Prolonged grief and post-traumatic growth after loss: Latent class analysis

Bereavement may trigger different psychological outcomes, such as prolonged grief disorder or post-traumatic growth. The relationship between these two outcomes and potential precipitators remain unknown. The current study aimed to identify classes of Chinese bereaved individuals based on prolonged grief symptoms and post-traumatic growth and to examine predictors for these classes. We used data from 273 Chinese individuals who lost a relative due to disease (92.3%), accident (4.4%) and other reasons (1.8%). Latent class analysis revealed three classes: a resilient class, a growth class, and a combined grief/growth class. A higher level of functional impairment was found for the combined grief/growth class than for the other two classes. Membership in the combined grief/growth class was significantly predicted by the younger age of the deceased and the death of a parent, child or spouse. Subjective closeness with the deceased and gender were marginally significant predictors. When the four variables were included in the multinomial regression analysis, death of a parent, child or spouse significantly predicted the membership to the combined grief/growth class. These findings provide valuable information for the development of tailored interventions that may build on the bereaved individuals' personal strengths.

Mining for Posttraumatic Growth (PTG) in Sexual Minority Women Who Survive Intimate Partner Violence: A Conceptual Perspective

This theoretical paper explores the need to use posttraumatic growth (PTG) as a framework when studying sexual minority women (SMW) who are survivors of intimate partner violence (IPV) to examine the relationship between risk factors such as stress, anxiety and alcohol use and to understand the role of protective factors through mining for the presence of posttraumatic growth (PTG). Despite a call for continued research in this highly vulnerable population, representative studies of SMW and PTG remain extremely limited. Research that examines the relationship between IPV, behavioral health issues, and posttraumatic growth would provide the opportunity to develop tailored intervention models and opportunities for program development to decrease isolation and increase factors of posttraumatic growth. In particular, the impact of how interpersonal relationships as potential mediators and/or outcomes of posttraumatic growth (PTG) needs to be explored more thoroughly. PTG is a valuable framework for vulnerable populations such as sexual minority women because it focuses on how transformative change may result from traumatic experiences such as surviving IPV.

Relationships Between Illness Perception and Post-traumatic Growth Among Newly Diagnosed HIV-Positive Men Who have Sex with Men in China

Newly diagnosed HIV-positive men who have sex with men (NHMSM) are at high risk of mental health problems but may also develop post-traumatic growth (PTG). According to the Common Sense Model, illness perception (including both cognitive representation and emotional representation) affects coping and health-related outcomes. A cross-sectional survey was conducted to examine the associations between illness perception and PTG among 225 NHMSM in Chengdu, China. Linear regression analyses indicated that the constructs of emotional representation subscale (β = -0.49) and five cognitive representation subscales (timeline, consequence, identity, attribution to god's punishment/will, and attribution to chance/luck) (β = -0.13 to -0.37) were negative correlates of PTG, while four other constructs of cognitive representation (coherence, treatment control, personal control, and attribution to carelessness) were positive correlates (β = 0.15 to 0.51). No moderating effects were observed. The associations between five cognitive representation subscales and PTG were fully-mediated via emotional representation. The results indicate that interventions promoting PTG among NHMSM are warranted and should alter illness perception, emotional representation in particular. Future studies should clarify relationships between cognitive representation and emotional representation, and extend similar research to other health-related outcomes and HIV-positive populations.

The Effect of Cognitive-Emotional Training on Post-traumatic Growth in Women with Breast Cancer in Middle East

Overcoming distresses and negative consequences of serious crises such as cancers can lead to perception of positive changes in the patients. It is necessary to design and test the psychological interventions that can improve post-traumatic growth. The objective of this study was to determine the effect of cognitive-emotional training on post-traumatic growth in women with breast cancer referred to the department of chemotherapy. This is a quasi-experimental study and it was performed on 85 patients with breast cancer who referred to an educational hospital in southeastern of Iran in 2017. The eligible patients were selected through convenience method sampling among the patients and they randomly allocated into intervention and control groups. The intervention group received five sessions of emotional-cognitive training in two sessions per week. Each session lasted 60-90 min. The posttest data were collected by post-traumatic growth inventory (PTGI) 20 weeks after the end of the last intervention session. Collected data were analyzed by SPSS software version 21.00 using independent t test, paired t test, and Chi-square tests for demographic analysis. The results indicated that there is no significant difference in both groups in terms of individual variables such as age, marriage, duration of disease, and degree progression of cancer. Although the mean of PTG scores in posttest and the mean of variations in the PTG scores in the intervention group were 77.48 ± 11.18 and 25.81 ± 12.24, respectively, and it was significantly higher than the control group, 53.95 ± 14.86 and 7.69 ± 9, respectively (mean scores of PTG: p < .0001; mean changes of PTG: p < .001). According to the results of this study, cognitive-behavioral intervention had a positive and significant effect on post-traumatic growth in women with breast cancer. If intervention is found to be effective, cognitive and emotional strategies of such interventions could be integrated into daily clinical practice as a way to promote PTG in women who are being treated for breast cancer.

The Impact of Stigma and Social Support on Development of Post-traumatic Growth Among Persons Living with HIV

Given high rates of trauma in people living with HIV (PLH) and the health benefits of posttraumatic growth (PTG), understanding how to foster PTG in PLH exposed to trauma could be of interest to clinical psychologists working with this population. The current study examined factors theoretically related to development of PTG in PLH, namely HIV-related stigma, disclosure of HIV status, and emotional support. A sample of 334 HIV-positive adults answered a battery of self-report questionnaires. HIV-related stigma, disclosure to sexual partners, and emotional support were significant predictors of PTG: stigma was associated with lower PTG, whereas disclosure and emotional support were associated with higher PTG. Disclosure and emotional support remained significantly associated with PTG in the model including demographic factors and stigma. These findings highlight the need for development of interventions that can aid PLH in disclosing their HIV status to sexual partners and increasing available social support.

Eye Movement Desensitization and Reprocessing to Facilitate Posttraumatic Growth: A Prospective Clinical Pilot Study on Ferry Disaster Survivors

Objective

The purpose of this study was to investigate the therapeutic effects of eye movement desensitization and reprocessing (EMDR) on post-traumatic growth (PTG).

Methods

This study was conducted using a sample of ten survivors of a large-scale maritime disaster that occurred in the Yellow Sea, South Korea, in April 2014. A total of eight EMDR sessions were administered by a psychiatrist at two-week intervals over a period of five months, starting two or three months after the accident. Post-Traumatic Growth Inventory (PTGI), Stress-Related Growth Scale (SRGS), Clinician-Administered PTSD Scale (CAPS), and Connor-Davidson Resilience Scale (CD-RISC) were measured before treatment, after sessions 4 and 8, and at three months after treatment completion.

Results

After three months from treatment completion, significant increases were observed in PTG (PTGI: Z(8)=−2.380, p=0.017; SRGS: Z(8)=−2.380, p=0.017) and resilience (CD-RISC: Z(8)=−2.386, p=0.017). A decrease in post-traumatic stress disorder (PTSD) level was also significant (CAPS: Z(8)=−2.176, p=0.030). The reduction of CAPS scores was correlated with increases of PTGI (rho=0.78, p=0.023) and SRGS (rho=0.79, p=0.020) scores. The changes in CAPS, PTGI, and SRGS scores between time point of end 8-session and three months follow-up was not significant (all p>0.05). Subjects with higher pre-treatment CD-RISC scores showed more significant improvements in PTGI (rho=0.88, p=0.004) and SRGS (rho=0.83, p=0.010) scores after treatment than did those with lower pre-treatment CD-RISC scores.

Conclusion

EMDR therapy using standard protocol for trauma processing helped facilitating PTG in disaster survivors. To generalize these findings, further controlled studies comparing with other treatment modalities for PTSD are needed.

Haemato-oncology patients' perceptions of health-related quality of life after critical illness: A qualitative phenomenological study

INTRODUCTION

Haemato-oncology patients often require critical care support due to side-effects of treatment. Discharge can mark the start of an uncertain journey due to the impact of critical illness on health-related quality of life. Qualitatively establishing needs is a priority as current evidence is limited.

AIMS

To qualitatively explore perceptions of haemato-oncology patients' health-related quality of life after critical illness and explore how healthcare professionals can provide long-term support.

METHODS

Nine in-depth interviews were conducted three to eighteen months post-discharge from critical care. Phenomenology was used to gain deeper understanding of the patients' lived experience.

SETTING

A 19-bedded Intensive Care Unit in a specialist cancer centre.

FINDINGS

Five major themes emerged: Intensive care as a means to an end; Rollercoaster of illness; Reliance on hospital; Having a realistic/sanguine approach; Living in the moment. Haemato-oncology patients who experience critical illness may view it as a small part of a larger treatment pathway, thus health-related quality of life is impacted by this rather than the acute episode.

CONCLUSIONS

Discharge from the intensive care unit can be seen as a positive end-point, allowing personal growth in areas such as relationships and living life to the full. The contribution of health-care professionals and support of significant others is regarded as critical to the recovery experience.

Current status and influencing factors of post-traumatic growth in maintenance hemodialysis

OBJECTIVE

To study the post-traumatic growth level and influencing factors in patients with maintenance hemodialysis.

METHODS

A total of 179 patients receiving maintenance hemodialysis from a third-level grade A hospital in Tianjin, China were investigated using Post-traumatic Growth Inventory (PTGI), Perceived Social Support Scale, and Medical Coping Modes Questionnaire.

RESULTS

The total score for the PTGI was 53.73 ± 16.45. Multiple linear regression analysis showed that social support, coping style, marital status, and family income significantly influenced the post-traumatic growth level in patients undergoing maintenance hemodialysis. These factors explained 41.4% of the variance.

CONCLUSION

Medical staff should help patients under maintenance hemodialysis to fulfill their potentials by boosting the level of social support and to effectively cope with internal conflicts. In addition, nursing staff should provide relevant psychological health education to patients to improve their post-traumatic growth.

Exploration of life experiences of positive growth in long-term childhood cancer survivors

PURPOSE

The aim of this study was to explore experiences of positive growth in long-term childhood cancer survivors, from their perspective.

METHODS

Fifteen long-term survivors of childhood cancer provided descriptions of their experiences. Data were collected through face-to-face interviews and the analysis was based on Giorgi's phenomenological research method.

RESULTS

The analysis of positive growth experienced by long-term childhood cancer survivors revealed three themes: self-directed life, normalcy in life, and inner maturity. Long-term survivors defined positive growth as a successful transition to a self-satisfactory life based on motivation acquired through their cancer experience and on subjective goal-setting, as well as becoming cancer-free and living a normal life within society. They seemed to have acquired optimistic, flexible, active attitudes toward life while demonstrating profound gratefulness and consideration of people around them, as well as prudent approaches to health.

CONCLUSIONS

The findings of this study verified that long-term survivors of childhood cancer have grown positively due to their negative past experience. We expect these findings to contribute to the development of programs that promote positive growth in long-term childhood cancer survivors.

Memory as a cognitive representation of post-traumatic growth

BACKGROUND AND OBJECTIVES

Previous studies on traumatic memory have primarily focused on the correlation between traumatic symptoms and negative memories, often utilizing the directed forgetting paradigm. Different from previous research, this study aimed to examine the correlation of post-traumatic growth (PTG) and positive memories, with the objective to explore the directed forgetting effect of positive material and its relationship with PTG.

DESIGN

A 2 (PTG level: high vs. low) × 2 (instructions: To-Be-Forgotten vs. To-Be-Remembered) × 3 (word valence: positive vs. neutral vs. trauma related) mixed-factorial-designed experiment was applied.

METHODS

Participants were 46 senior high-school students who had survived in the Sichuan earthquake in 2008. Participants were divided into two groups based on PTG: high (n = 24) and low (n = 22). Both groups were presented, and asked to recall, three word categories (positive, trauma-related, and neutral) following the directed forgetting paradigm.

RESULTS

A mixed-design factorial ANOVA yielded a significant interaction effect of word valence and PTG group, with the high-PTG group recalling more positive words than the low-PTG group.

CONCLUSIONS

This was the first study to identify a key cognitive process of PTG by integrating the directed forgetting paradigm into an investigation of PTG.

Socio-demographic and Psychological Correlates of Posttraumatic Growth among Korean Americans with a History of Traumatic Life Experiences

This study examined socio-demographic and psychological correlates of posttraumatic growth (PTG) among Korean Americans (KAs) with traumatic life experiences. A total of 286 KAs were included. Being a woman or having a lower annual household income had positive associations with PTG, while having no religion had a negative association with it. In addition, praying and visiting a mental health professional for coping with stress or for psychological problems was positively associated with PTG. Higher resilience scores increased PTG, while depressive symptoms decreased it. We suggest reinforcing help seeking behaviors and accessibility to care facilities, and gender specific strengthening programs for enhancing PTG among KAs.

Evolution of post-traumatic growth during the first 12 months of dialysis: A longitudinal study

BACKGROUND

Initiating dialysis can produce psychological benefits. These positive changes, most frequently referred to as posttraumatic growth (PTG), have not previously been explored in these patients.

OBJECTIVE

To identify patterns in the temporal course of PTG in patients during their first 12 months of dialysis, and to relate to perceived stress.

DESIGN

A prospective, longitudinal, observational study.

SETTING AND METHODS

The sample included 98 patients, aged from 18 to 70 years, who commenced dialysis in the nine nephrology units of the Basque Country, Spain. Three assessments were carried out at 1, 6 and 12 months, using a PTG questionnaire and the Perceived Stress Scale. ANOVAs with post-hoc analysis were performed to identify significant differences between the groups.

RESULTS

Four groups were established based on the observed changes in PTG over time: high, increasing, decreasing and low PTG. Maintaining high PTG and decreasing PTG levels was associated with moderate levels of perceived stress.

CONCLUSION

Four different patterns of PTG have been identified, contributing to our understanding of the dynamics of the process of growth and enabling us to identify patients who may be more vulnerable.

Using health psychology to help patients: promoting wellbeing

This article explores the construct of wellbeing. Research concerning the relationship between subjective wellbeing and health is discussed. Key components of wellbeing that are important to health include 'sense of coherence', 'optimism' and 'benefit finding and post-traumatic growth'. A range of positive psychology interventions that aim to increase positive thoughts, feelings and emotions in order to improve wellbeing have been developed. Mindfulness-based approaches to improving wellbeing are especially popular and are evidence based. These focus on helping the individual to develop an awareness of the present with acceptance and attention. Instead of trying to change uncomfortable thoughts or feelings, the individual practices accepting these, without judgement. Nurses can draw on the information in this article to provide evidence-based advice and guidance to help improve their patients' and their own wellbeing.

Resilience, post-traumatic stress, and posttraumatic growth: Veterans' and active duty military members' coping trajectories following traumatic event exposure

As part of the "Joining Forces" Initiative ("JFI"), the White House and nursing leaders announced nurses' commitment to recognize symptoms, provide care, and refer veterans and active duty military members for post-traumatic stress disorder ("PTSD"). The JFI is positioned to save lives through nursing education and raising PTSD awareness. Nurses should also be educated to recognize resilience (stable trajectory of healthy functioning across time following a traumatic event) and assess for post-traumatic growth ("PTG") (positive meaning making) alongside PTSD. In veterans who do develop PTSD, nearly three fourths of them with moderate PTSD will also experience PTG. Nurses' frontline contact with veterans in the VA, private sector healthcare settings, and community enable them to educate veterans and active duty military members about these coping trajectories.

Post-traumatic growth enhances social identification in liver transplant patients: A longitudinal study

OBJECTIVE

The main aim of this paper is to investigate the prediction that greater subjective identification with relevant groups and social categories (i.e. 'family' and 'transplantees') can be an outcome of post-traumatic growth (PTG). To date there are no studies that have explored these relationships.

METHODS

A longitudinal study was conducted with a group of 100 liver transplant patients from the outpatient populations of the participating centre. Data were collected by means of a self-report questionnaire, which was completed at two different time points (T1 and T2) that were 24months apart. PTG was assessed using the Post-Traumatic Growth Inventory, while both transplantee and family identification were assessed using group identification scales. A path model was tested, using a structural equation model (SEM) approach, to examine the reciprocal effects among family identification, transplantee identification, and PTG over time.

RESULTS

As predicted, we found that greater PTG T1 predicted both greater family identification T2 and marginally greater transplantee identification T2. However, the two identification variables did not predict PTG over time.

CONCLUSIONS

The results show that family identification and transplantee identification may be outcomes of the PTG process, confirming the importance of adopting a thriving multidimensional model of adjustment to medical illness, whereby people facing adverse life events, such as transplantation, may flourish rather than deteriorate psychologically.

Flourishing and Posttraumatic Growth. An Empirical Take on Ancient Wisdoms

Considerations of well-being or flourishing include Maslow's and Rogers' concepts of self-actualisation and actualising tendency. Recent empirical findings suggest that only a modest proportion of the population might be considered to be flourishing. Separate findings focused upon the nature and determinants of post-traumatic growth identify it as comparable to flourishing, and facilitated by supported accommodation to the trauma. This can be understood as reflecting self-actualisation. Empirical findings such as these provide ontological stability to a set of phenomena that share much with ancient teachings extolling redemption through suffering. This framework challenges conventional healthcare policies and practices, but in ways that offer insights into how patient-centred approaches to chronic illness and disability might be better conceived and enabled. It also throws into doubt the rectitude of an economic model built around services and products designed to provide easy access to sources of immediate gratification.

Post-traumatic growth: a qualitative analysis of experiences regarding positive psychological changes among Iranian women with breast cancer

INTRODUCTION

Cancer diagnosis is an extremely stressful experience that has a profound impact on a patient's life. Cancer related perceived stress and complications may lead to the experience of positive psychological changes and post-traumatic growth (PTG). Since there is lack of qualitative research assessing the experience of PTG in Iranian women with breast cancer, this study aims to investigate experiences relating to PTG of Iranian women.

METHODS

A qualitative phenomenological approach was selected to explore the experiences of Iranian women with PTG. Data were gathered using semi-structured, in-depth interviews with 18 eligible patients, which were then transcribed and analyzed using Van Manen's thematic analysis approach. Data gathering and analyses were conducted simultaneously. In addition, MAXQDA software was used for data management.

RESULTS

In this study, the participants were 18 Iranian women between the ages of 31 and 65 years. Four prominent themes were extracted from the participant's statements that demonstrated the Iranian women's experiences with breast cancer-induced psychological growth and maturity: 1) appreciate of life, 2) stability, 3) spiritual prosperity, and 4) effective interaction.

CONCLUSION

Health care professionals are strongly recommended to design robust and timely intervention programs to improving PTG among breast cancer survivors and reduce their perceived distress resulting from cancer diagnosis.

Association between virtues and posttraumatic growth: preliminary evidence from a Chinese community sample after earthquakes

Objective. Relationship, vitality, and conscientiousness are three fundamental virtues that have been recently identified as important individual differences to health, well being, and positive development. This cross-sectional study attempted to explore the relationship between the three constructs and post-traumatic growth (PTG) in three directions, including indirect trauma samples without post-traumatic stress disorder (PTSD), direct trauma samples without PTSD, and direct trauma samples with PTSD.

Methods. A total of 340 community participants from Sichuan Province, Mainland China involved in the study, most of which experienced Wenchuan and Lushan Earthquake. Participants were required to complete the self-reported questionnaire packages at one time point for obtaining their scores on virtues (Chinese Virtues Questionnaire), PTSD (PTSD Checklist-Specific), and PTG (Post-traumatic Growth Inventory-Chinese).

Results. Significant and positive correlations between the three virtues and PTG were identified (r = .39–.56; p < .01). Further regression analysis by stepwise method reveled that: in the indirect trauma samples, vitality explained 32% variance of PTG. In reference to the direct trauma sample without PTSD, both relationship and conscientiousness explained 32% variance of PTG, whereas in the direct trauma sample with PTSD, only conscientiousness accounted for 31% the variance in PTG.

Conclusion.This cross-sectional investigation partly revealed the roles of different virtues in trauma context. Findings suggest important implications for strengths-based treatment.

[Parental death in childhood: the state of theoretical knowledge and clinical challenges in the future]

Although children's psychological adaptation to parental cancer is a wide field for psycho-oncological research, few empirical studies target children bereavement specifically following parental cancer. In this paper, our purpose is to make a state of art about literature concerning parental death. Literature dealing with grief concerns psychopathological consequences of parental loss and most recently post-traumatic growth. Although references about support programs have emerged, few of these programs have been scientifically evaluated. This review underlines that more studies are needed with prospective quantitative and qualitative studies, in order to describe more precisely children bereavement process and long term effects of bereavement. Psychological support for other family members and evaluation of support programs seem to be critical to improve children adaptation to parental death.

Post-traumatic growth in stomach cancer survivors: Prevalence, correlates and relationship with health-related quality of life

PURPOSE

Post-traumatic growth (PTG) is defined as positive psychological changes experienced as a result of struggle with highly challenging life circumstances. Interest in PTG has increased in cancer survivorship care; however, little is known about PTG among stomach cancer survivors. This study aimed to examine the prevalence and correlates of PTG, and to identify relationships between PTG and health-related quality of life (HRQOL).

METHODS

Cross-sectional descriptive design. In total, 122 stomach cancer survivors were recruited from one university hospital in South Korea. Measurements included the Korean version of the Post-traumatic Growth Inventory and the Functional Assessment of Cancer Therapy--General Population.

RESULTS

Over half (53.3%) of the participants experienced moderate to high levels of PTG. 'Change of self-perception' was the most common growth domain, followed by 'relating to others', 'new possibilities' and 'spiritual change'. Older age, low socio-economic status (i.e. low education level and low monthly income) and lack of religion were associated with lower levels of PTG. Survivors with higher levels of PTG had better social/family well-being (P < 0.001) and better functional well-being (P < 0.001).

CONCLUSIONS

Psychological interventions to enhance PTG may have a positive effect on impaired HRQOL among stomach cancer survivors.

The factorial and discriminant validity of the German version of the Post-traumatic Growth Inventory in stroke patients

Post-traumatic growth (PTG) is the experience of positive changes that can follow a traumatic event. The current study examined the factorial as well as the discriminant validity of the German version of the Post-traumatic Growth Inventory (PTGI-G) in stroke patients. A total of 188 adult stroke patients (63.3% male; median age 69 years) completed the PTGI-G and the German version of the Hospital Anxiety and Depression Scale (HADS-D) at the end of their inpatient rehabilitation. Confirmatory factor analyses indicate an acceptable model fit of both the original five-factor solution as well as a second-order factor model of the PTGI-G (CFI > .95; RMSEA < .01). Small and non-significant correlations between the PTGI-G subscales and the depression scale of the HADS-D support the discriminant validity of the PTGI-G. The PTGI-G appears to be a valid tool in the context of stroke research.

Interaction between genetic variants and exposure to Hurricane Katrina on post-traumatic stress and post-traumatic growth: a prospective analysis of low income adults

BACKGROUND

There is considerable variation in psychological reactions to natural disasters, with responses ranging from relatively mild and transitory symptoms to severe and persistent posttraumatic stress (PTS). Some survivors also report post-traumatic growth (PTG), or positive psychological changes due to the experience and processing of the disaster and its aftermath. Gene-environment interaction (GxE) studies could offer new insight into the factors underlying variability in post-disaster psychological responses. However, few studies have explored GxE in a disaster context.

METHODS

We examined whether ten common variants in seven genes (BDNF, CACNA1C, CRHR1, FKBP5, OXTR, RGS2, SLC6A4) modified associations between Hurricane Katrina exposure and PTS and PTG. Data were from a prospective study of 205 low-income non-Hispanic Black parents residing in New Orleans prior to and following Hurricane Katrina.

RESULTS

We found a significant association (after correction) between RGS2 (rs4606; p=0.0044) and PTG, which was mainly driven by a cross-over GxE (p=0.006), rather than a main genetic effect (p=0.071). The G (minor allele) was associated with lower PTG scores for low levels of Hurricane exposure and higher PTG scores for moderate and high levels of exposure. We also found a nominally significant association between variation in FKBP5 (rs1306780, p=0.0113) and PTG, though this result did not survive correction for multiple testing.

LIMITATIONS

Although the inclusion of low-income non-Hispanic Black parents allowed us to examine GxE among a highly vulnerable group, our findings may not generalize to other populations or groups experiencing other natural disasters. Moreover, not all participants invited to participate in the genetic study provided saliva.

CONCLUSIONS

To our knowledge, this is the first study to identify GxE in the context of post-traumatic growth. Future studies are needed to clarify the role of GxE in PTS and PTG and post-disaster psychological responses, especially among vulnerable populations.