Posttraumatic Growth Among Operation Enduring Freedom and Operation Iraqi Freedom Amputees

Validity and Reliability of the Empowered Veteran Index-Short Form (EVI-SF)

PURPOSE

Veteran empowerment may include connection, community impact, and personal growth. At least one valid and reliable tool has been developed to measure the aforementioned framework: the empowered veteran index (EVI). However, there is a need for a shorter measure to prevent survey fatigue.

MATERIALS AND METHODS

We recruited military veteran members of a nonprofit (n = 316), The Mission Continues, for participation in this cross-sectional online survey study. Participants completed the 35-item EVI. A short form of the EVI (EVI-SF) was developed through bifactor confirmatory factor analysis (CFA).

RESULTS

The 10-item EVI-SF model demonstrated satisfactory performance (χ2 p = 0.68, SRMR = 0.02, RMSEA = 0.01, CFI = 0.99, TLI = 0.99). All factor loadings in this model were ≥ 0.30, providing evidence for the validity of the interval structure. Internal consistency reliability was good for all three subscales (omegas >0.7).

DISCUSSION

Analysis of the EVI-SF showed that the instrument was valid and reliable. The EVI-SF contains 10 items with seven-point Likert scale response options. Use of the instrument may provide for the opportunity to measure empowerment of military veterans.

CONCLUSION

This study provides preliminary psychometric validation of the EVI-SF.

Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis

PURPOSE

Combat deployment increases exposure to potentially traumatic events. Perceived social support (PSS) may promote health and recovery from combat trauma. This systematic review and meta-analysis aimed to synthesize studies investigating the level of PSS and associated factors among (ex-)military personnel who served in the Iraq/Afghanistan conflicts.

METHODS

Five electronic databases were searched in August 2023 and searches were restricted to the beginning of the Iraq/Afghanistan conflicts in 2001. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A quality assessment was carried out, and a meta-analysis and narrative synthesis were performed.

RESULTS

In total, 35 papers consisting of 19,073 participants were included. Of these, 31 studies were conducted in the United States (US) and 23 were cross-sectional. The pooled mean PSS score was 54.40 (95% CI: 51.78 to 57.01). Samples with probable post-traumatic stress disorder had a lower mean PSS score (44.40, 95% CI: 39.10 to 49.70). Approximately half of the included studies (n = 19) investigated mental health in relation to PSS, whilst only four explored physical health. The most frequently reported risk factors for low PSS included post-traumatic stress disorder, depression and anxiety, whilst post-traumatic growth and unit support were protective factors.

CONCLUSION

Higher levels of PSS were generally associated with more positive psychosocial and mental health-related outcomes following deployment. PSS should be targeted in psychosocial interventions and education programmes. Future research should investigate PSS in (ex-)military personnel across other countries and cultures, based on the lack of studies that focused on PSS in countries outside of the US.

Factors Contributing to Resilience Among First Generation Migrants, Refugees and Asylum Seekers: A Systematic Review

Objectives: We aimed at 1) collating and evaluating the current evidence on factors contributing to resilience of adult transnational migrants, 2) identifying methodological factors which contribute to the findings, 3) identifying and analyzing promotive and preventive factors contributing to the findings. Methods: A systematic search for relevant studies published until 2021 was conducted in PubMed, PsycINFO, PTSDPubs, and Web of Science. Both, quantitative and qualitative peer-reviewed observational studies reporting on resilience and wellbeing, sense of coherence, or post-traumatic growth outcomes among transnational migrants (aged 18+). Risk of Bias was assessed using the Critical Appraisal Skills Program for qualitative studies and the Appraisal Tool for cross-sectional studies. Due to the heterogeneity of studies we did a narrative review. Results: Database search yielded 3,756 unique records, of those n = 80 records, representing n = 76 studies met the inclusion criteria. The studies provided knowledge on resilience for n = 9,845 transnational migrants across 23 countries. All studies except two were cross sectional. N = 45 reported on resilience, n = 4 on Sense of Coherence and n = 15 on Post-Traumatic Growth. The study methods were not related to the findings. Future orientation, hope and religion/spirituality, caring for others and having opportunities were shown to be more pertinent to resilience outcomes than institutional care structures. Conclusion: Our findings highlight that mental health professionals and policymakers should try to support positive perspectives for the future and encourage policies tailored towards giving refugees opportunities to work, learn and care and to help others.

Examination of the relationship between post-traumatic growth and social support and life satisfaction in wounded veterans in Turkey

AIM

This study aims to examine the effects of social support and life satisfaction on post-traumatic growth in wounded veterans in Turkey.

METHODS

1175 wounded veterans participated in the cross-sectional study. The sociodemographic questionnaire, the Post-Traumatic Growth Inventory, the Multidimensional Scale of Perceived Social Support, and the Satisfaction with Life Scale were used to collect data. Data were analyzed via SPSS.

RESULTS

The results of the study show that the mean age is 43.04 ± 7.36. The participants are low in education and socioeconomic level. The mean of the Post-Traumatic Growth Inventory score is 43.44 ± 21.18, the mean of the Multidimensional Scale of Perceived Social Support score is 50.01 ± 15.23, and the mean of the Satisfaction With Life Scale score is 9.86 ± 4.04. The results of the study show that there is a positive relationship between social support and life satisfaction and post-traumatic growth.

CONCLUSION

It can be suggested to develop psychosocial intervention strategies and service delivery systems to promote the life satisfaction, social support mechanisms of wounded veterans.

Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study

BACKGROUND

Post-traumatic growth (PTG) is a positive psychological consequence of trauma. The aims of this study were to investigate whether combat injury was associated with deployment-related PTG in a cohort of UK military personnel who were deployed to Afghanistan, and whether post-traumatic stress disorder (PTSD), depression and pain mediate this relationship.

METHODS

521 physically injured (n = 138 amputation; n = 383 non-amputation injury) and 514 frequency-matched uninjured personnel completed questionnaires including the deployment-related Post-Traumatic Growth Inventory (DPTGI). DPTGI scores were categorised into tertiles of: no/low (score 0-20), moderate (score 21-34) or a large (35-63) degree of deployment-related PTG. Analysis was completed using generalised structural equation modelling.

RESULTS

A large degree of PTG was reported by 28.0% (n = 140) of the uninjured group, 36.9% (n = 196) of the overall injured group, 45.4% (n = 62) of amputee and 34.1% (n = 134) of the non-amputee injured subgroups. Combat injury had a direct effect on reporting a large degree of PTG [Relative risk ratio (RRR) 1.59 (95% confidence interval (CI) 1.17-2.17)] compared to sustaining no injury. Amputation injuries also had a significant direct effect [RRR 2.18 (95% CI 1.24-3.75)], but non-amputation injuries did not [RRR 1.35 (95% CI 0.92-1.93)]. PTSD, depression and pain partially mediate this relationship, though mediation differed depending on the injury subtype. PTSD had a curvilinear relationship with PTG, whilst depression had a negative association and pain had a positive association.

CONCLUSIONS

Combat injury, in particular injury resulting in traumatic amputation, is associated with reporting a large degree of PTG.

Posttraumatic Growth in Women Who Have Experienced Intimate Partner Abuse

The purpose of the current qualitative descriptive study was to describe the experiences of women who have endured intimate partner abuse using the theoretical framework of posttraumatic growth (PTG). Women (N = 14) who reported emotional and/or physical abuse by their male partners were interviewed. Five themes were identified: Acknowledging the Abusive Relationship; Fear of Him: Threats, Control, Pain, and Isolation; Accepting Support: Grabbing the Life Preserver; Rediscovering Myself: Digging Deep; and Appreciating Life and Helping Others. Findings have practical implications for nurses who are in pivotal positions to educate and influence others about the possibility of PTG following partner abuse. Nurses can help women find their way through this trauma and teach others about coping, healing, and recovery. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 34-41.].

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

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

Posttraumatic growth in women who have experienced the loss of their spouse or partner

BACKGROUND

The loss of a spouse or long-term partner has a significant impact on a woman's well-being; psychological, physical, social, spiritual, and economic. Women dealing with loss are faced with numerous stressors which place them at risk for a variety of health challenges.

PURPOSE

The aim of this study was to describe the experiences of women who have lost their spouse or partner to death using the theoretical framework of posttraumatic growth (PTG) developed by Tedeschi and Calhoun.

METHODS

A qualitative descriptive study was conducted with semi-structured interviews of 15 widows. Purposive sampling was employed using the researchers' nursing network of colleagues through their academic institutions, hospital affiliations, and professional organizations.

FINDINGS

Six themes emerged from the data analysis: (1) Listen to my story of loss, (2) Pushing through the sadness, (3) Anticipated versus unanticipated loss, (4) A new depth of compassion and empathy, (5) My strength grew over time, and (6) My view of myself changed. Participants experienced varying degrees of PTG evidenced by a greater appreciation of life, personal strength, improved relationships, new possibilities, and spiritual growth.

IMPLICATIONS FOR NURSING

Knowledge development in this sphere enhances nursing practice in caring for women as they navigate life without their significant other. Nurses are in pivotal positions to educate others about the grieving process and the possibility of PTG. They help women find their way through trauma and teach others about healing, coping, empathy, compassion and the power of being connected to other human beings.

Posttraumatic Growth in Women who have Experienced Loss of a Child

PURPOSE

The purpose of this study was to describe and explore the experiences of women who have lost a child and the degree of posttraumatic growth revealed by the experiences.

STUDY DESIGN AND METHOD

A qualitative descriptive study was conducted with interviews of mothers and grandmothers of children who died using the posttraumatic growth framework.

FINDINGS

Participants included 11 mothers and 2 grandmothers. The posttraumatic growth framework was useful in examining their experiences. Seven themes were identified through data analysis: When my child died, I lost part of myself; Anticipated loss versus unanticipated loss; Picking up the pieces of my life; Support, kindness, and compassion helped; Moving on while still broken; Never forgotten, always in my heart; and Holding my loved ones close.

CLINICAL IMPLICATIONS

Nurses are in strategic positions to help women who have experienced the loss of a child by building rapport, establishing trust, and demonstrating empathy.

Health Outcomes Used to Determine Facets of Health-related Quality of Life for Post-9/11 Veterans Using Assistive Technology for A Combat-related Mobility Impairment: A Literature Review

INTRODUCTION

Novel rehabilitation methods, including distribution and adoption of assistive technology for lower extremity impairments, are becoming crucial to ensure positive quality of life in all individuals. The quality of life of post-9/11 combat veterans is not well understood, in comparison to research on other populations. The following essay describes a review on health outcomes used to determine health-related quality of life (HR-QoL) among combat-injured service members who require mobility-related assistive technology.

MATERIALS AND METHODS

Reviews pooled data from research on PubMed, EMBASE, CINAHL, and PsycINFO published after September 11, 2001, and included service members who sustained a mobility impairment because of involvement in a post-9/11 combat operation. Basic descriptors were extracted in addition to health outcomes used, which were then categorized and summarized by six domains for HR-QoL as defined by the World Health Organization.

RESULTS

This review found health outcomes that fit in the pain and discomfort, negative emotions, mobility, social relations, access to and quality of healthcare services, and religious/spiritual/personal beliefs subdomains. The categorized results detailed their application to track and model HR-QoL health states in those with mobility impairments using mobility-based assistive technology.

CONCLUSIONS

The research on combat-induced mobility impairments indicates assistive technology improves otherwise poor health states. The results model these domains and subdomains to determine overall HR-QoL and the quality of a healthcare intervention, though additional research is needed as only one study was identified to be experimental in design.

Combat Experience, New-Onset Mental Health Conditions, and Posttraumatic Growth in U.S. Service Members

Objective: Studies examining posttraumatic growth (PTG) rely on surveys evaluating PTG in relation to prior traumatic experiences, resulting in psychometric problems due to the linkage of the dependent and independent variables. Few studies have assessed PTG following combat deployment while also controlling for mental health problems.Method: Longitudinal data on PTG, combat experience, and mental health were examined among U.S. Millennium Cohort Study deployers (n = 8732). Scores from a short-form (SF) version of the PTG inventory assessing current-state beliefs (C-PTGI-SF) independent of any predictor variables were assessed at time 1 (T1), before deployment, and change in scores were assessed approximately 3 years later after deployment at time 2 (T2). All participants screened negative for posttraumatic stress disorder (PTSD) and depression at T1.Results: Combat deployment severity was associated with a worsening of C-PTGI-SF scores at T2 among participants with moderate C-PTGI-SF scores at T1. A positive screen for comorbid PTSD/depression was associated with a worsening of C-PTGI-SF scores at T2 among participants with moderate or high C-PTGI-SF scores at T1. At T2, a strong inverse correlation was found between C-PTGI-SF scores and PTSD (r = -0.38) and depression (-0.41). Only 5% of participants who screened positive for a mental health problem at T2 (23/517) also experienced positive growth.Conclusions: These results challenge the clinical utility of the PTG construct. While PTG may be a useful framework for supporting trauma recovery on an individual basis, PTG does not appear to be distinct and independent from the negative psychological impact of traumatic experiences.

Post-Traumatic Growth of Nurses Who Faced the COVID-19 Epidemic and Its Correlation With Professional Self-Identity and Social Support

OBJECTIVE

To investigate post-traumatic growth (PTG) and analyze its correlation with professional self-identity and social support in Chinese nurses who faced the coronavirus disease 2019 (COVID-19) epidemic.

METHODS

A cross-sectional descriptive design was used in this study. An online questionnaire was completed by 266 nurses who faced the COVID-19 emergency in Hubei Province, China. The Post-traumatic Growth Inventory (PTGI), Professional Self-identity Scale, and Perceived Social Support Scale were used to assess the level of PTG, professional self-identity, and social support. Descriptive, univariate analysis and multiple regression analyses were used in exploring related influencing factors.

RESULTS

Participants' mean scores were 96.26 (SD = 21.57) for PTG, 115.30 (SD = 20.82) for professional self-identification, and 66.27 (SD = 12.90) for social support. Multiple regression analysis showed that nurses from other provinces moving to support Hubei Province, professional self-identity, and social support were the main factors affecting nurse stress (p = 0.014, < 0.001, and 0.017, respectively). Professional self-identity and social support were positively correlated with PTG (r = 0.720 and 0.620, respectively).

CONCLUSIONS

There was a phenomenon of PTG when the nurses faced COVID-19 in Hubei Province. Providing an active coping style helps to improve the level of PTG.

Social support moderates association between posttraumatic growth and trauma-related psychopathologies among victims of the Sewol Ferry Disaster

Disasters have numerous harmful effects on the mental health status of trauma-exposed people. We investigated the differences in the association between trauma-related psychopathologies and posttraumatic growth according to the perceived social support level among victims of the Sewol Ferry disaster on April 16, 2014, in South Korea. Data from 241 bereaved family members, survivors, and family members of survivors were used. The Duke-UNC Functional Social Support Questionnaire, Posttraumatic Growth Inventory, PTSD Checklist-5, Posttraumatic Embitterment Disorder Self-Rating Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 were used to evaluate perceived social support, posttraumatic growth, and trauma-related psychopathologies. We found that the severity of depression and anxiety showed inverse correlations with posttraumatic growth only in the low-social support group, while they did not demonstrate significant correlations in the high-social support group. The social support level had correlations with posttraumatic growth and the severity of posttraumatic stress disorder and posttraumatic embitterment disorder only in female respondents. Furthermore, there was a mediation pathway from social support level to posttraumatic growth through depressive symptoms. This study explored the complex relationship between social support, posttraumatic growth, trauma-related psychopathologies, and gender among trauma-exposed individuals in the aftermath of the Sewol Ferry disaster.

Analysis of post-traumatic growth status and its influencing factors in patients with facial palsy

Background

Facial nerve paralysis in patients occurs in varying degrees of self-image disorders, both physically and mentally, resulting in low self-esteem, anxiety, depression, and even suicide; however, there were few researches on psychological problems in facial palsy patients at home and abroad. This study’s objective was to investigate post-traumatic growth (PTG) in facial nerve palsy patients and analyze its influencing factors.

Methods

Using the convenience sampling method, a total of 47 patients with facial nerve paralysis were enrolled in the current study between June 1, 2016, and May 31, 2017. Post-traumatic growth rating scale was utilized to investigate the post-traumatic growth of these patients, and factors influencing patients’ post-traumatic growth were analyzed through collecting the general sociological information, disease-related information, simple coping style questionnaire, and social support rating scale.

Results

The total score of post-traumatic growth in patients with facial nerve paralysis was mean (M) = 63.1, standard deviation (SD) = 19.14. The ranking of five dimensional scores from high to low was as follows: new possibilities, personal strength enhancement, appreciation of life, mental changes, and improvement of relationships with others. Multiple linear regression analysis showed that six variables, namely, the personality type, duration with facial nerve paralysis, and four coping styles, consisting of three types of positive coping styles and one negative coping style, could explain 71.6% of the total post-traumatic growth score.

Conclusions

Post-traumatic growth in facial nerve palsy patients is moderate. The personality type of patients, the disease duration, and the coping style are the primary influencing factors. Therefore, clinical staffs should perform personalized nursing protocol and psychological intervention for facial nerve palsy patients to reduce their negative mood, improve their compliance with treatment, and help them recover more rapidly.

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.

From core belief challenge to posttraumatic growth in para sport athletes: moderated mediation by needs satisfaction and deliberate rumination

Purpose: To examine how deliberate rumination and psychological need satisfaction interact to facilitate posttraumatic growth for para sport athletes with acquired disability. Methods: Utilizing a sample of 70 para sport athletes, the hypothesized mediating role of deliberate rumination was examined via a simple mediation model. The interaction between needs satisfaction and deliberate rumination and their effect on posttraumatic growth was examined utilizing a moderated mediation procedure. Results: Disruption to one's core beliefs was significantly associated with posttraumatic growth. This relationship, was in part, explained by the deliberate rumination engaged in soon after the trauma. Needs satisfaction, while a significant predictor of posttraumatic growth, did not moderate the indirect effect. Conclusions: Although deliberate rumination at both timeframes and needs satisfaction were independently associated with posttraumatic growth, they did not interact in the hypothesized manner to influence posttraumatic growth. There remains a need to better understand how the experience of posttraumatic growth is achieved amongst individuals with acquired disability, and the role that para sport may play in this process. Implications for rehabilitation The disruption to one's core beliefs caused by acquiring a physical disability is not only a natural experience but also a necessary antecedent to posttraumatic growth. As such, rehabilitation practitioners ought to normalize these types of challenges when working with individuals with acquired disability. Practitioners may help to facilitate growth outcomes by encouraging individuals to deliberately ruminate about their acquired disability. That is, practitioners can help those with acquired disability to seek meaning and understanding about their disability or the precipitating event. For those who struggle to deliberately ruminate in the immediate disability aftermath, practitioners may encourage para sport participation to potentially prompt constructive cognitive processing. Individuals with acquired disabilities would also be well served by rehabilitation practitioners and para sport organizations that provide opportunities for basic psychological needs satisfaction. Specifically, individuals with acquired disabilities should be given the opportunity to demonstrate physical competence, make meaningful relationships, and feel a sense of volitional control over their rehabilitation or para sport participation. For example, practitioners and para sport organizations could establish mentorship programs wherein individuals with more recent disabilities can be mentored by those with greater disability experience.

Suffering of Traumatic Amputees in Spain: Meaning, Spirituality, and Biomedicine

Amputation is a traumatic incident that entails a chain of psychological, physical, and social events. The objectives of the study are to describe the beliefs and the philosophies of life related to the experience of suffering of traumatic amputees, analyze the importance of biomedical care, and describe other forms of care used.

Posttraumatic growth in individuals with amputations

BACKGROUND

Studying positive outcomes post-amputation is an important area of research in order to help individuals recover with the optimal quality of life possible.

OBJECTIVE

To examine posttraumatic growth (PTG) in the understudied population of individuals with amputations. Our main aim was to assess the effect of gender, veteran status, age, and time since amputation on PTG. Our secondary aim was to examine the role support group participation on PTG.

METHODS

Sixty-six adults with amputations completed an online survey consisting of the Posttraumatic Growth Inventory (PTGI) and free response questions about experiences with support groups. T-tests and correlations were the main statistical analyses.

RESULTS

There were no gender differences in PTGI scores. Veterans had significantly lower PTGI scores than civilians, t(64) = 2.63, p < 0.05, Cohen's d = .41. Age was negatively correlated with PTGI score, r = -.27, p < 0.05. Participants who indicated consistent engagement in a support group had significantly higher PTGI scores than participants without support group engagement, t(64) = 3.49, p < 0.01, Cohen's d = .89.

CONCLUSIONS

Veterans may be a specific population to target for PTG. Support groups appear to be a venue associated with higher levels of growth.

Trauma or growth after a natural disaster? The mediating role of rumination processes

The aim of this study was to test a cognitive model of posttraumatic symptoms (PTS) and posttraumatic growth (PTG) after exposure to a natural disaster. It was hypothesized that although subjective severity of trauma would be related to the severity of PTS, this relation would be mediated by brooding and cognitive strategies related to the presence of repetitive negative content in thoughts. Furthermore, the relation between severity and PTG would be fully mediated by deliberate rumination (DR), cognitive strategies related to conscious efforts focused on handling the event. To evaluate the cognitive model, adults (N=351) who lost their homes as a result of the earthquake and tsunami that occurred in Chile on February 27, 2010, were selected. Structural equation modeling was used to analyze the data. The resulting model had adequate indices of goodness adjustment and showed that brooding completely mediated the relation between subjective severity and PTS, and DR completely mediated the relation between subjective severity, brooding, and PTG. These results highlight the role of both the content and process of rumination in mediating the association between subjective severity of trauma, PTS, and PTG. The implications of these results for a more comprehensive model of symptom severity that occurs after trauma are discussed.

An Integrated Model of Posttraumatic Stress and Growth

A number of recent models have examined cognitive predictors of posttraumatic stress and posttraumatic growth (S. Barton, A. Boals, & L. Knowles, 2013; J. Groleau, L. Calhoun, A. Cann, & G. Tedeschi, 2013; K. N. Triplett, R. G. Tedeschi, A. Cann, L. G. Calhoun, & C. L. Reeve, 2012). The current study examined an integrated model of predictors of distress and perceived growth in 194 college undergraduates. Domains covered included the roles of core belief challenge, event centrality, posttrauma cognitions, and event-related rumination. Negative cognitions about the self and the centrality of the event directly predicted both growth and distress, although intrusive rumination predicted only posttraumatic stress disorder symptoms, and deliberate rumination predicted only posttraumatic growth. Future research should continue to examine the shared and unique predictors of postevent growth and distress.

"No one gets through it OK": the health challenge of coming home from war

Few studies have sought to explore the subjective experience of reintegration for veterans of the current Operations Enduring Freedom/Iraqi Freedom/New Dawn military campaigns, and even less attention has been given to discover strategies used by veterans to overcome difficulties with transitioning from life in a combat zone to life at home. Findings of this mixed-method study describe reintegration challenges faced by a sample of student veterans as well as some of the strategies they used in response to those challenges. This study provides direction for nurses and postsecondary educators to support veterans who struggle with their personal experience of coming home from the war.

Battlefield compassion and posttraumatic growth in combat servicepersons

The literature is replete with studies related to the negative outcomes of serving in combat. However, for some military servicepersons, healing could be assisted by understanding the positive experiences and outcomes related to combat service. This study surveyed 59 servicepersons to identify acts of battlefield compassion, as well as other positive military experiences. In addition, participants were asked to identify personal changes as a result of compassionate experiences and to give an overall rating of their time in combat. Results are compared to the posttraumatic growth (PTG) literature and reveal that participants identified positive changes associated with experiences of compassion.