Postwar winners and losers in the long run: determinants of war related stress symptoms and posttraumatic growth

The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry

The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.

Mechanisms of recovery: Community perceptions of change and growth following multiple disasters

Introduction and purpose

The geographic location of the Gulf South leaves communities in continuous threat, response, and recovery disaster cycles. Hurricane Katrina in 2005 provided an opportunity to study disaster mental health. Less than 5 years after the storm, many Hurricane Katrina survivors were impacted again by the Deepwater Horizon Gulf oil spill. Despite adversities impacting Gulf communities, over 90% of participants reported they were resilient. The purpose of this study was to improve the understanding of the mechanisms that contribute to strengths following adversity in communities affected by repeated disasters. Specifically, we focused on survivor perceptions of personal, spiritual, or community changes in efforts to describe community resilience and posttraumatic growth (PTG).

Methods

Participants were recruited through a quantitative survey and community flyers. Participants represented southeastern Louisiana, in areas impacted by hurricanes and the oil spill—for a total of five focus groups and 41 participants. Focus groups began by asking each participant to provide a brief overview of their disaster survival story and three additional guiding strengths-based questions. Data were transcribed using Dragon Speech Recognition software. A total of 963 unique responses were analyzed and coded.

Results

The following themes were identified: connectedness (n = 259), coping (n = 94), spirituality (n = 60), adaptability (n = 47), and self-reliance (n = 23). Participants noted a growth mindset from the disasters and also acknowledged coinciding negative experiences (n = 154) associated with community change and loss, where subthemes included change in connectedness (n = 97), crime (n = 26), and feeling like an outsider (n = 31).

Discussion and implications

These findings help scholars and mental health practitioners better understand the lived experiences of PTG in a community of survivors impacted by recurring traumatic experiences. In keeping with previous literature, PTG and negative experiences associated with trauma are not mutually exclusive, but occur simultaneously. Our results offer a holistic picture of coping with cumulative or repeated traumas and suggest that connectedness, coping, and spirituality provide important buffers to negative psychosocial outcomes.

Psychological resilience and posttraumatic growth in adolescent survivors of earthquake: A 10-year cohort study

This 10-year cohort study explored whether individual differences in resilience during early stages post-earthquake could have diverse impacts on future PTG and whether the impacts varied by sex. 1357 Chinese adolescent survivors of the Wenchuan earthquake were assessed on their resilience at 6-, 12-, 18-, and 24-months post-earthquake. 799 participants responded to an online survey 10 years later, and 744 of which provided useable data for subsequent analysis. Resilience trajectories were modeled using the latent class growth analysis. Linear regressions were used to test the predictive effects of different resilience trajectories on subsequent PTG. Of 744 samples (M_age=15.44, SD = 0.66 at baseline), 59.1% were females. Three trajectories of resilience were identified, including low resilience (19.8%), moderate resilience (58.7%), and high resilience (21.5%). Highly resilient participants reported greater PTG 10 years later (β = 0.12, 95%CI 0.60-6.08) after adjusting for demographic variables, earthquake exposure, negative life events, and mental health problems. Moreover, the same findings only existed in males (β = 0.22, 95%CI 1.26-11.01). Our findings highlight the importance of classifying survivors by resilience trajectories in order to better account for different implications on future PTG. Moreover, sex-specific programs are needed to provide tailored intervention.

The ins and outs of posttraumatic growth in children and adolescents: A systematic review of factors that matter

Posttraumatic growth (PTG) refers to a positive psychological change that occurs following a seismic and highly challenging life circumstance. An individual who experiences PTG reports posttrauma development that surpasses their baseline level of pretrauma function in various domains. The present systematic review of the current literature aimed to explore factors related to the development of PTG in children and adolescents exposed to trauma. Included studies investigated a range of factors that impact PTG development in youth from five countries: the United States, Israel, China, Japan, and Norway. Studies addressed multiple types of traumatic experiences, including medical trauma, war- and terror-related trauma, and environmental trauma. Findings suggested that factors that impact the development of PTG include the presence of posttraumatic stress symptoms, specifically intrusiveness, and cognitive factors, such as the use of positive reappraisal and deliberate rumination. Many factors demonstrated inconsistencies across studies, such as the impact of age, gender, social support, and parent factors. The findings from this systematic research study encourage the notion that certain clinical intervention strategies, such as deliberate rumination, positive reappraisal coping strategies, and trauma-informed group therapy, may facilitate growth in trauma survivors. Future research should test if these intervention strategies directly impact growth and whether there is an evidence-based form of intervention that can assist clinicians in taking a growth- and strengths-based perspective after trauma.

Strength‐based parenting and stress‐related growth in adolescents: Exploring the role of positive reappraisal, school belonging, and emotional processing during the pandemic

Introduction

Methods

Results

Conclusions

Stress-Related Growth in Adolescents Returning to School After COVID-19 School Closure

The move to remote learning during COVID-19 has impacted billions of students. While research shows that school closure, and the pandemic more generally, has led to student distress, the possibility that these disruptions can also prompt growth in is a worthwhile question to investigate. The current study examined stress-related growth (SRG) in a sample of students returning to campus after a period of COVID-19 remote learning (n = 404, age = 13-18). The degree to which well-being skills were taught at school (i.e., positive education) before the COVID-19 outbreak and student levels of SRG upon returning to campus was tested via structural equation modeling. Positive reappraisal, emotional processing, and strengths use in students were examined as mediators. The model provided a good fit [χ 2 = 5.37, df = 3, p = 0.146, RMSEA = 0.044 (90% CI = 0.00-0.10), SRMR = 0.012, CFI = 99, TLI = 0.99] with 56% of the variance in SRG explained. Positive education explained 15% of the variance in cognitive reappraisal, 7% in emotional processing, and 16% in student strengths use during remote learning. The results are discussed using a positive education paradigm with implications for teaching well-being skills at school to foster growth through adversity and assist in times of crisis.

Maternal psychological growth following childbirth

Although maternal postpartum mental health has been extensively studied, rather little is known regarding the factors that may facilitate psychological growth following childbirth. The present study set forth to examine various pre-birth, birth, and post-birth correlates of overall psychological growth and growth domains in postpartum women, assessed within the first months following childbirth. A sample of 428 women completed self-report measures pertaining to psychological growth, mental health, maternal attachment, and childbirth characteristics. We found that the majority of women reported psychological growth following childbirth, with those experiencing stressors in childbirth reporting the highest levels of appreciation for life. In regression analyses, postpartum factors were significantly associated with overall growth and growth domains, taking into account other factors. The more the childbirth was perceived as central to the mothers' identity and the better the maternal attachment was to the child, the higher levels of growth. Growth was also negatively related to endorsement of childbirth PTSD. Background factors, such as maternal age, education, and prior mental health, were associated with specific growth domains, although the association was small and there was no association with overall growth. Post-birth factors are important in ensuing psychological growth in the first months following birth. Attention to opportunities of growth following childbirth is warranted in clinical care, in particular following traumatic childbirth.

Psychometric Properties of the Farsi Version of Posttraumatic Growth Inventory for Children-Revised in Iranian Children with Cancer

Objective:

Coping with childhood cancer, as a stressful incident, can lead to a growth in various aspects of the child's life. Therefore, this study aims to validate Posttraumatic Growth Inventory for Children-Revised (PTGI-C-R) in children with cancer.

Methods:

This methodological research was carried out in referral children hospitals in Tehran. PTGI-C-R was translated and back-translated. Content and face validity were assessed. Confirmatory factor analysis (CFA) was performed on 200 children with inclusion criteria, using LISREL V8.5. Due to the rejection of the model, an exploratory factor analysis (EFA) was done, using SPSS V21. The correlation of posttraumatic growth (PTG) with the variables, i.e., age and gender, was investigated.

Results:

Some writing changes were made in phrases in the sections concerning face and content validity. CFA rejected the five-factor model due to the undesirable fit indices. Therefore, an EFA was used and the three-factor model was not approved, either despite the statistical appropriateness or due to the lack of similarity between the items loaded on factors. The results also indicated a significant relationship between PTG and age (r = 0.13, P = 0.05). There is no significant relationship between PTG and gender (z = −1.35, P = 0.83).

Conclusions:

PTGI-C-R does not have desirable psychometric properties in Iranian children with cancer and may not be able to reflect all the aspects of PTG experienced by them. Therefore, it cannot be used as an appropriate scale, and it is necessary to develop and validate a specific tool through a qualitative study.

Socio-ecological determinants of distress in Filipino adults during COVID-19 crisis

The present study examined the socio-ecological factors that influenced psychological distress (combined index of depression and anxiety symptoms) among Filipino adults during the COVID-19 crisis. The study involved 401 adult participants currently residing in the Philippines. Data were collected using a self-reported online questionnaire administered to the participants. Findings revealed that one individual level factor, such as individual resilience, and two family level factors, such as safety at home and being a parent, negatively influenced psychological distress. On the other hand, a family level factor, family’s financial difficulties, positively predicted psychological distress. Societal level factor such as national resilience, but not the community level factor, community resilience, positively predicted psychological distress in Filipino adults. Findings identified individual resilience, national resilience, and financial difficulties as the strongest predictors of psychological distress among Filipino adults during the COVID-19 crisis. Implications, limitations, and future directions are discussed.

A test of a resilience based intervention for mental health problems in Iraqi internally displaced person camps

Background and Objectives: The mental health needs of those in internally displaced persons camps are significant and are compounded by a number of barriers to care. Traditional methods of mental health care are often not feasible and thus a need exists for interventions that can successfully meet these conditions. The current study introduces and tests a new positive-psychology intervention, GROW, which was designed specifically for use in internally displaced persons camps. Design: Pre-Post-Follow-up longitudinal examination of those who participated in the GROW intervention group (N = 766). Methods: The study includes three waves of data for the intervention, which was administered in a group format, using paraprofessionals, over a two-week period in internally displaced persons camps in Iraq. Results: The results indicate significant decreases in symptoms of PTSD for participants from pre- to post-intervention and demonstrates these changes were maintained at a three-month follow-up. Post hoc results indicated participants who were older, female, or who attended more sessions were more likely to respond to the intervention. Conclusions: These data provide initial support for the intervention and suggest additional research to more fully validate this intervention are warranted.

Posttraumatic Growth in Tibetan Adolescent Survivors 6 Years After the 2010 Yushu Earthquake: Depression and PTSD as Predictors

This cross-sectional study explored the prevalence of posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD) in Tibetan adolescent survivors (98% Tibetan and 2% Han) 6 years after the 2010 Yushu earthquake to identify the PTG predictors. In 2016, 850 high school students (from 11 to 20 years) in Yushu (N = 850) completed the self-rating depression scale, the PTSD Check List-Civilian version, the exposure degree scale, and the posttraumatic growth inventory. It was found that the PTG and probable PTSD prevalence rates were 49.7% and 8.9% 6 years after the earthquake, and that exposure level, depression level, and PTSD symptoms were all significant negative predictors for PTG in both the junior high school and senior high school students. Specifically, having a lower degree of exposure, a lower PTSD level, and no depression symptoms were associated with higher PTG. There was a significant PTG difference found between males and females; however, this gender difference was not found in the senior high school students. No significant PTG differences were found for the different ethnicities. The implications of the results and the limitations of this study are discussed.

Patterns of posttraumatic stress disorder and posttraumatic growth among breast cancer patients in China: A latent profile analysis

OBJECTIVE

The aim of this study was to identify the patterns of posttraumatic responses among breast cancer (BC) patients, to explore the variables associated with these patterns, and to compare anxiety and depression on various posttraumatic response patterns.

METHODS

A questionnaire survey was conducted with a sample of 612 BC patients who were currently undergoing treatment. The questionnaire package included Posttraumatic Stress Disorder Symptom Scale (PSS), Posttraumatic Growth Inventory (PTGI), Network of Relationships Inventory, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Modeling was performed using a latent profile analysis (LPA) to explore patterns of posttraumatic responses among BC patients.

RESULTS

Based on the fitting indicators of LPA, three-class patterns model of posttraumatic responses was optimal. Resisting group (34.6%): patients reported mild posttraumatic stress symptoms (PTSS) and mild posttraumatic growth (PTG). Growth group (47.4%): patients showed mild PTSS and high PTG. Struggling group (18.0%): patients showed high PTSS and high PTG. BC patients with lower income were more likely to belong to Resisting group and Struggling group. BC patients with high levels of social support were more likely to belong to Growth group. Patients in Struggling group had the highest levels of anxiety and depression.

CONCLUSIONS

This study showed that there was heterogeneity in posttraumatic response patterns of BC patients. The results provided theoretical base guiding the development of health care schemes and psychological interventions for patients, suggesting the necessity of differentiated health care for BC patients with different posttraumatic response patterns.

Measuring national resilience: A new short version of the scale (NR-13)

This article is aimed at describing and validating a new short version of the National Resilience Scale (NR-13). The available 25-item National Resilience Scale has been employed and validated by several studies. However, the present data show that it can be substantially shortened without losing either its reliability or its validity. The new short version of the scale has been examined by the responses of an Israeli sample of adults (N = 1022). Results indicate, as expected, that national resilience promoting factors (community resilience and sense of coherence) significantly and positively predict NR-13. A resilience-suppressing factor (sense of danger) negatively and significantly predicts NR-13. These predictions have been replicated in an additional sample of Israeli higher education students (N = 423). These results support the reliability and the validity of the short National Resilience Scale (NR-13).

Posttraumatic Growth, Personality Factors, and Social Support Among War-Experienced Young Georgians

Despite much research on adult posttraumatic growth in recent decades, few studies have focused on posttraumatic growth in the young and especially after experiencing war. This study examined personality factors and different types and sources of social support as key correlates of posttraumatic growth in war-experienced children and adolescents. Participants were 242 individuals from settlements for internally displaced people in Georgia with a mean age of 13.22 years (SD = 2.73). Relations between variables were examined with correlations, standard multiple regressions, and mediation analyses. Results showed that the main predictors of posttraumatic growth were extraversion, conscientiousness, and social support. In addition, informational type of support from peers related significantly to posttraumatic growth. Moreover, general social support mediated the link between personality factors and posttraumatic growth. Conclusions are drawn on the mechanisms underlying posttraumatic growth in young persons.

Trauma-Informed Care and Posttraumatic Growth Among Bereaved Youth: A Pilot Study

Although a fair amount has been written about posttraumatic stress disorder among bereaved children and adolescents, less has been written about posttraumatic growth (PTG) and its predictors among this population. This study examines predictors of PTG and the impact of trauma-informed care on PTG among bereaved youth. A preexperimental, pretest-posttest design was applied to measure PTG among bereaved children (N = 32) before and after attending a healing camp that provides trauma-informed care. A regression model was applied to examine predictors of PTG. Results showed that children participating in the camp increased their PTG scores to a statistically significant degree. Circumstance of death (sudden or expected) was a predictor in this study. The results are discussed in relation to limitations, implications for future research, and practice.

A comparative study of psychotic and affective symptoms in Rwandan and Kenyan students

AIMS

War and conflict are known to adversely affect mental health, although their effects on risk symptoms for psychosis development in youth in various parts of the world are unclear. The Rwandan genocide of 1994 and Civil War had widespread effects on the population. Despite this, there has been no significant research on psychosis risk in Rwanda. Our goal in the present study was to investigate the potential effects of genocide and war in two ways: by comparing Rwandan youth born before and after the genocide; and by comparing Rwandan and Kenyan adolescents of similar age.

METHODS

A total of 2255 Rwandan students and 2800 Kenyan students were administered the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen. Prevalence, frequency and functional impairment related to affective and psychosis-risk symptoms were compared across groups using univariate and multivariate statistics.

RESULTS

Rwandan students born before the end of the genocide and war in 1994 experienced higher psychotic and affective symptom load (p's < 0.001) with more functional impairment compared with younger Rwandans. 5.35% of older Rwandan students met threshold for clinical high-risk of psychosis by the WERCAP Screen compared with 3.19% of younger Rwandans (χ 2 = 5.36; p = 0.02). Symptom severity comparisons showed significant (p < 0.001) group effects between Rwandan and Kenyan secondary school students on affective and psychotic symptom domains with Rwandans having higher symptom burden compared with Kenyans. Rwandan female students also had higher rates of psychotic symptoms compared with their male counterparts - a unique finding not observed in the Kenyan sample.

CONCLUSIONS

These results suggest extreme conflict and disruption to country from genocide and war can influence the presence and severity of psychopathology in youth decades after initial traumatic events.

An application of an ecological framework to understand risk factors of PTSD due to prolonged conflict exposure: Israeli and Palestinian adolescents in the line of fire

OBJECTIVE

Adolescents living in Israel and the Palestinian authority are exposed to political violence. This review examines psychosocial risk factors for posttraumatic stress disorder (PTSD) organized within an ecological framework.

METHOD

Relevant articles were identified through PubMed and PsycINFO. Studies measuring risk and/or protective factors for PTSD in the Palestinian and/or Israeli adolescent populations because of conflict exposure from 1990 to present were included.

RESULTS

A total of 20 studies met inclusion criteria. Greater violence exposure, poor economic resources, living in rural compared with urban areas, poor family and peer relations, and poor coping skills were associated with PTSD symptoms.

CONCLUSIONS

The ecological framework is a useful approach to understanding factors affecting adolescent PTSD. Future research should focus on socioecological levels that have received limited attention. (PsycINFO Database Record

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.

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.

Children's Experience of Posttraumatic Growth: Distinguishing General from Domain-Specific Correlates

Although the five domains of posttraumatic growth (new possibilities, relating to others, personal strength, spiritual change and appreciation of life) have been studied extensively in adults, little is known about these domains and their correlates in children. We aimed to examine whether demographic and/or social characteristics are related to children’s reports of overall posttraumatic growth and of growth in specific domains. In a general population study, children aged 8–12 years who had been exposed to adverse events (N = 1290) filled out questionnaires on their experiences, demographic characteristics (gender, age, time lag since event), stress reactions, peer support, religiosity and posttraumatic growth. All demographic and social characteristics were related to overall posttraumatic growth, except time lag. Associations varied across the five domains with the strongest effects being found for stress reactions and religiosity. A higher level of stress reactions was related to more growth in all domains (general effect), whereas religious children experienced more spiritual growth than non-religious children without differences on other domains (domain specific effect). Other effects were small, and some did not remain significant after Bonferroni corrections. These findings suggest the presence of both general and domain-specific correlates of child posttraumatic growth. Although effects were generally small, the current findings show the need to differentiate between the domains of posttraumatic growth in both further research and clinical practice. This will allow a better understanding of the mechanisms of posttraumatic growth in children as well as more tailored assessment and intervention.

Post-traumatic growth among veterans in the USA: results from the National Health and Resilience in Veterans Study

BACKGROUND

There is increasing recognition that, in addition to negative psychological consequences of trauma such as post-traumatic stress disorder (PTSD), some individuals may develop post-traumatic growth (PTG) following such experiences. To date, however, data regarding the prevalence, correlates and functional significance of PTG in population-based samples are lacking.

METHOD

Data were analysed from the National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 3157 US veterans. Veterans completed a survey containing measures of sociodemographic, military, health and psychosocial characteristics, and the Posttraumatic Growth Inventory-Short Form.

RESULTS

We found that 50.1% of all veterans and 72.0% of veterans who screened positive for PTSD reported at least 'moderate' PTG in relation to their worst traumatic event. An inverted U-shaped relationship was found to best explain the relationship between PTSD symptoms and PTG. Among veterans with PTSD, those with PTSD reported better mental functioning and general health than those without PTG. Experiencing a life-threatening illness or injury and re-experiencing symptoms were most strongly associated with PTG. In multivariable analysis, greater social connectedness, intrinsic religiosity and purpose in life were independently associated with greater PTG.

CONCLUSIONS

PTG is prevalent among US veterans, particularly among those who screen positive for PTSD. These results suggest that there may be a 'positive legacy' of trauma that has functional significance for veterans. They further suggest that interventions geared toward helping trauma-exposed US veterans process their re-experiencing symptoms, and to develop greater social connections, sense of purpose and intrinsic religiosity may help promote PTG in this population.

Centrality of positive and negative deployment memories predicts posttraumatic growth in danish veterans

OBJECTIVE

The purpose of the present study was to examine theoretically motivated predictors for the development of positive changes following potentially traumatic experiences (i.e., posttraumatic growth). Specifically, we wanted to examine the prediction that memories of highly negative and positive deployment events predict subsequent posttraumatic growth.

METHOD

A total of 251 Danish soldiers (7% female, mean age 26.4) deployed to forward operating bases in Afghanistan filled out questionnaires before, during, and after deployment. This allowed us to perform prospective as well as cross-sectional analyses of the data.

RESULTS

The main findings were that the centrality of highly emotional memories from deployment predicted growth alongside openness to experience, combat exposure, and social support. Importantly, the centrality of both positive and negative memories predicted growth equally well.

CONCLUSION

The perceived importance of both negative and positive events may play an important part in the development of posttraumatic growth.

Individual and collective dimensions of resilience within political violence

Research has documented a link between political violence and the functioning of individuals and communities. Yet, despite the hardships that political violence creates, evidence suggests remarkable fortitude and resilience within both individuals and communities. Individual characteristics that appear to build resilience against political violence include demographic factors such as gender and age, and internal resources, such as hope, optimism, determination, and religious convictions. Research has also documented the protective influence of individuals' connection to community and their involvement in work, school, or political action. Additionally, research on political violence and resilience has increasingly focused on communities themselves as a unit of analysis. Community resilience, like individual resilience, is a process supported by various traits, capacities, and emotional orientations toward hardship. This review addresses various findings related to both individual and community resilience within political violence and offers recommendations for research, practice, and policy.

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

OBJECTIVE

The purpose of the study was to explore the relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG) after Hurricane Katrina, and the role of demographics, predisaster psychological distress, hurricane-related stressors, and psychological resources (optimism and purpose) in predicting each.

METHOD

Participants were 334 low-income mothers (82.0% non-Hispanic Black) living in the New Orleans area prior to Hurricane Katrina, who completed surveys in the year prior to the hurricane (T1 [Time 1]) and 1 and 3 years thereafter (T2 and T3).

RESULTS

Higher T2 and T3 PTS full-scale and symptom cluster subscales (Intrusion, Avoidance, and Hyperarousal) were significantly associated with higher T3 PTG, and participants who surpassed the clinical cutoff for probable posttraumatic stress disorder at both T2 and T3 had significantly higher PTG than those who never surpassed the clinical cutoff. Older and non-Hispanic Black participants, as well as those who experienced a greater number of hurricane-related stressors and bereavement, reported significantly greater T3 PTS and PTG. Participants with lower T2 optimism reported significantly greater T3 intrusive symptoms, whereas those with higher T1 and T2 purpose reported significantly greater T3 PTG.

CONCLUSIONS

Based on the results, we suggest practices and policies with which to identify disaster survivors at greater risk for PTS, as well as longitudinal investigations of reciprocal and mediational relationships between psychological resources, PTS, and PTG.

Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway

Background

Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.

Methods

Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.

Results

All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins.

A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.

Conclusions

Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.

Elderly people coping with the aftermath of war: resilience versus vulnerability

OBJECTIVES

The present study compares coping of elderly people and two younger groups 1 year after a war. Coping was determined by stress symptoms and posttraumatic recovery and two levels of resiliency.

DESIGN AND SETTING

Thirty-six streets (covering most of the city streets) were sampled randomly from the map of Kiryat Shemona (a town next to the Lebanese border) about a year after the end of the Second Lebanon War.

PARTICIPANTS

The sample constituted 870 adult residents of the town. Participants were divided into three age groups: elderly (age 65 years and older, N = 108), adults (age 46-64 years, N = 252) and young adults (age 20-45 years, N = 462).

MEASUREMENTS

1) Stress symptoms measured by short version of Brief Symptom Inventory; 2) Individual resilience measured by Sense of Coherence Inventory; 3) Posttraumatic Recovery Inventory (PTR); and 4) Public Resilience Scale (included a scale for community and national resilience).

RESULTS

The results indicated 1) The elderly group reported significantly higher levels of stress symptoms and lower levels of PTR; 2) Females in the three age groups reported higher levels of stress symptoms and lower levels of PTR and individual resilience than males; 3) Individual and public resilience negatively predicted stress symptoms and positively predicted posttraumatic recovery across three age groups; and 4) Public resilience has a differential effect on stress symptoms in each of the three age groups but not on PTR.

CONCLUSION

Results question the division of older people into a vulnerable or inoculated group, indicating that the participants responded concurrently in a more vulnerable and a more resilient manner. Older people were characterized by higher levels of postwar stress symptoms, as well as a higher sense of coherence.

Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study

PURPOSE

Long-term outcome of traumatic experiences among war-exposed civilians living in their home country has been seldom documented. The present study examined change in posttraumatic stress disorder (PTSD) frequency and perceived physical and mental health in a cohort of Kosovar Albanians over 6 years (2001-2007).

METHODS

Of 996 Albanian Kosovar civilians included in the 2001 survey, 551 subjects (55.3%) were recalled and interviewed in 2007. Diagnoses of PTSD and major depressive episode were assessed using the Mini International Neuropsychiatric Interview. Subjective physical and mental health were investigated using the Medical Outcomes Study 36-Item Short-Form (SF-36). A list of traumatic events adapted from the Harvard Trauma Questionnaire and other stressful life events was also considered.

RESULTS

Posttraumatic stress disorder was significantly less frequent in 2007 than in 2001 (14.5% vs. 23.2%, p < 0.001). For 18.0, 5.3 and 9.3% of participants, PTSD remitted, persisted and developed over the 6-year follow-up period, respectively. Ill health without having access to medical care and major changes in responsibilities at work were associated with both persistence and new occurrence of PTSD. While the SF-36 mental component summary score significantly improved (mean change +4.5, p < 0.001), the physical component summary score did not change between 2001 and 2007, after adjustment for age (mean change -0.8, p = 0.14).

CONCLUSIONS

Results point at the importance of economic and health system reconstruction programs with respect to public health in post-conflict countries.