Post-traumatic growth in (ex-) military personnel: review and qualitative synthesis

Interpretations of ambiguous situations in combat veterans with and without post-traumatic stress disorder

Deployed combat personnel are at increased risk of post-traumatic stress disorder (PTSD). People with PTSD often judge ambiguous information as negative or threatening (interpretation bias). However, this may be adaptive during deployment. The current study aimed to investigate the extent to which interpretation bias in combat personnel is associated with PTSD symptoms, rather than with appropriate situational awareness. Combat veterans with and without PTSD and civilians without PTSD generated explanations for ambiguous situations and judged the likelihood of various possible explanations. They also made judgements about future consequences of worst-case scenarios, and their coping ability. Veterans with PTSD generated more negative explanations for ambiguous situations, judged negative interpretations as more likely and felt less able to cope with the worst-case scenario than veteran and civilian controls. Veterans with versus without PTSD judged worst-case scenarios to have more severe and insurmountable consequences, although they did not differ significantly from civilians. Veteran versus civilian controls rated their coping ability as higher; this was the only difference between control groups. In summary, group differences in interpretation bias were associated with PTSD symptoms rather than combat role. Veterans without PTSD may be particularly resilient when coping with everyday adversity.

Rumination and threat-biased interpretation mediate posttraumatic stress and growth responses to military stressors

We examined the role of rumination and threat-biased interpretation in stress and growth responses to military stressors. Two online surveys were completed by 183 (survey 1) and 393 (survey 2) currently serving or retired military personnel. The surveys measured exposure to potential military stressors (exposure to combat, witnessing the consequences of war, and perceived moral injury), posttraumatic stress symptomatology (PTSS), posttraumatic growth (PTG), and personal wellbeing, with survey 1 including measures of rumination, and survey 2 including a measure of threat-biased interpretation. Path analyses revealed that indirect paths from both witnessing the consequences of war and experiencing betrayal to PTSS were mediated by intrusive rumination and threat-biased interpretation, and that indirect paths from both betrayal and transgressions by others to PTG were mediated by deliberate rumination and threat-biased interpretation. The results reveal the idiosyncratic nature of military stressors, their differential involvement with cognitions that underpin rumination about past events and interpretation of current events, and their relevance to posttraumatic stress and growth in military personnel.

Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic

The Irish Defense Forces (DF) responded to the COVID-19 pandemic and national public health crisis by deploying personnel to aid domestic civil authorities in medical and care settings, contact tracing, logistics, and operations. Current research on COVID-19 reveals increased psychological distress among frontline workers and the general public. Resilience has previously been associated with lower levels of psychological distress. This study sets out to test these associations, and to examine mental health differences between DF personnel deployed in Ireland on pandemic-related duties (DIPD) and non-DIPD. Participants were 231 DF members who completed the: Connor-Davidson Resilience Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Coronavirus Threat Questionnaire, Brief Trauma Questionnaire, Post-traumatic Stress Disorder Checklist-5, and Alcohol Use Disorder Identification Test. Independent t-tests revealed no differences between DIPD and non-DIPD on measures of psychological distress or on self-rated mental health prior to COVID-19 (PC19) and during COVID-19 (DC19). Results of multiple hierarchical regression analyses revealed that depression predicted lower levels of resilience, while multiple traumatic events predicted higher levels of resilience. The total adjusted variance explained by the model was 25%. Clinical and policy implications for improving access to psychological support within the DF and military populations are discussed.

Research hotspots and theme trends in post-traumatic growth: A co-word analysis based on keywords

Objectives

To analyze and summarize the research hotspots and advancement of post-traumatic growth (PTG) over the past 15 years based on co-word analysis of keywords, and provide references for PTG-related research and clinical intervention.

Methods

All studies related to PTG were retrieved from PubMed and Web of Science (WOS) from January 2013 to July 2022. A total of 11 Medical Subject Headings (MeSH) and keywords were used to identify qualified studies. Bibliographic Item Co-occurrence Matrix Builder (BICOMB; version 2.0) was used to conduct high-frequency keywords extraction and matrix setup, Graphical Clustering Toolkit (gCLUTO; version 1.0) was employed to perform clustering analysis, and SPSS (version 25.0) was used to carry out strategic diagram analysis.

Results

A total of 2,370 publications were selected, from which 38 high-frequency keywords were extracted. The results revealed six research hotspots on PTG during the period from 2013 to 2022, including research on i) emotional reactions after negative life events, ii) PTG among cancer survivors, iii) rumination and resilience after trauma, iv) PTG among children and adolescents, v) role of social support and coping strategy in PTG, and vi) association between PTG and quality of life.

Conclusions

This co-word analysis effectively reveals an overview of PTG over the past 15 years. The six research categories deduced from this study can reflect that the research content in the field of PTG is abundant, but some research topics have not yet been mature. The findings of this study are of great value to future investigations associated with PTG.

The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen

BACKGROUND

Psychological distress such as anxiety of medical students especially during the first-year has been widely acknowledged. However, many students could exhibit post-traumatic growth when experiencing anxiety. Previous study demonstrated that anxiety might have impacts on post-traumatic growth, but how anxiety affects post-traumatic growth is still undefined. This study sought to examine whether resilience has a moderating role between state and trait anxiety and post-traumatic growth when medical freshmen are experiencing stressful events.

METHODS

A total of 295 medical freshmen were administered the Post Traumatic Growth Inventory, the State-Trait Anxiety Inventory and the Connor-Davidson Resilience Scale.

RESULTS

Post-traumatic growth was negatively correlated with state anxiety and trait anxiety, with a correlation coefficient of -0.474 and -0.462 (p < 0.01), and positively correlated with resilience, with a correlation coefficient of 0.635 (p < 0.01). Resilience acted as a moderator for the indirect effect of state and trait anxiety on post-traumatic growth.

CONCLUSIONS

These findings demonstrated resilience could be of extreme importance for developing post-traumatic growth, and therapeutic interventions tailored to the medical freshmen to promote their resilience to adapt to life in college.

Post-traumatic growth in polytraumatized patients after 20+ years: a long-term follow-up study of 337 patients treated at a level 1 trauma center

PURPOSE

There is limited research on the long-term psychiatric outcomes of polytraumatized patients. Existing studies focus mainly on the negative sequelae. Post-traumatic growth (PTG) describes positive personal development after severe physical or mental distress. In this study, we investigated post-traumatic growth in polytraumatized patients at least 20 years after trauma.

METHODS

Patients treated for polytrauma at a German level 1 trauma center between 1971 and 1990, were contacted 20+ years later. A questionnaire with 37 questions from the stress-related growth scale (SRGS) and the post-traumatic growth inventory (PGI) was administered. PTG was quantified in five specific areas. PTG and patient demographics were then analyzed using logistic regression.

RESULTS

Eligible questionnaires were returned by 337 patients. 96.5% of patients reported improvements regarding at least one of the 37 questions. Approximately, a third of patients noticed distinct improvements regarding their relationship to others (29.2%), appreciation of life (36.2%) and attitudes towards new possibilities (32.5%). Patient demographics were significant predictors for the development of PTG: Older (p < 0.001), female (p = 0.042) and married patients (p = 0.047) showed a greater expression of PTG. We also saw significantly more PTG in patients with higher injury severity (p = 0.033).

CONCLUSION

20 years after polytrauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Women and married patients show higher expression of PTG. Furthermore, there is higher expression of PTG with higher age and injury severity. Post-traumatic growth should be identified and fostered in clinical practice.

LEVEL OF EVIDENCE

III-prospective long-term follow-up study.

Potentially traumatic events and post-traumatic growth among Chinese peacekeepers: A moderated mediation model

Peacekeepers are inherently exposed to potentially traumatic events (PTEs) in the line of duty. However, little is known about whether PTEs during peacekeeping missions may foster post-traumatic growth (PTG) among peacekeepers and its mechanisms. This study aimed to investigate the association between PTEs and PTG among Chinese peacekeepers, as well as the mediating role of coping style and the moderating role of resilience. Five hundred ninety-five Chinese peacekeepers completing the United Nations (UN) peacekeeping mission in South Sudan and returning to China were recruited to complete Peacekeeping Traumatic Stress Exposure Scale, Posttraumatic Growth Inventory, Simplified Coping Style Questionnaire and the Chinese version of Connor and Davidson's Resilience Scale. PTEs were positively associated with PTG among Chinese peacekeepers. Coping style partially mediated the association between PTEs and PTG. Resilience moderated the association between coping style and PTG. Specifically, at a lower level of resilience, positive coping style was more effective in predicting PTG. This study contributes to understanding the complex association between PTEs in peacekeeping missions, coping style, resilience and PTG by focusing on the experiences of Chinese peacekeepers and adds value to the current literature on psychological health in peacekeepers.

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol

BACKGROUND

Research suggests the use of different forms of therapy as a way of decreasing dropout rates in the treatment of post-traumatic stress disorder (PTSD). The psychotherapies to be assessed in this study are trial-based cognitive therapy (TBCT), mindfulness-based health promotion (MBHP) and positive psychotherapy (PPT).

OBJECTIVES

(1) to assess the online efficacy of TBCT compared to MBHP and PPT to reduce the symptoms of PTSD in the context of the Coronavirus Disease 2019 (COVID-19) pandemic; (2) to compare the efficacy of these psychotherapies in improving anxiety, depression, guilt and in promoting well-being; and (3) to describe how professionals perceive online treatment.

METHODS

A randomized, multicenter, single-blind clinical trial will be conducted, with three separate arms. An estimated sample of 135 patients will receive either TBCT, MBHP or PPT and will be treated through online, individual, weekly visits, totaling 14 sessions. The primary outcome will be CAPS-5 and secondary outcomes will be HADS and WHO-5. The variables used to mediate these outcomes will be the Trauma-Related Guilt Inventory (TRGI), Negative Core Beliefs Inventory (NCBI) and the California Psychotherapy Alliance Scale (CALPAS-P).

EXPECTED RESULTS

PTSD symptoms are expected to be reduced after TBCT, MBHP and PPT. No statistical difference is expected to be found among the three.

DISCUSSION

The present study will evaluate and contribute towards the development of new psychotherapeutic options for patients with PTSD. The results of this study will allow the dissemination of new effective and adaptable interventions for patients with PTSD.

Posttraumatic growth and psychosocial gains from adversities of korean special forces: a consensual qualitative research

Because military special forces carry out dangerous missions, they are much more exposed to adversities and traumatic events compared to other occupational groups. According to Posttraumatic Growth theory, individuals tend to obtain positive growth through adversities. Moreover, a framework of Psychosocial Gains from Adversity argues not only individual changes but also social changes in the group to which the individual belongs are induced. Therefore, the present study aimed to explore the adverse experiences of special forces operatives and delineate the positive shift at an individual and social level via Consensual Qualitative Research (CQR). Eight individuals serving in special forces at the Korean Army, Navy and Air Force were interviewed using a semi-structured protocol. Four domains including 10 categories and 34 subcategories were identified: (a) Adverse experiences; (b) Personal change; (c) Social change; and (d) Attributes related to adverse experience. The findings and clinical implications are discussed in light of growth over facing adversities and interaction between personal and social factors.

Recognition and development of customized cosmetics for military trainees in 20s and 30s in Republic of Korea

BACKGROUND

For the health of the skin, social standards have been changed to increase the public's interest in achieving perfect skin. With the diversification of consumer needs, the reorganized core market for demand pursues the attributes of customization that bring the individual ego and product image to match through aggressive consumer needs.

OBJECTIVES

Therefore, in this study, we conducted a questionnaire to 450 men in their 20s and 30s, Chuncheon City, Gangwon-do, Republic of Korea, focused on the fact that customized cosmetics drive individuals and optimization.

METHODS

Statistical processing of materials collected by the data analysis method is analyzed using the SPSS (Statistical Package for Social Science) WIN25.0 statistical package program through the process of data coding and data cleaning.

RESULTS

As a result, "I think I need customized cosmetics for me." 3.91 (SD = 1.19), and it seems that the number of custom cosmetics used will increase in the future. "3.99 (SD = 1.06) It was the highest in terms of points. Also, I would like to use PX's men's custom cosmetics when they are released." The average was 4.34 (SD = 0.91), which was the highest. Comprehensive research results of P <0 .001 and above suggested the possibility of developing customized cosmetics for men.

CONCLUSION

Therefore, this requires continuous research on personalized bespoke cosmetics according to work and usage characteristics, and PX custom products for future soldiers should be developed. In the future, the researcher plans to continue to study the recognition and development potential of customized cosmetics for female military personnel in South Korea in subsequent research.

Growth from adversity in trans and gender diverse people of color

BACKGROUND

Trans-negativity and gender-based discrimination negatively impact on the wellbeing and mental health in transgender (trans) and gender diverse people (TGD). There is limited research on TGD people thriving under adversity, and no research to date has considered TGD people of color in this context.

METHOD

We used the Post-Traumatic Growth Inventory (PTGI-X) to survey 125 TGD people of color and 625 white TGD adults (18 to 68 years old, M = 26.0, SD = 9.2) about their experiences of growth from adversity. Confirmatory factor analysis (CFA), using sub-sampling to compensate for our unequal sample sizes, supported a five-factor structure of the PTGI-X consisting of growth in relating to others, finding new possibilities, personal strength, greater appreciation of life, and spiritual/existential change. Measurement invariance tests confirmed configural, metric, and scalar invariance of this structure across the two TGD subgroups.

RESULTS

A MANOVA revealed that growth from adversity in TGD participants was generally greater than that reported by people who have recently been exposed to a traumatic event. T-tests revealed that TGD people of color experienced more growth in terms of relating to others and more personal strength than white TGD participants. Subsequent hierarchical regressions revealed that race moderated associations between PTGI-X scores and personal well-being, with TGD people of color reporting more benefits (more well-being) at high levels of growth but also more deficits (less well-being) at low levels of growth than the white TGD subgroup.

CONCLUSION

The results support the use of the PTGI-X with TGD populations and across racial TGD subgroups and indicate that growth from adversity is not only prevalent in TGD people but also relevant to positive outcomes, particularly in TGD people of color.

A qualitative analysis of meaning-making and mental health among OIF/OEF veterans

OBJECTIVE

After combat, veterans may experience mental health symptomology and attempt to make meaning from their experiences. The present study qualitatively examined the mental health effects of deployment and meaning-making among Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) veterans.

METHOD

OIF/OEF veterans who were exposed to combat (N = 14) participated in semi-structured interviews to assess how their perspectives had changed post-deployment. Most participants (86%) were male, with a mean age of 30.

RESULTS

Veterans described issues post-combat that caused psychological distress or promoted distancing from others. Veterans also discussed factors that could promote or hinder meaning-making, including perceptions of growth, changed global beliefs, and disillusionment. Finally, veterans described psychological reactions to death, which could be related to moral injury.

CONCLUSION

Mental health concerns, meaning-making, and consideration of mortality appear to characterize veterans' experiences post-deployment. These constructs may be important for clinicians to consider when working with OIF/OEF veterans.