A bright side of adversity? A systematic review on posttraumatic growth among refugees

Until the third trimester of 2022, 103 million people worldwide had been forced to leave their homes and become refugees. The traumatic experiences of refugees can lead not only to mental disorders but also to Posttraumatic Growth (PTG). (1) To find the variables positively and negatively associated with PTG in refugees. (2) To investigate the relationship between PTG and Posttraumatic Stress Disorder (PTSD) among refugees. We systematically searched Medline, Web of Knowledge, PsycInfo, Scopus, and PTSD Pubs for studies about PTG in refugees. Epidemiological studies using the Posttraumatic Growth Inventory. Grey literature, reviews, and meta-analysis. Risk of bias was assessed by the 'The Joanna Briggs Institute Prevalence Critical Appraisal Tool'. We included 24 studies investigating PTG and associated factors. The factors positively associated with PTG were social support, regular migration status, religiosity, satisfaction with life, time, and problem-focussed and emotion-focussed coping. The factors negatively associated with PTG were: irregular migration status, emotional suppression, and avoidance coping. Studies on PTG in refugees are essential to finding new ways to address mental health in this field. Few studies offered risk of bias, particularly regarding the sample selection. We conclude that PTG may be influenced by many factors and it would be of importance that the centres for support, as well as public policies, took that into account to foster the outcome and not only to focus on disease. This study was partially supported by CAPES and registered on PROSPERO (CRD42020215607).

Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents

BACKGROUND

This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis.

METHODS

867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28.

RESULTS

Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG.

LIMITATIONS

The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes.

CONCLUSIONS

Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.

Meaning-Making Predicts Forgiveness as an Indicator of Posttraumatic Growth and Resilience in a Culturally Diverse Sample

Trauma is a growing public health concern as global crises increase. Trauma can result in significant adverse psychological outcomes such as posttraumatic stress disorder (PTSD). Past research indicates that forgiveness may buffer the adverse psychological effects of trauma. We hypothesized that restoring individual and collective sense of meaning promotes forgiveness toward self and others and enables posttraumatic growth (PTG). Established PTG models posit that meaning can be found in surviving a traumatic event. We propose that PTG manifests as forgiveness in the face of both natural and humanmade disasters. Data were collected from individuals ( N = 3,534) in 11 countries from diverse global regions that have experienced collective traumas. Our study examined the predictive nature of meaning in life and PTSD symptoms on forgiveness. Hierarchical regression analysis indicated that trauma and meaning significantly predicted forgiveness, with a larger effect for humanmade disasters. Results indicated that presence of meaning, but not search for meaning, plays a role in PTG as measured by the ability to forgive after experiencing trauma, thus demonstrating its possible centrality to the healing process. Interventions and community-based programs that foster meaning-making following trauma may be part of an effective multicultural approach for enhancing community-wide PTG and resilience following disasters.

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.

The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents

This study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, psychiatric co-morbidity, trauma centrality and posttraumatic growth (PTG) among Chinese adolescents. Nine hundred and forty-eight Chinese adolescents (M = 462, F = 486) were recruited from two secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Centrality of Events Scale, the Posttraumatic Growth Inventory, the General Health Questionnaire-28, and the Educational Stress Scale for Adolescents. After controlling for demographic variables and levels of academic stress, structural equation modeling showed that PTSD was positively associated with trauma centrality and psychiatric co-morbidity but negatively associated with posttraumatic growth. Trauma centrality mediated the impacts of PTSD on posttraumatic growth and psychiatric co-morbidity. To conclude, PTSD from past trauma could impact adolescents' ways of perceiving positive aspects of their trauma and psychological well-being. Such impact, however, was influenced by the changes in their self-concept.

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.

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.

Patterns of Posttraumatic Stress Disorder and Posttraumatic Growth Among Adolescents After the Wenchuan Earthquake in China: A Latent Profile Analysis

Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) often coexist in the survivors of traumatic events. The current study examined the coexisting patterns of PTSD and PTG using latent profile analysis in a sample of 591 adolescent survivors of the May 12, 2008 Wenchuan earthquake in China. Logistic regression analysis was used to examine the effects of traumatic exposure on specific coexisting patterns. A three-class solution characterized by a growth group (39.6%), a low symptoms group (10.3%), and a coexistence group (50.1%) fitted the data best. Members of the low symptoms group were more likely to be male, odds ratio (OR) = 2.67, 95% CI [1.48, 4.81]; and adolescents in the coexistence group were more likely to be older, OR = 1.22, 95%CI [1.09, 1.37], and to have had experienced serious indirect exposure, OR = 1.07, 95% CI [1.02, 1.12], and posttraumatic fear, OR = 1.20, 95% CI [1.11, 1.31].

Trait resilience moderates the longitudinal linkage between adolescent posttraumatic stress disorder symptoms and posttraumatic growth

The current study examined the longitudinal association between posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) as well as the moderating role of trait resilience in that association. Participants completed measures of PTSD symptoms, PTG, and trait resilience at 12, 18, and 24 months after the Wenchuan earthquake. Results showed that after adjusting PTG at wave 1, PTSD symptoms at wave 1 were positively and significantly related to PTG at wave 2 for low-resilience individuals, but not for individuals with the other two levels (middle and high) of trait resilience. After adjusting PTSD symptoms at wave 1, PTG at wave 1 was positively and significantly related to PTSD symptoms at wave 2 for middle-resilience individuals, but not for individuals with the other two levels (low and high) of trait resilience. No other cross-lagged correlations were significant. Implications of the results for psychological service providers are discussed.

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.

Exploring self-perceived growth in a clinical sample of severely traumatized youth

OBJECTIVE

The aims of this study were threefold: (1) examine the prevalence of Posttraumatic Growth (PTG) among severely traumatized youth, (2) systematically describe the PTG reported, and (3) study the course of PTG from pre- to post-treatment.

METHOD

The sample consisted of 148 severely traumatized Norwegian youth (M age=15, SD=2.2, 79.1% girls) receiving treatment in child mental health clinics. The Clinician Administered PTSD Scale for Children (CAPS) was used to assess level of posttraumatic stress symptoms (PTSS) pre- and post-treatment. One of the questions in CAPS: "How do you think (traumatic event) has affected your life?" formed the basis for our analysis of PTG. Words and phrases indicative of PTG were identified using the Consensual Qualitative Research method.

RESULTS

Pre-treatment, the prevalence rate of PTG was low compared to previous findings, and reports of PTG were not related to levels of PTSS. The main PTG themes identified were: personal growth, relational growth, and changed philosophy of life. A sub-theme of personal growth; greater maturity/wisdom, was the most salient theme identified both pre- and post-treatment. Age was significantly related to reports of PTG; older participants reported more growth. Reports of PTG increased significantly from pre- to post-treatment, but were not related to decrease in PTSS.

CONCLUSIONS

The findings suggest that PTG is not only possible for youth, but quite similar to that observed among adults. However, we need to carefully consider whether reports of self-perceived positive change among traumatized youth actually are indicative of growth, or simply indicative of increased vulnerability.