Posttraumatic growth among people with serious mental illness, psychosis and posttraumatic stress symptoms

Posttraumatic growth among Israeli female combat veterans: The mediating roles of posttraumatic stress symptoms and self-efficacy

Posttraumatic growth (PTG) is a possible common reaction to exposure to potentially traumatic events (PTEs) during military service. However, knowledge about correlates of PTG among female combat veterans is sparse. This study examines associations between combat exposure, posttraumatic stress symptoms (PTSS), general self-efficacy (GSE), and PTG among Israeli female veterans. This is a cross-sectional studyA volunteer sample of female Israeli combat veterans (n = 616) and non-combat veterans (n = 484) responded to self-report questionnaires. Combat veterans reported higher levels of combat exposure, PTSS, GSE, and PTG, as compared to non-combat veterans. Among combat veterans, combat exposure and GSE were associated with greater PTG. Importantly, PTSS and GSE mediated the link between combat exposure and PTG. The study's findings are among the first to report about possible psychological growth outcomes among Israeli combat veterans. Clinicians treating female veterans coping with combat trauma should be aware of the heterogeneity of reactions to military service challenges and the importance of enhancing veterans' GSE to facilitate PTG.

Posttraumatic growth, spiritual damage, and psychosocial and mental health problems in survivors of clergy-perpetrated child sexual abuse: A mixed methods approach

INTRODUCTION

Although clergy-perpetrated child sexual abuse (CSA) implies severe traumatic repercussions for the victims, they may also experience posttraumatic growth (PTG) deriving from the need to deal with the trauma suffered. This PTG is associated with the processes of recovery, healing, and empowerment.

OBJECTIVE

Applying a mixed methods approach to analyse PTG outcomes and to explore experiences of PTG in survivors of Spanish clergy-perpetrated CSA and its relation with psychosocial, mental and spiritual suffering.

PARTICIPANTS

Thirty-one survivors (M = 51.6 years; SD = 12.4) in the quantitative stage of the research, and seven (M = 49.3; SD = 8.9) in the qualitative stage.

METHODS

A sequential explanatory mixed methods study design was applied using standardized questionnaires and semi-structured interviews. Descriptive, correlation and thematic analyses were conducted. The quantitative and qualitative data were integrated.

RESULTS

Positive associations were found between PTG and psychosocial and mental health problems (r = 0.53; p < .01), damage to faith in God (r = 0.43; p < .05) and damage to faith in the Church (r = 0.48; p < .01). Three themes emerged from the qualitative data that explained, expanded, and complemented the quantitative results, highlighting the relationship between damage and growth and the specific meanings of PTG from the perspectives of the survivors.

CONCLUSIONS

This study shows that survivors may develop PTG in the course of the processes of psychological suffering, spiritual transformation, and meaning-making of traumatic experiences.

Posttraumatic growth in eating disorder recovery

OBJECTIVE

To investigate posttraumatic growth in individuals recovering from an eating disorder.

DESIGN

A convergent parallel mixed methods design was used.

PARTICIPANTS

The sample consisted of 28 participants who completed the entire study and an additional 10 who completed only the quantitative portion of this mixed methods study.

METHODS

The National Eating Disorders Association (NEDA) provided a link to the electronic survey via their website. Participants were asked to complete the Posttraumatic Growth Inventory (PTGI) and the Core Beliefs Inventory (CBI) in the quantitative strand. For the qualitative strand, participants were asked to describe any positive changes in their beliefs or life as the result of their eating disorder (ED).

RESULTS

Participants reported a high amount of posttraumatic growth as indicated by their mean score on the CBI (30.39, SD 7.89) and (71.26, SD 16.58) on the PTGI. Qualitative categories included relating to others, personal strength, new possibilities, appreciation of life, and spiritual change.

CONCLUSION

Participants described the transformation they experienced in the recovery process, with recovery from an eating disorder facilitating an opportunity for growth. Providing posttraumatic growth interventions may have the potential to help individuals with eating disorders find meaning in their pathway through recovery.

Exploring the Meanings of Posttraumatic Growth in Spanish Survivors of Clergy-Perpetrated Child Sexual Abuse: A Phenomenological Approach

A healing and recovery perspective related to child sexual abuse (CSA) has gained attention in the past two decades, a concept that accurately refers to the process is posttraumatic growth (PTG). Scarce empirical research on PTG in clergy-perpetrated CSA survivors shows evidence of the presence of growth after the abusive experience and a tendency to create accounts of trauma as a way to heal. The general aim of the study is to explore the experiences and meanings of PTG as lived by survivors of clergy-perpetrated CSA. Seven clergy-perpetrated CSA survivors were interviewed with semi-structured in-depth interviews conducted in person. Using reflexive thematic analysis, we identified three dominant themes in the participants' stories: (a) the hindering of PTG; (b) the meanings of PTG, and (c) the internal and contextual and facilitators of PTG. The present study brings new insights into the meanings of PTG, the close relationship between damage and growth, and the mechanisms (both internal and contextual) that are involved in healing from clergy-perpetrated CSA in Spanish culture.

Predictors of undocumented PTSD in persons using public mental health services

Individuals diagnosed with serious mental illness (SMI) have greater trauma exposure and are at increased risk for posttraumatic stress disorder (PTSD). However, PTSD is rarely documented in their clinical records. This study investigated the predictors of PTSD documentation among 776 clients with SMI receiving public mental health services, who had probable PTSD as indicated by a PTSD Checklist score of at least 45. Only 5.3% of clients had PTSD listed as a primary diagnosis, and 8.4% had PTSD as a secondary diagnosis, with a total 13.7% documentation rate. PTSD documentation rate was highest for clients with major depression (18.8%) compared to those with schizophrenia (4.1%) or bipolar disorder (6.3%). Factors that predicted a lower likelihood of having a chart diagnosis of PTSD included being diagnosed with schizophrenia/schizoaffective disorder or bipolar disorder. Factors that predicted a higher likelihood of having a chart diagnosis of PTSD included being of non-white race, being female, and experiencing eight or more types of traumatic events. Findings highlight the need for PTSD screening and trauma informed care for clients with SMI receiving public mental health services.

Post-traumatic growth in psychosis: a systematic review and narrative synthesis

BACKGROUND AND OBJECTIVE

People with psychosis report experiences of highly traumatic events. Positive change or post-traumatic growth (PTG) can occur as a result of traumatic experiences. Yet there is limited attention on PTG in psychosis, possibly due to the negative impact of psychotic symptoms on functioning and quality of life. The aim of this review was to identify significant correlates and mediators of PTG in psychosis, and to develop a conceptual framework synthesising facilitators of PTG in psychosis.

METHOD

Ten electronic databases were searched in seven languages, and five journals and grey literature were searched in English. Quantitative studies were eligible if examining correlates, mediators, or the temporal relationship between PTG and one or more variables. Qualitative studies were eligible if describing PTG arising from experiences of psychosis. Findings from quantitative papers were grouped by analysis method, with significant correlates, mediators, and temporal relationships descriptively reported upon. Narrative synthesis was conducted on findings in qualitative papers.

RESULTS

Thirty-seven papers were included. Significant correlates and mediators of PTG were identified. Mediators of PTG in psychosis included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. No studies describing the temporal relationship between PTG and psychosis were identified. The narrative synthesis identified seven facilitators of PTG in psychosis: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, and Relationships, giving the acronym PROSPER.

CONCLUSIONS

Individuals with psychosis can be supported to grow from traumatic experiences. Clinicians can support PTG through the provision of trauma-informed care that supports positively valued identity changes. For researchers, the findings provide an evidence-based theoretical framework for conceptualising PTG, which can be validated through longitudinal cohort studies and underpin the development of new clinical interventions.

Protective Factors Associated With Post-traumatic Outcomes in Individuals With Experiences of Psychosis

Trauma and trauma-specific mental health difficulties (e.g., post-traumatic stress disorder) are highly prevalent in people with psychosis. However, not everyone develops post-traumatic symptoms, and some people even experience post-traumatic growth (PTG) following trauma. It is important to identify which protective factors are associated with less severe trauma symptoms and/or positive outcomes to inform the development and implementation of interventions fostering these variables. Eighty-five patients with experiences of psychosis took part in a cross-sectional study. They were administered questionnaires measuring exposure to traumatic events, symptoms of PTSD and complex PTSD and potential protective factors assumed to be associated with lower vulnerability for post-traumatic symptoms and higher post-traumatic growth (trait resilience, secure attachment, social support, adaptive coping, optimism, general self-efficacy). Multiple hierarchical regression showed that some of these protective factors, in particular optimism, were associated with lower post-traumatic symptoms, explaining 21% of the variance in complex PTSD symptoms and 16% of the variance in PTSD symptoms. However, the hypothesized protective factors, in particular resilience and adaptive coping, explained a considerably larger proportion of variance in PTG (44%). Our results suggest that whilst these variables provide only moderate protection from the vulnerability to experience post-traumatic stress, they may play an important role in allowing people to find meaning despite multiple traumas and subsequently lead more fulfilling lives. Therapies targeting the emotional and psychological consequences of trauma in people with psychosis might benefit from the integration of intervention strategies to enhance these additional psychological protective factors, which in turn may lead to positive treatment outcomes beyond the mere reduction of post-traumatic stress symptoms.

Patients responses to diagnoses of mental disorders: Development and validation of a reliable self-report measure

OBJECTIVES

Psychiatric patients are regularly informed about diagnoses. Treatment guidelines assume that informing patients fosters functional coping processes, but few research exists on how patients respond. Thus, the objective was to develop a standardized self-report measure to assess patients reactions to diagnoses.

METHODS

Fifty nine items were generated based on a qualitative study. The process of item selection and determination of the factor structure were performed on a sample of 252 patients: Results of an explorative factor analysis with a randomly split sub-sample 1 were cross-validated by confirmatory factor analysis on sub-sample 2. The revised 26-item instrument was revaluated using data from an independent sample of 1.271 patients with different diagnoses.

RESULTS

Three functional and three dysfunctional processing styles emerged from the analyses and provided good model fit in the revaluation study (TLI = 0.935; CFI = 0.943; RMSEA = 0.051; SRMR = 0.048). Variance-analytical calculations and post hoc analyses revealed significant differences among diagnoses with regard to coping styles, such as schizophrenia was associated with self-stigmatization and anorexia nervosa showed pronounced over-identification. Overall, various diagnosis-dependent specifics were found.

CONCLUSIONS

As patients reactions to diagnoses vary substantially, their formation, impact on treatment and overall cause should be investigated in further studies.

Growth in the Aftermath of Psychosis: Characterizing Post-traumatic Growth in Persons With First Episode Psychosis in Singapore

Experiencing first episode psychosis (FEP) is a highly traumatic life event. However, there is evidence to show that the outcome of psychosis is more nuanced than was conventionally thought. Young persons with FEP can grow from the experience of psychosis. In this study, we aim to characterize post-traumatic growth (PTG) in persons with FEP over 1 year. A total of 99 FEP clients receiving services from an early psychosis intervention team in Singapore were recruited. The PTG Inventory, among other scales, like Questionnaire on the Process of Recovery and Connor-Davidson Resilience Scale, were administered in this population. A total of 52 participants completed the questionnaire at two timepoints (one year apart). The Reliable Change Index was calculated for participants who completed both timepoints. Repeated measures of correlation were performed, which identified personal recovery and resilience to be associated with PTG in this sample. This clinical population exhibited PTG in the aftermath of psychosis. PTG was associated with personal recovery and resilience, but not clinical indicators, like symptoms and functioning. Data from this study suggests that recovery and growth from first episode psychosis is a possibility. Clinical implications, strengths and limitations of this study are discussed.

The Remission of Social Anxiety Disorder After Trauma: A Case Report of Posttraumatic Growth?

Posttraumatic growth (PTG) describes positive psychological change and improvement beyond one's previous functioning. It manifests as a change of self-perception, improvement in the relationship with others, and a better outlook on life. Despite consistent literature on the occurrence of PTG in healthy subjects, there is still a dearth of studies in people with pre-existing mental disorders, especially anxiety disorders. We report the case of a patient previously diagnosed with social anxiety disorder (SAD), whose symptoms remitted, and life view improved after a traumatic event, illustrating a case of PTG. The trauma shattered the patient's previous belief system, allowing the emergence of a new cognitive schema. Although PTG and symptom remission do not necessarily correspond to the same construct, we believe that these phenomena were related to each other in this case, probably because of a notable change in our patient's underlying belief system.

Relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease: A cross-sectional study

AIM

This study aimed to investigate the relationships among hope, meaning in life, and post-traumatic growth (PTG) in patients with chronic obstructive pulmonary disease.

DESIGN

A cross-sectional study design.

METHODS

Between October 2018-September 2019, 221 chronic obstructive pulmonary disease patient completed the questionnaires including sociodemographic information, Chinese Version of Herth Hope Index, Meaning in Life Questionnaire, and Post-traumatic Growth Inventory. Descriptive analysis, Spearman's correlation analysis, the Kruskal-Wallis H test, the Mann-Whitney U test, and the ridge regression analysis were used for analysis.

RESULTS

Spearman's correlation analysis showed that hope and meaning in life were positively interrelated with PTG (r = 0.20-0.45, r = 0.36-0.54, p < 0.01). Ridge regression analysis results showed that hope, meaning in life, time since diagnosis, habitation, medical insurance, and monthly income could explain 47.30% of the variance in PTG (F = 33.863, p < 0.001).

CONCLUSION

Chinese patients with chronic obstructive pulmonary disease experienced a slightly positive change in meaning in life and a moderate degree of hope and PTG. Results suggested that hope and meaning in life were positively connected with PTG. Therefore, enhancing hope and meaning in life might be crucial for patients with chronic obstructive pulmonary disease to promote PTG.

IMPACT

The findings added better understanding of relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease which can help nurse give interventions in the early stage of disease diagnosis.

Relational trajectories in families with parental mental illness: a grounded theory approach

BACKGROUND

Adult children of parents with mental illness experience a myriad of complex emotions as they attempt to make meaning of the lived experiences of their parents. A crucial time for adult children is emerging adulthood, a time when they move away from their family of origin and establish their own identity and independence. Despite existing research that provides a static description of adult children's lived experiences, the literature lacks an explanatory theory about the dynamic, relational processes that occur as adult children progress from one life stage to the next.

METHODS

The current study aimed to develop an explanatory theory of the relational trajectory that adult children might experience as they course through adulthood and parenthood over time. Semistructured interviews using grounded theory analysis were conducted with 10 adult children aged between 27 and 51 years old.

RESULTS

Three key phases within the Relational Trajectory Model (RTM) were identified: (i) confusion, (ii) contemplation, and (iii) reconciliation. By reflecting on their own parenting role, adult children were able to reach an evolved parental identity, with the majority of participants also making relationship reparations with their parents with mental illness. Parallels are drawn to theories of identity and intergenerational family systems to further explain and substantiate the processes encompassed within the RTM.

CONCLUSION

Generating an explanatory theory serves as a potential guide for mental health professionals working with families with parental mental illness, by drawing attention to the intricacies of familial relationships and interpersonal ties.

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

OBJECTIVES

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

DESIGN

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

SETTING

England.

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION NUMBER

ISRCTN11152837.

"It's Brought Me a Lot Closer to Who I Am": A Mixed Methods Study of Posttraumatic Growth and Positive Change Following a First Episode of Psychosis

Background: A first episode of psychosis is often a traumatic experience that may also lead to positive change, a phenomenon that has received little attention. This knowledge gap may impede service providers' capacity to foster positive change among service users. Objective: To investigate aspects of positive change among persons receiving early intervention services for psychosis. Design: The study objective was addressed using a mixed methods convergent design, which entailed simultaneously employing qualitative and quantitative methods. Setting: This study was conducted at a specialized early intervention service for psychosis based in Montreal, Quebec, Canada. Participants: Participants included service users receiving services at an early intervention service for psychosis. Participants had to be fluent in English or French, be clinically stable enough to take part in the study, and have received at least 6 months of treatment. Participants were conveniently sampled in the quantitative component and purposefully sampled in the qualitative component. The quantitative component was carried out using a cross-sectional survey design. Ninety-four participants completed the Posttraumatic Growth Inventory, a widely used measure of positive change. Data on the extent and domains of posttraumatic growth were summarized using descriptive statistics. The qualitative component was carried out using a qualitative descriptive approach. Semistructured interviews were conducted with 12 participants. Data were analyzed using thematic analysis. Findings from both components were integrated using a weaving method in the discussion section. Results: Quantitative results indicated that most participants reported a moderate amounts of posttraumatic growth. A greater appreciation of life was the most commonly endorsed domain, whereas spiritual growth was the least commonly endorsed domain. The qualitative results revealed that in addition to suffering, participants experienced positive changes, such as improved health and personality, and a stronger sense of self; stronger, more balanced religiosity and spirituality; improved relationships with others; and improved lifestyles, goals, and expectations for the future. Conclusions: Positive change may be a common phenomenon in the aftermath of first episode psychosis. The study findings may provide hope to those who have experienced a first episode of psychosis and can inform efforts by early intervention services to provide recovery-oriented, growth-focused care.