caring for the child, the child's age at diagnosis, and the duration of the disease).

CONCLUSION

This study reports on different levels of illness cognition and associated factors among parents of children with leukemia. The results may help pediatric oncology medical staff identify risk factors for poor psychological adjustment to children's diseases. Parents may benefit from psychological support aimed at improving positive illness cognition.

Post-traumatic growth correlates among parents of children with chronic illnesses: A systematic review and meta-analysis

Parenting a child with a chronic illness presents a complex journey marked by various challenges, along with possible personal growth following these challenges. In this systematic review we present three meta-analyses, in order to examine the associations of post-traumatic growth (PTG) among parents of children with diverse chronic illnesses, and psychological distress, social support, and resilience. Analyzing 34 studies encompassing a total of 5328 parents, the results reveal several key findings. First, PTG was found to be prevalent among the parents. Second, there was no significant correlation between PTG and psychological distress, suggesting that these two processes may exist independently. Third, a positive correlation was observed between PTG and both social support and resilience-related factors, underscoring the role of these factors in fostering growth among parents of children with chronic illnesses. Additionally, illness type emerged as a moderator, affecting the strength of the above-mentioned correlations with PTG. Specifically, in the case of psychiatric illnesses, correlations of PTG with social support and resilience were stronger than in the context of other illnesses. Overall, this review emphasizes the significance of recognizing and addressing PTG correlates among parents of children with chronic illnesses, offering insights for clinical practice.

Post-traumatic growth in parents of long-term childhood cancer survivors compared to the general population: A report from the Swiss childhood cancer survivor study-Parents

OBJECTIVE

Post-traumatic growth (PTG) describes perceived positive changes following a traumatic event. We describe (i) PTG in parents of long-term childhood cancer survivors (CCS-parents) compared to parents of similar-aged children of the general population (comparison-parents), (ii) normative data for the Swiss population, and (iii) psychological, socio-economic, and event-related characteristics associated with PTG.

METHODS

CCS-parents (aged ≤16 years at diagnosis, ≥20 years old at study, registered in the Childhood Cancer Registry Switzerland (ChCR), and the Swiss population responded to a paper-based survey, including the PTG-Inventory (total score 0-105). We carried out (i) t-tests, (ii) descriptive statistics, and (iii) multilevel regression models with survivor/household as the cluster variable.

RESULTS

In total, 746 CCS-parents (41.7% fathers, response-rate = 42.3%) of 494 survivors (median time since diagnosis 24 (7-40) years), 411 comparison-parents (42.8% fathers, 312 households), and 1069 individuals of the Swiss population (40.7% male, response-rate = 20.1%) participated. Mean [M] total PTG was in CCS-parents M = 52.3 versus comparison-parents M = 50.4, p = 0.078; and in the Swiss population M = 44.5). CCS-parents showed higher 'relating-to-others' (18.4 vs. 17.3, p = 0.010), 'spiritual-change' (3.3 vs. 3.0, p = 0.038) and 'appreciation-of-life' (9.3 vs. 8.4, p = 0.027) than comparison-parents, but not in 'new-possibilities' and 'personal-strength'. Female gender, older age, higher post-traumatic stress, and higher resilience were positively associated with PTG. Individuals reporting events not typically classified as traumatic also reported growth.

CONCLUSIONS

Our findings highlight that mothers and fathers can experience heightened growth many years after their child's illness. Being able to sensitively foreshadow the potential for new-possibilities and personal development may help support parents in developing a sense of hope.

Associations among posttraumatic growth, demographic characteristics, posttraumatic stress symptoms, and trauma type, with a focus on sexual violence

This study assessed posttraumatic growth (PTG) across multiple trauma types and by demographic characteristics (i.e., sex, age, education). Moreover, we examined the association between PTG and posttraumatic stress disorder (PTSD) symptoms as well as the characteristics and predictors of PTG after sexual violence. A phone survey was conducted in a nationally representative sample of 1,766 Icelandic adults. In total, 1,528 individuals reported having experienced some form of trauma and were included in the analysis, and 563 reported experiencing sexual violence. Interpersonal trauma (e.g., sexual violence, emotional abuse, and domestic violence) was associated with the highest levels of PTG. Moderate levels of PTSD symptoms were associated with the highest levels of PTG, whereas high- or low-level PTSD symptoms were related to less PTG. Women reported significantly more PTG than men, d = 0.16 and survivors of sexual violence reported significantly more PTG than individuals who reported other forms of trauma exposure, d = 0.28. Among sexual violence survivors, no demographic factors were associated with PTG, but cumulative trauma and positive social reactions were significantly related to higher levels of PTG. This study highlights that personal growth can result from aversive experiences and suggests a curvilinear association between PTG and PTSD symptoms.

Concerns experienced by parents of children treated for cancer: A qualitative study to inform adaptations to an internet-administered, low-intensity cognitive behavioral therapy intervention

OBJECTIVE

Childhood cancer treatment completion is associated with mental health difficulties and negative socioeconomic consequences for parents. However, psychological support needs are often unmet. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy-based self-help intervention (EJDeR) and examined feasibility and acceptability with a single-arm feasibility trial (ENGAGE). Results suggest EJDeR is acceptable, however, adherence, especially for fathers, could be improved. Following the Medical Research Council complex interventions framework, this study explores concerns experienced by parents actively seeking support related to their child's cancer who were recruited into ENGAGE to inform further adaptation of EJDeR.

METHOD

Seventy-three semi-structured interviews (26 fathers, 47 mothers) were conducted, with data analyzed using manifest content analysis.

RESULTS

Analysis resulted in seven categories: (1) Feeling lost and lonely in life; (2) Low mood; (3) Parenting difficulties; (4) Productivity difficulties; (5) Relationship challenges; (6) Stress reactions; and (7) Worry. With the exception of subcategories Afraid of not being a good parent, Cancer recurrence, and Child's development and future a somewhat higher percentage of mothers than fathers mentioned all identified concerns.

CONCLUSION

Parents described experiencing a range of concerns after their child had completed cancer treatment. EJDeR will be adapted to address these concerns and include indirect intervention modules targeting concerns such as stress. Information to support parenting, relationships, finance, and employment difficulties, alongside signposting to inform help-seeking, will be included. Findings also suggest a need to improve the gender-sensitivity of EJDeR.

A meta-analysis of the association between event-related rumination and posttraumatic growth: The Event-Related Rumination Inventory and the Posttraumatic Growth Inventory

Trauma can disrupt an individual's core beliefs about themselves, others, and the world. Posttraumatic growth (PTG) is thought to be the outcome of a reconstruction process involving ruminative processing. This meta-analysis examined the strength of the associations between event-related intrusive and deliberate rumination and PTG. The moderating effects of variables including age, time since trauma exposure, and trauma type were examined. Eight databases were searched for English-language, peer reviewed studies examining the associations between PTG and types of event-related rumination in adults. Effect sizes (Pearson's r) were extracted and analyzed, and study quality was assessed using the Study Quality Assessment Tool for Observational and Cohort studies. In total, 46 studies were included based on the inclusion and exclusion criteria. A significant main effect was observed for the association between retrospectively reported deliberate rumination that occurred soon after a traumatic event and PTG, r = .45, 95% CI [.41, .49]. There was significant variability in effect sizes, and the strength of this association differed according to age. The association between intrusive rumination and PTG was not significant and varied in direction. Deliberate rumination that occurred relatively soon following trauma exposure was shown to be positively associated with PTG. The findings highlight the importance of supporting trauma survivors to engage in the deliberate cognitive processing of their experiences to encourage PTG. Longitudinal research is needed to further delineate the temporal role of event-related rumination in PTG development.

PTSD and PTG in French and American Firefighters: A Comparative Study

Studies show that experiencing traumatic events can lead to positive psychological change, or posttraumatic growth (PTG). In the hope of promoting PTG, authors have been focusing on identifying the factors that may foster PTG. Despite these attempts, the literature shows inconsistencies, making it difficult to know which variables may be involved in the process of growth. Indeed, authors seem to disagree on the nature of the relationship between PTSD and PTG, time since the event, social support, intrusive rumination, and sociodemographics. Thus, this study aims to clarify these discrepancies, and verify whether the processes involved are the same across two different cultural groups, both of which are confronted with traumatic events regularly: 409 American firefighters, and 407 French firefighters. Results indicate that, in both samples, PTG is positively related to PTSD, subjective perceptions of the event, stress during the event, disruption of core-beliefs, and deliberate rumination; and unrelated to social support, core-self evaluations, and socio-demographic variables (age, gender, relationship status, etc.). However, time since the event and the number of years on the job only predicted PTG in the American sample, while colleague and emotional support only predicted PTG in the French sample. Additionally, American firefighters reported more growth, more social support, more positive self-perceptions, more intrusive rumination, and more neuroticism than French firefighters. These results suggest that the process of growth, as defined by Tedeschi and Calhoun, is relatively stable among firefighters, but that some differences do exist between cultural groups.

Posttraumatic Growth in Youth, Young Adults, and Caregivers Who Experienced Solid Organ Transplant

OBJECTIVE

To explore posttraumatic growth (PTG) in pediatric patients who have undergone solid organ transplant (SOT) and their caregivers, and to examine potential correlates of PTG.

METHOD

Youth and young adults with a history of SOT (heart, kidney, liver) at least 1 month prior to participation and caregivers completed measures of PTG, demographic, and medical factors. In total, 59 youth (M = 12.68 years, SD = 1.91), 21 young adults (M = 19.37, SD = 0.82), and 95 caregivers (M = 37.95 years, SD = 9.37) participated.

RESULTS

Overall, 67% of youth, 76% of young adults, and 89% of caregivers reported PTG within the medium to very high range. Appreciation of Life was the highest PTG subscale across all groups. Youth and caregiver PTG scores were significantly positively correlated. Religious affiliation and religious coping were positively associated with PTG for caregivers, and the relationship yielded large effect sizes for young adults. Caregivers of children with kidney transplants endorsed lower PTG than other organ types and caregivers of children who had an acute medical condition endorsed greater PTG than caregivers of children who had chronic illness.

CONCLUSION

Findings suggest the pediatric SOT experience can yield positive changes such as a greater appreciation of life. Although small sample sizes may have led to reduced power for detecting significant findings for some analyses, results suggest religious, medical, and parent-child relationship factors are likely related to PTG in pediatric SOT and warrant future investigation.

Understanding the relationship between traumatic suffering, posttraumatic growth, and prosocial variables

OBJECTIVE

We investigated facets of posttraumatic growth (PTG) theory, including the nature of the index event, the relationship between suffering and PTG, and prosocial correlates of PTG.

METHODS

Undergraduate students (N = 253) completed measures of PTG and trauma-related, psychopathology/affect, and prosocial correlates.

RESULTS

Differences emerged in PTG according to event severity, with greater PTG for those who experienced a trauma compared to a stressor. PTG was associated with nearly all trauma-related, select psychopathology/affect (e.g., anxiety, positive affect) and prosocial (e.g., empathy, volunteerism) variables. In a multivariable model, race/ethnicity, helpfulness, perceived chronicity of distress, and positive affect were associated with PTG. Curvilinear trends demonstrated that moderate chronicity of distress and current emotional distress from trauma were associated with the greatest PTG.

CONCLUSIONS

Findings highlight factors associated with growth, including a moderately distressing trauma, positive affect, and prosocial behavior. Results clarify PTG theory and contribute to understanding conflicting evidence in prior PTG literature.

A Systematic Review of Benefit-Finding and Growth in Pediatric Medical Populations

OBJECTIVE

This review synthesizes the literature on benefit-finding and growth (BFG) among youth with medical illnesses and disabilities and their parents. Specifically, we summarized: (a) methods for assessing BFG; (b) personal characteristics, personal, and environmental resources, as well as positive outcomes, associated with BFG; (c) interventions that have enhanced BFG; and (d) the quality of the literature.

METHODS

A medical research librarian conducted the search across PubMed, Scopus, PsycInfo, Google Scholar, and Cochrane Library. Studies on BFG among children ages 0-18 with chronic illnesses and disabilities, or the parents of these youth were eligible for inclusion. Articles were uploaded into Covidence; all articles were screened by two reviewers, who then extracted data (e.g., study characteristics and findings related to BFG) independently and in duplicate for each eligible study. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42020189339).

RESULTS

In total, 110 articles were included in this review. Generally, BFG capabilities were present across a range of pediatric health conditions and disabilities. Correlates of both youth and parent BFG are presented, including personal and environmental resources, coping resources, and positive outcomes. In addition, studies describing interventions aimed at enhancing BFG are discussed, and a quality assessment of the included studies is provided.

CONCLUSIONS

Recommendations are provided regarding how to assess BFG and with whom to study BFG to diversify and extend our current literature.

Crescimento Pós-Traumático no Câncer de Mama: Centralidade de Evento e Coping

Resumo Crescimento pós-traumático (CPT) refere-se à mudança positiva em algum aspecto da experiência humana como resultado do enfrentamento de adversidades. Investigou-se a relação entre CPT, estilos de enfrentamento e centralidade de evento. Participaram do estudo 65 mulheres que concluíram os tratamentos recomendados para o câncer de mama. Tratou-se de uma pesquisa quantitativa cujos instrumentos foram respondidos on-line. Identificou-se correlações altas entre CPT e centralidade de evento e moderadas entre CPT e os estilos de enfrentamento: estratégia focada no problema, busca de suporte social e práticas religiosas. A centralidade de evento e as estratégias focadas no problema mostraram-se melhores preditoras de CPT. Os resultados sugerem que quanto maior a adversidade percebida, maior a possibilidade de crescimento, sendo as estratégias de enfrentamento focadas no problema um componente importante para a sua ocorrência. Este estudo apontou a possibilidade de crescimento pessoal relacionado ao enfrentamento do CA de mama e indicou estratégias relevantes para desenvolvê-lo.

Parental Posttraumatic Growth After Pediatric Hematopoietic Stem Cell Transplant

Little is known about the development of posttraumatic growth among parents of children with serious advanced disease. The purpose of this study is to describe parental posttraumatic growth 100 days after pediatric stem cell transplant. This is a cross-sectional, descriptive study of 24 parents, approximately 100 days after their children received stem cell transplant. Participants reported environmental, personal, and disease characteristics and completed measures of distress, coping, rumination, and posttraumatic growth. Evidence of parental posttraumatic growth was described in each of 5 dimensions (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life). Posttraumatic growth was positively associated with parental distress, disengagement coping, and rumination measures (r = 0.44-0.47, P < .05). Appreciation of life demonstrated the strongest associations with distress and rumination (r = 0.53-0.61, P < .01). Curvilinear relationships were observed for the association of distress, disengagement coping, and involuntary engagement with posttraumatic growth (P < .05). Study results highlight opportunities for palliative care nurses and clinicians to facilitate opportunities to support parent posttraumatic growth during treatment for children's advanced disease.

Caregiver Religious Coping and Posttraumatic Responses in Pediatric Hematopoietic Stem Cell Transplant

OBJECTIVE

Caregivers often experience their child's hematopoietic stem cell transplant (HCT) treatment as traumatic. Although many caregivers develop posttraumatic stress symptoms (PTSS) in response to supporting their child through HCT, other caregivers demonstrate posttraumatic growth (PTG). Religious coping may contribute to these different adjustment trajectories; however, more information is needed to clarify the unique associations of positive versus negative religious coping on caregiver PTSS and PTG in the context of pediatric HCT. This study aimed to examine the relationships between negative and positive religious coping on caregivers PTSS and PTG while controlling for caregiver sex, self-efficacy, and social support.

METHODS

Caregivers (N = 140) of youth admitted to the hospital for their first HCT were asked to complete self-report measures of their use of positive and negative religious coping, PTSS, PTG, social support, and self-efficacy. Two hierarchical linear regressions were conducted to test hypotheses.

RESULTS

Greater positive religious coping, but not negative religious coping, was associated with caregivers reporting more PTG in response to pediatric HCT. More negative religious coping, but not positive religious coping, was associated with caregivers experiencing greater PTSS.

CONCLUSIONS

Engaging in positive religious coping appears to promote better caregiver adjustment to pediatric HCT, whereas negative religious coping may increase caregiver risk for developing PTSS. Screening caregivers' religious beliefs, including the type of religious coping they employ, could inform providers regarding the best approach to supporting caregivers towards a growth trajectory and mitigate PTSS.

Parent Caregiving Experiences and Posttraumatic Growth Following Pediatric Hematopoietic Stem Cell Transplant

Background: Parents of children recovering from hematopoietic stem cell transplant (HSCT) experience significant distress due to unpredictable and potentially life-threatening complications. Distress is heightened by intensive caregiving parents provide the child during the first 100 days after HSCT. Management of distress and adaptation to caregiving responsibilities may be enhanced if parents find benefit in their experiences through posttraumatic growth (PTG), yet little is known about how parents' experiences after HSCT foster PTG. This study aimed to explore how parents experience caregiving and PTG 100 days after children's HSCT. Methods: Thirty-one parents completed semi-structured interviews ∼100 days after children received HSCT. Results: Four major themes emerged from the data to describe parent experiences after HSCT: (1) psychosocial and healthcare contextual factors; (2) cognitive, affective, and social support reactions to HSCT; (3) problem-based, emotion-based, and cognitive coping strategies; and (4) PTG. Discussion: Results increase the understanding of how parents' experiences and caregiving responsibilities contribute to PTG. These findings may guide future research to understand how these experiences influence PTG. Nurses are integral to the parents' experiences. Future work should focus on nursing interventions that enhance positive reinterpretation of parents' experiences after their children's HSCT.

Do beliefs influence posttraumatic growth in fathers of children with intellectual disabilities?

BACKGROUND

Although facing a child's intellectual disability (ID) is considered to threaten paternal psychosocial wellbeing, in recent years there has also been a burgeoning interest in positive contributions of raising children with ID, including posttraumatic growth (PTG) in parents.

METHOD

142 fathers of children with ID completed Polish versions of three inventories: The Post-traumatic Growth Inventory (PTGI), Basic Hope Inventory (BHI), and General Self-Efficacy Scale (GSES). The average child's age was 11.06 (range: 7-13 years). The stages of the analysis included: descriptive statistics for posttraumatic growth (PTG), basic hope (BH), and self-efficacy (GSE), correlation analysis and the Preacher and Hayes procedure of bootstrapping to test whether GSE mediates the relationship between BH and PTG.

RESULTS

85.91 % of fathers of children with ID experience average or high levels of PTG with the highest scores in its two dimensions: greater appreciation of life, and positive changes in relations with others. PTG is significantly negatively related to a child's age. GSE is a significant mediator of the relationship between BH and PTG (total score and all dimensions).

CONCLUSION

The importance of beliefs for experiencing positive changes as a result of raising a child with disability may be useful in therapeutic and supportive activities offered to fathers who experience difficulties in fulfilling their paternal role.

Posttraumatic Growth of Adolescents with Childhood Leukemia and their Parents

Purpose

Childhood leukemia is a serious trauma affecting both adolescents and their parents, who experience painful process. However, adolescents with leukemia and their parents also experience positive changes, which is referred to as posttraumatic growth. We examined posttraumatic growth, core beliefs, impact of event, and event-related rumination in adolescents within 5 years of a diagnosis of childhood leukemia and their parents.

Methods

The participants were 68 adolescents with childhood leukemia (aged 13~18 years) and their parents, who were recruited from C university hospital in Korea from May to September 2016. The Posttraumatic Growth Inventory, Core Belief Inventory, Impact of Event Scale-Revised, and Event-related Rumination Inventory were completed by the adolescents and their parents. The mean scores and correlations between variables were investigated for both set of participants.

Results

Parents showed significantly higher levels of posttraumatic growth, disruption of core beliefs, impact of event, and invasive rumination than adolescents. Disruption of core beliefs and deliberate rumination were positively correlated with posttraumatic growth in both groups.

Conclusion

Nursing intervention programs that involve modifying core beliefs and inducing a positive thought can help adolescents with leukemia and their parents grow after traumatic events.

The prevalence of moderate-to-high posttraumatic growth: A systematic review and meta-analysis

BACKGROUND

Posttraumatic growth (PTG) is positive psychological changes after encountering challenging events. The main purpose of this meta-analysis was to summarize the prevalence of moderate-to-high PTG in people who experienced traumatic events and to understand what social-demographic and trauma characteristics distinguish those who show a high rate of PTG from those of low level.

METHODS

Six electronic databases were searched. Loney's appraisal criteria were used to evaluate the quality of studies. Freeman-Turkey double arcsine transformation method was used to calculate the combined prevalence. Age, time since event, type of trauma and trauma form were analyzed as subgroup factors. According to the source of the trauma, the type of trauma was divided into three different categories: disease, accident and specific profession. Specific profession refers to firefighters, veterans, intensive care staff, etc. The complex working environment, irregular lifestyle, various unpredictable factors, as well as the frequently adverse stimuli from others contribute to great physical and mental pressure.

RESULTS

Twenty-six articles were deemed as qualified for this systematic review and meta-analysis. The level of PTG across studies ranged from 10% to 77.3%, and heterogeneity tests showed high heterogeneity (I²= 92.3%, 95%CI = 90.1%-94.0%, p < 0.01). Random effect model was chosen to calculate the combined prevalence and the prevalence was 52.58% (95%CI = 48.66%-56.48%). People whose age was younger than 60,had shorter time since trauma,worked in a specific profession and suffered from direct trauma reported high rate of moderate-to-high PTG.

LIMITATIONS

Because the included studies haven't provided adequate PTG-related information, these factors could not be used to performed subgroup analyses. In addition, some studies were excluded due to the different standard may lead to deviation of the combined prevalence.

CONCLUSIONS

Nearly half of the investigated individuals reported moderate-to-high PTG after experiencing a traumatic event. Future research needs to further study the determinants of PTG to provide relevant interventions for the victims of trauma.