Change in MMPI scores from college to adulthood as a function of military service

Protective Factors Associated With the Loss of a Child due to Oncological Illness: Systematic Review

This systematic review explores factors influencing resilience and post-traumatic growth in parents who have lost a child under 25 to cancer. While such parents are vulnerable to complicated grief, not all experience it. Eight qualitative and mixed studies from ProQuest, Science Direct, PubMed, and Cochrane databases were included. They highlight the importance of support and communication with palliative care teams and other grieving families. Understanding the ambivalence experienced during the process is crucial. The review underscores the limited research in this area and offers direction for future studies. Psychological interventions could aid these parents in adapting to their new reality.

Do Psychopathic Traits Statistically Protect Against PTSD? A Retrospective Study of Vietnam Veterans

Although psychopathy traits are traditionally associated with maladaptivity, certain traits may statistically buffer against risk for posttraumatic stress disorder (PTSD). Research suggests that psychopathy traits are differentially associated with PTSD, as boldness traits are negatively related to PTSD whereas disinhibition features are positively related. The authors sought to clarify the relations between psychopathy and PTSD in a large sample of Vietnam veterans (N = 2,598) and to examine the statistical interactions among (a) psychopathy traits and (b) combat exposure and psychopathy traits in predicting PTSD. Results indicate that psychopathy traits are differentially associated with PTSD in combat-exposed veterans, although the authors found little evidence that boldness was protective against PTSD. Nonetheless, meanness was significantly, albeit weakly, protective against PTSD in the presence of combat exposure. The authors consider the implications of these findings for future research, including the need to consider fearlessness as a heterogeneous construct, and they examine whether the findings generalize to PTSD in DSM-5.

Post-traumatic growth in the military: a systematic review

Background

Post-traumatic growth is defined as positive psychological, social or spiritual growth after a trauma.

Objectives

This systematic review aimed to identify studies that quantitatively measured post-traumatic growth among (ex-) military personnel, to determine whether there is evidence of growth in this context and whether such growth is associated with any sociodemographic, military, trauma or mental health factors.

Data sources

The electronic databases PsycInfo, OVIDmedline and Embase were searched for studies published between 2001 and 2017.

Study eligibility criteria and participants

Papers were retained if they involved military or ex-military personnel, where some had been deployed to Iraq or Afghanistan.

Study appraisal

Quality assessment was conducted on all studies.

Results

21 studies were retained. The Post-Traumatic Growth Inventory was employed by 14 studies: means ranged from 32.60 (standard deviation = 14.88) to 59.07 (23.48). The Post-Traumatic Growth Inventory Short Form was used by five studies: means ranged from 17.11 (14.88) to 20.40 (11.88). These values suggest moderate growth. Higher levels of social support, spirituality and rumination and minority ethnicity were most frequently associated with more post-traumatic growth.

Limitations

The involved studies may lack generalisability and methodological quality.

Conclusions

Overall, this paper confirms that negative reactions to trauma, particularly post-traumatic stress disorder, are not the only possible outcomes for service personnel, as moderate post-traumatic growth can also be observed.

Implications of key findings

Interventions aimed at helping current and former armed forces personnel to identify and promote post-traumatic growth post-conflict may be beneficial for their well-being.

A Salutogenic Perspective on Adverse Experiences

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

Personality and Post-traumatic Growth of Adolescents 42 Months after the Wenchuan Earthquake: A Mediated Model

The aim of this study was to examine the relationship of teenagers' post-traumatic growth (PTG) and personality and coping style by developing a mediating model with matched data from 772 adolescents. The sample consisted of 772 adolescents (mean age = 12.93, SD = 1.80) from several middle schools located in the areas that were most severely affected by the earthquake. Five factor model of personality, Coping Style Scale and Post-traumatic Growth Inventory were used to measure personality, coping and PTG of adolescents respectively. The results showed that the mean of PTG is 2.87 (SD = 0.93). Moreover, the relationship between personality and PTG is mediated by cognitive coping. The model's fit indices indicated a good fit (CFI = 0.996, TLI = 0.962, NFI = 0.994, RMSEA = 0.055). Results showed that a positive cognition coping style mediated the relationship between personality and PTG.

Combat Exposure, Perceived Benefits of Military Service, and Wisdom in Later Life

Stress, even extremely traumatic stress, may pose both risks and benefits. Although combat can have lifelong negative consequences, the perception of positive benefits from military experience can mitigate the negative effects of combat on mental health. However, little research has examined the impact of trauma earlier in life on the development of positive adaptation, such as wisdom, later in life. The authors examined whether combat exposure and the perception of benefits from military experience, assessed in 1990, were associated with greater wisdom in later life, assessed in 2001 in 615 men from the Normative Aging Study men (mean age 74 years, SD = 6.8 years). A quadrilinear relationship between combat exposure and wisdom was found. Moderate levels of combat were associated with higher levels of wisdom. The perception of benefits and coping predicted wisdom. Thus, how one appraises and copes with problems may be more important in the prediction of positive adaptation than the simple occurrence of stress.

When Nations Call

Most scholarship on aging is based on cohorts born early in the 20th century, and these cohorts have had significant experience with war. Wartime experiences may therefore be critical but largely hidden variables underlying current scientific knowledge about aging. Evidence marshaled in this article illustrates the powerful insights gained when research on this topic is guided by lifecourse propositions and data. It reveals how wartime military service, especially during World War II, affected the short- and long-ranging development of recruits. It also highlights the need to better account for the potential legacies of service for physical, psychological, and social functioning in late life. These matters will become increasingly important as sizable World War II and Korean veteran populations move through advanced old age, and as the Vietnam veteran population moves into old age. Systematic attention to the effects of wartime service is necessary to determine the degree to which contemporary knowledge about aging can be generalized to future cohorts.

The Origins of Health and Strength: From ‘Salutogenesis’ to ‘Fortigenesis’

It is argued that Antonovsky's concept of ‘salutogenesis’, referring to the origins of health, should be broadened to ‘fortigenesis’, which refers to the origins of psychological strength in general. The argument is based on his own writings. A number of related constructs are referred to in which the metaphor of strength is also inherent. Research on the development of psychological strength through appropriate work experiences, through military and combat experience, and through work force participation in the case of homemakers is reviewed.

Assessment of Intellectual Resources in Gulf War Veterans: Relationship to PTSD

War stress frequently leads to the subsequent development of psychopathology including posttraumatic stress disorder (PTSD), but recent research has indicated that individual difference factors may alter vulnerability to trauma-related distress. In an effort to examine the potential buffering effects of intellectual resources on PTSD development, this study assessed intellectual functioning in subsets of Persian Gulf War zone veterans with and without PTSD diagnoses. The two subsets, comprised of 18 PTSD-diagnosed and 23 psychopathology-free Persian Gulf War veterans, were compared on a multi-faceted test of intellectual functioning, the Wechsler Adult Intelligence Scale-Revised. As compared to psychopathology-free veterans, PTSD-diagnosed veterans performed significantly more poorly on tasks of verbal intellectual functioning including those tasks thought to reflect premorbid functioning. The two groups did not differ on visuospatial tasks or on a task of attention. Findings suggest that intellectual resources, particularly verbal skills, may buffer development of stress-related psychopathology following trauma exposure.

Relationship of War-Zone Coping Strategies to Long-Term General Life Adjustment Among Vietnam Veterans: Combat Exposure as a Moderator Variable

In this study, we examined long-term general life adjustment among members of one trauma-exposed population, Vietnam veterans, using data from a nationally representative sample. Our particular concern was the relationship between coping strategies used in the war zone and the outcomes of achievement, life satisfaction, and lifetime adaptation (the latter defined in terms of the absence of psychosocial problems in core life domains) as a function of level of combat exposure. Hierarchical multiple regression analyses supported a hypothesized quadratic interaction between problem-focused coping and the outcomes of achievement and lifetime adaptation, with this form of coping most strongly related to adjustment (positively) at moderate levels of combat exposure. One aspect of emotion-focused coping, the use of wishful thinking, likewise interacted in a quadratic manner for the dependent variable of achievement, exhibiting its strongest association with adjustment (negatively) at moderate levels of combat exposure. The importance of interactions between coping and stressors, especially quadratic interactions, is emphasized.

Vulnerability and resilience: a critical nexus

Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and intentionally impose conditions of vulnerability on others; and sometimes we knowingly and intentionally enter into and assume conditions of vulnerability for ourselves (for example, when we decide to trust or forgive, enter into intimate relationships with others, become a parent, become a subject of medical or psychotherapeutic treatment, and the like). In this article, I propose a presently overlooked basis on which one might evaluate whether the imposition or assumption of vulnerability is acceptable, and on which one might ground a significant class of vulnerability-related obligations. Distinct from existing accounts of the importance of promoting autonomy in conditions of vulnerability, this article offers a preliminary exploration of the nature, role, and importance of resilience promotion, its relationship to autonomy promotion, and its prospects for improving human wellbeing in autonomy inhibiting conditions.

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.

Postcancer experiences of childhood cancer survivors: how is posttraumatic stress related to posttraumatic growth?

Understanding posttraumatic growth (PTG) and the factors associated with PTG among cancer survivors is important to improve their quality of life. This study examined PTG among 225 Korean adolescents and young adults between 15 years and 39 years of age who survived childhood cancer (58.5% males and 41.5% females). We explored the relationships between PTG and several sociodemographic and medical variables, and whether the relationships between PTG and posttraumatic stress disorder (PTSD) symptoms were linear or curvilinear. The Posttraumatic Stress Diagnostic Scale (PDS) and the Posttraumatic Growth Inventory (PTGI) were used to assess PTSD symptoms and PTG, respectively. In addition to the effects of sociodemographic and medical variables, there were linear effects of PDS on PTGI (R(2) change = .03, p = .008). No evidence of a curvilinear relationship between PDS and PTGI was found. Higher PDS scores were associated with lower PTGI scores (β = -.18). Older age (β = .41) and shorter time since diagnosis (β = -.42) were associated with greater PTGI. Understanding the factors that were associated with PTG among Korean adolescent and young adult survivors of cancer adds to the knowledge on PTG and may help develop services to promote PTG in this group.

Resilience

When adverse life events occur, people often suffer negative consequences for their mental health and well-being. More adversity has been associated with worse outcomes, implying that the absence of life adversity should be optimal. However, some theory and empirical evidence suggest that the experience of facing difficulties can also promote benefits in the form of greater propensity for resilience when dealing with subsequent stressful situations. I review research that demonstrates U-shaped relationships between lifetime adversity exposure and mental health and well-being, functional impairment and health care utilization in chronic back pain, and responses to experimentally induced pain. Specifically, a history of some lifetime adversity predicts better outcomes than not only a history of high adversity but also a history of no adversity. This has important implications for understanding resilience, suggesting that adversity can have benefits.

Do Stress Trajectories Predict Mortality in Older Men? Longitudinal Findings from the VA Normative Aging Study

We examined long-term patterns of stressful life events (SLE) and their impact on mortality contrasting two theoretical models: allostatic load (linear relationship) and hormesis (inverted U relationship) in 1443 NAS men (aged 41-87 in 1985; M = 60.30, SD = 7.3) with at least two reports of SLEs over 18 years (total observations = 7,634). Using a zero-inflated Poisson growth mixture model, we identified four patterns of SLE trajectories, three showing linear decreases over time with low, medium, and high intercepts, respectively, and one an inverted U, peaking at age 70. Repeating the analysis omitting two health-related SLEs yielded only the first three linear patterns. Compared to the low-stress group, both the moderate and the high-stress groups showed excess mortality, controlling for demographics and health behavior habits, HRs = 1.42 and 1.37, ps <.01 and <.05. The relationship between stress trajectories and mortality was complex and not easily explained by either theoretical model.

Challenge or threat? Cardiovascular indexes of resilience and vulnerability to potential stress in humans

Humans continually face situations that require actions to achieve valued goals with meaningful consequences at stake. Although the pursuit of such goals can be a negatively "stressful" experience, it is not necessarily so. According to the biopsychosocial model of challenge and threat, evaluations of personal resources and situational demands determine to what extent individuals experience a relatively positive (challenge) versus negative (threat) psychological state in this context. Challenge occurs when evaluated resources meet or exceed demands, whereas threat occurs when demands exceed resources. The challenge response thus reflects resilience in the face of potential stress. Because challenge and threat reliably result in distinct patterns of physiological changes, assessing cardiovascular responses in particular can provide valuable insight into underlying psychological processes. Research applying this methodology to individual differences (e.g., self-esteem level and stability and cumulative lifetime exposure to adversity) has implications for understanding how early life experience could contribute to resilience versus vulnerability to potential stress in daily life.

Lifetime manic-hypomanic symptoms in post-traumatic stress disorder: relationship with the 18 kDa mitochondrial translocator protein density

Initially explored in military settings, post-traumatic stress disorder (PTSD) has shown increasing prevalence in the general population. The high comorbidity rates between bipolar disorder (BD) and PTSD have raised the issue of whether some characteristics of BD could represent risk factors for PTSD. In combat-related PTSD, the 18 kDa mitochondrial translocator protein (TSPO), essential for steroid synthesis, was found to be decreased. Aims of the present study were: 1) the assessment of the TSPO mitochondrial density in lymphomonocytes from civilian patients with non-combat-related PTSD, without current or lifetime Axis I mood comorbidity, versus controls; 2) the exploration of the correlations between TSPO density and the presence of comorbid manic/hypomanic lifetime spectrum symptoms. Assessments included the Structured Clinical Interview for DSM-IV (SCID), the Impact of Event Scale (IES), and the lifetime Mood Spectrum Self-Report (MOODS-SR). Blood samples were processed to assess TSPO binding parameters in lymphomonocyte mitochondrial membranes. PTSD patients showed a significant decrease in TSPO density, without changes in mitochondrial citrate synthase activity. Further, TSPO density correlated with the number of lifetime manic/hypomanic spectrum symptoms. For the first time, TSPO density was found to be decreased in non-war-related PTSD and such decreases correlated with comorbid manic/hypomanic spectrum symptoms, indicating a possible role of sub-threshold bipolar comorbidity in PTSD-related neurobiological dysregulation.

PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress

This prospective study examined: (a) the effects of Iraq War deployment versus non-deployment on pre- to postdeployment change in PTSD symptoms and (b) among deployed soldiers, associations of deployment/postdeployment stress exposures and baseline PTSD symptoms with PTSD symptom change. Seven hundred seventy-four U.S. Army soldiers completed self-report measures of stress exposure and PTSD symptom severity before and after Iraq deployment and were compared with 309 soldiers who did not deploy. Deployed soldiers, compared with non-deployed soldiers, reported increased PTSD symptom severity from Time 1 to Time 2. After controlling for baseline symptoms, deployment-related stressors contributed to longitudinal increases in PTSD symptoms. Combat severity was more strongly associated with symptom increases among active duty soldiers with higher baseline PTSD symptoms.

Post-traumatic growth and spirituality in burn recovery

For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. This growth occurs in areas such as a greater appreciation of life and changed priorities; warmer, more intimate relations with others; a greater sense of personal strength, recognition of new possibilities, and spiritual development. In addition, surveys of trauma survivors report that spiritual or religious beliefs played an important part in their recovery and they wished more healthcare providers were comfortable talking about these issues. Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth (PTG). This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters PTG and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.

The relationship of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms among Sri Lankan university students

The relationships of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms were examined in 93 Sri Lankan university students who had experienced a traumatic life event. Posttraumatic growth was associated with peritraumatic dissociation and posttraumatic stress symptoms, but was not associated with peritraumatic emotional distress. Results indicated a curvilinear relationship between peritraumatic dissociation and posttraumatic growth and between posttraumatic stress symptoms and posttraumatic growth. In a regression model predicting posttraumatic growth scores, each of the quadratic relationships of peritraumatic dissociation and posttraumatic stress symptoms to posttraumatic growth were statistically significant, and combined accounted for 22% of the variance. Results suggest that moderate levels of peritraumatic dissociation and symptoms are most associated with the greatest levels of growth.

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

Two studies of assault survivors (Ns = 180, 70) examined associations between posttraumatic growth (PTG) and posttrauma psychopathology. Both studies found significant curvilinear associations between PTG and posttraumatic stress disorder, whereas only Study 1 found a curvilinear association between PTG and depression symptom severity. Survivors with no or high growth levels reported fewer symptoms than those who reported moderate growth. Study 1 also investigated potential PTG predictors. Non-Caucasian ethnicity, religiousness, peritraumatic fear, shame, and ruminative thinking style, assessed at 2 weeks, predicted growth at 6 months. Posttraumatic growth may thus be most relevant in trauma survivors who attach enduring significance to the trauma for their lives and show initial distress. Moderate levels of PTG do not seem to ameliorate posttrauma psychopathology.

Posttraumatic stress disorder and posttraumatic growth among Israeli ex-pows

In this article, the authors present a prospective study that dealt with pathological (posttraumatic stress disorder; PTSD) and salutary (posttraumatic growth; PTG) outcomes of captivity and the correlates of those outcomes among a sample of ex-prisoners of war (POWs) and a control group of combat veterans. Posttraumatic stress disorder and its correlates were assessed in 1991 and 2003, and PTG was assessed in 2003. The results indicate that ex-POWs exhibited higher levels of PTSD and PTG than did the controls. In addition, both linear and quadratic associations between PTSD and PTG were found. The authors discuss some unresolved issues related to assessment of PTG and salutary outcomes, and outline directions for future research.

Positive change following trauma and adversity: a review

Empirical studies (n = 39) that documented positive change following trauma and adversity (e.g., posttraumatic growth, stress-related growth, perceived benefit, thriving; collectively described as adversarial growth) were reviewed. The review indicated that cognitive appraisal variables (threat, harm, and controllability), problem-focused, acceptance and positive reinterpretation coping, optimism, religion, cognitive processing, and positive affect were consistently associated with adversarial growth. The review revealed inconsistent associations between adversarial growth, sociodemographic variables (gender, age, education, and income), and psychological distress variables (e.g., depression, anxiety, posttraumatic stress disorder). However, the evidence showed that people who reported and maintained adversarial growth over time were less distressed subsequently. Methodological limitations and recommended future directions in adversarial growth research are discussed, and the implications of adversarial growth for clinical practice are briefly considered.

Hardiness: an examination of its relationship with positive and negative long term changes following trauma

Two models positing direct versus moderating effects of hardiness were examined in relation to long term positive and negative changes following exposure to traumatic stress. Participating in the study were 164 Israeli POWs and a matched group of 184 veterans of the 1973 Yom Kippur War. Participants completed a battery of questionnaires that included the Personal Views Survey (hardiness); the Trait, Attitude, and Behavior Change questionnaire; and questions related to their captivity/war experiences. Findings were consistent with a model that posits moderating effects of hardiness on both long term negative and positive changes. The discussion addresses the possible role of hardiness in relation to negative and positive outcomes of traumatic events.

Head injury as a predictor of psychological outcome in combat veterans

Although it is recognized that psychosocial variables influence the expression of psychopathology following trauma exposure, physiological variables have received less attention as potential mediators of psychological outcome in trauma victims. The purpose of this study was to examine the relationship of head injury to psychological outcome in 171 combat veterans seeking compensation for service-connected disabilities for mental disorders attributed to etiologies other than head injury. Veterans underwent structured psychiatric diagnostic interview and completed self-report measures of combat exposure, posttraumatic stress disorder (PTSD), depression, and occurrence of head injury. Comparisons between veterans with and without history of head injury indicated that head injury was associated with more severe depression. Regression analysis suggested that head injury predicted depression, but not PTSD, severity.

Two-year stability of Psychosis Proneness Scales and their relations to personality disorder traits

Two-year stability of Physical Anhedonia (PhA), Perceptual Aberration (PER), and Magical Ideation (MI) scale scores and their relation to personality disorder traits were examined. Additionally, the effects of a time-lagged (prospective) versus concurrent measurement of psychosis proneness and personality disorder traits were studied to examine the specificity of MI, PER, and PhA. With a non-college-student sample (n = 404), stability for PhA was sufficiently high, but for PER and MI, stability was moderate to low. The correlations between personality disorder traits and psychosis proneness scales demonstrate that simultaneous assessment leads to a more nonspecific pattern of associations for MI and PER, although the correlation to schizotypal personality disorder traits were the highest. However, prospectively only MI, but neither PER nor PhA, emerged as a significant predictor for schizotypal and paranoid personality disorder traits in multiple-regression analysis. This suggests that MI may allow for a more specific assessment of psychosis proneness than PER.

Psychology of comorbid posttraumatic stress disorder and substance abuse: lessons from combat veterans

This article provides important phenomenological observations, conceptual models, research findings, theoretical ideas, and psychotherapeutic techniques that are proving useful in working with combat veterans who display both PTSD and substance abuse disorders. Some of the clinical challenges of treating patients displaying a complicated trauma response are explored, such as the phenomena of patient and therapist dichotomous thinking, a "tuned-out" patient style, and difficulty establishing or maintaining therapeutic alliance. A clinically useful model (cocomplication model) is presented that views PTSD and substance abuse as tending mutually to impede resolution of one another, so that over time the patient may never achieve significant resolution of either problem. An overview of historical and current models of PTSD is then presented in order to provide a context for understanding ways that pretrauma variables might help determine the nature, persistence, and severity of adverse psychological reactions to overwhelming stress. Pathogenic beliefs developed in response to childhood mistreatment, abuse, or neglect are capable of mediating responses to later trauma. Once reinforced in combat or by other trauma, such beliefs may become particularly tenacious and compelling. Pathogenic beliefs incompatible with recovery from the trauma response and from addiction are reviewed. Testing for safety among traumatized populations is discussed and treatment suggestions are provided to avoid confirmation of pathogenic beliefs. A clinical case is provided that illustrates the application of these concepts to formulation and treatment.