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Yang T, Bi C. Examining the trajectory of meaning violation and its bidirectional relationship with perceived posttraumatic growth. Stress Health 2024:e3394. [PMID: 38459793 DOI: 10.1002/smi.3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Despite extensive theoretical discussions on the dynamic process of meaning violation (MV) and restoration, empirical research on this topic remained lacking. This study aimed to explore the trajectory of MV and the bi-directionality between MV and perceived posttraumatic growth (PPTG). This study employed a 3-wave longitudinal design spanning over 3 months, and a sample of participants from China who experienced any distressing event within the past 3 months was considered eligible. Participants (N = 215; aged 18-38 years old) were instructed to assess MV and PPTG regarding a chosen event. A latent growth model was used to examine changes in MV over time and a random intercept cross-lagged panel model was used to analyze bidirectional associations between MV and PPTG. Results revealed that, at the within-person level, MV at T1 negatively predicted PPTG at T2, while PPTG at T2 negatively predicted MV at T3. These results indicate that the sense of MV may have impeded PPTG in the initial stages, whereas PPTG might serve as a predictor for diminished MV at later stages. At the between-person level, a positive relationship between these two constructs was observed, suggesting that individuals who experienced higher levels of MV, in general, also tended to report greater PPTG. These findings reflect the complex and dynamic nature of meaning reconstruction processes and provide empirical evidence for the meaning-making model.
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Affiliation(s)
- Tongping Yang
- Research Center for Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China
| | - Chongzeng Bi
- Research Center for Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China
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2
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Harwood-Gross A, Bergman YS, Pat-Horenczyk R, Schiff M, Benbenishty R. Parenthood during the COVID-19 pandemic: Post-traumatic growth amongst university students. FAMILY PROCESS 2023; 62:1608-1623. [PMID: 36572646 PMCID: PMC9880650 DOI: 10.1111/famp.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
This study sought to investigate a positive dimension of coping with the COVID-19 pandemic, that of post-traumatic growth (PTG). This study investigated coping difficulties and PTG amongst parent and nonparent students in Israeli Universities. A total of 4022 parents (3648 Jews and 374 Palestinian-Arab Citizens [PACs]) and 14,651 nonparents (12,010 Jews and 2641 PACs) completed measures of coping, social support and PTG. Parents demonstrated significantly higher levels of coping and PTG. Amongst parents, fathers coped slightly better than mothers; however, while Jewish mothers demonstrated greater PTG than Jewish fathers, PAC fathers had significantly greater PTG than both PAC mothers and Jewish parents. These findings, while specific to COVID-19, indicate that PTG should be studied in greater depth in different ethnic and minority groups in order to develop enhanced understanding and facilitate promotion of post-traumatic growth, in addition to the prevention of COVID-19-related distress.
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Affiliation(s)
- Anna Harwood-Gross
- Hebrew University of Jerusalem, Jerusalem, Israel
- Metiv, Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
| | | | | | | | - Rami Benbenishty
- Hebrew University of Jerusalem, Jerusalem, Israel
- Andres Bello National University, Santiago, Chile
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García FE, Cova F, Vázquez C, Páez D. Posttraumatic growth in people affected by an occupational accident: A longitudinal multilevel model of change. Appl Psychol Health Well Being 2023; 15:409-424. [PMID: 35851747 DOI: 10.1111/aphw.12386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/30/2022] [Indexed: 02/07/2023]
Abstract
This study analyzed a predictive model of posttraumatic growth (PTG) in a cohort of 244 workers affected by an occupational accident. A longitudinal design with three points in time (i.e., 1, 6, and 12 months after the accident) was used. PTG, posttraumatic stress symptoms (PTSS), subjective severity of the event, deliberate rumination, and seeking social support were evaluated. In addition, time since the accident, age, and gender were included as predictors in our model. Deliberate rumination and seeking social support significantly predicted PTG trajectory in a multilevel model. Practical conclusions from the results suggest that work accident victims should be encouraged to seek social support and to positively reframe their experience.
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Affiliation(s)
- Felipe E García
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
| | | | - Darío Páez
- University of the Basque Country, San Sebastián, Spain
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Saltzman LY, Canetti D, Hobfoll SE, Hall BJ. The impact of political violence on posttraumatic stress symptomology: a longitudinal analysis. ANXIETY, STRESS, AND COPING 2022; 35:219-231. [PMID: 34269153 PMCID: PMC8761218 DOI: 10.1080/10615806.2021.1950694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The current paper uses the Conservation of Resources Theory to frame an examination of the impact of exposure to political violence on posttraumatic stress symptomology among three groups within Israeli society: (1) Native Born Jews; (2) Foreign Born Jews; and (3) Palestinian Citizens of Israel. METHODS The study population was a large nationally representative sample of 1613 respondents collected during The Second Intifada. The sample consists of approximately 40% Jews born in Israel (n = 652), 30% (n = 484) were Jews who immigrated to Israel, and close to 30% (n = 477) were Palestinian Citizens of Israel. Mediation analyses explored the role of resource loss in the relationship between social status and posttraumatic stress disorder (PTSD) symptom severity. RESULTS Compared to native born Jews, foreign born Jews and Palestinian Citizens of Israel reported greater PTSD symptom severity at wave III. These relationships were not mediated by psychosocial resource loss or economic resource loss. CONCLUSIONS We discuss the importance of tailored interventions with minority groups in the context of ongoing political violence.
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Affiliation(s)
| | - Daphna Canetti
- Professor and Head School of Political Science University of Haifa
| | | | - Brian. J Hall
- Associate Professor of Global Public Health, NYU Shanghai
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Jung HO, Han SW. Post-traumatic growth of people who have experienced earthquakes: Qualitative research systematic literature review. Front Psychiatry 2022; 13:1070681. [PMID: 36937000 PMCID: PMC10017470 DOI: 10.3389/fpsyt.2022.1070681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/25/2022] [Indexed: 03/06/2023] Open
Abstract
Introduction Earthquakes can have a variety of physical, emotional, and social effects on the people who experience them. Post-traumatic Growth (PTG) results from people attempting to reconstruct their lives after experiencing a traumatic event. We intend to inform the local community of the importance of disaster psychology by identifying and analyzing the literature on post-traumatic growth experiences of subjects who experienced earthquakes. Methods This study applied a systematic review of qualitative research published from January 1, 2012 to January 31, 2021 to understand PTG in people who have experienced earthquakes. The search expressions "Post-traumatic Growth", "Earthquake", "Qualitative" were applied to CINAHL, EMBASE, PubMed, PsycInfo, KISS, RISS, and NDSL databases. Initially, 720 papers were found; after removal of duplicates, 318 remained. After a review of titles and abstracts, 186 papers that did not meet the selection criteria of this study were removed. After a further examination of the remaining 132 papers, the researchers removed 65 papers that did not match the research topic. Lastly, of the remaining 67 papers, detailed review eliminated quantitative papers that did not match this study (25), articles that were not original (19), articles in which results were not PTG (8), articles that were not related to this study (3), articles that were not written in English (2), or articles that had mixed topics (2). Eight papers remained. Results The results of this study show that the PTG in people who have experienced earthquakes can be classified into three categories: "Change in self-perception", "Change of interpersonal relationships", and "Spiritual change". They can be further classified into eight subcategories: "Reviewing one's existence", "Acceptance", "Discovering strengths by working through adversity", "Gratitude for life", "Changes in personal relations", "Changes in social relations", "Accepting the existence of God", and "A breakthrough to overcome difficulties". Discussion These results can be used as basic data for a positive psychological understanding for those who have experienced earthquake trauma.
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Affiliation(s)
- Hyun-Ok Jung
- College of Nursing, The Research Institute of Nursing Science, Daegu Catholic University, Daegu, South Korea
| | - Seung-Woo Han
- Department of Nursing, Kwangju Women's University, Gwangsan-gu, Gwangju, South Korea
- *Correspondence: Seung-Woo Han
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Yuan GF, Shi W, Elhai JD, Montag C, Chang K, Jackson T, Hall BJ. Gaming to cope: Applying network analysis to understand the relationship between posttraumatic stress symptoms and internet gaming disorder symptoms among disaster-exposed Chinese young adults. Addict Behav 2022; 124:107096. [PMID: 34469784 DOI: 10.1016/j.addbeh.2021.107096] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/17/2022]
Abstract
Research has demonstrated that posttraumatic stress disorder (PTSD) is associated with internet-related problematic behaviors. However, studies have not explored the linkage between PTSD symptoms and internet gaming disorder (IGD) symptoms. The current study aimed to investigate the relationship between posttraumatic stress symptoms (PTSS) and IGD symptoms via network analysis. We conducted a cross-sectional study with 341 Chinese young adults directly exposed to a typhoon and examined the network structure of PTSS and IGD symptoms, along with bridge symptoms, to elucidate how they co-occur. Results indicated that 'avoiding external reminders' and 'anhedonia' were identified as the most central symptoms in the PTSD network, whereas 'preoccupation,' 'gaming despite harms', and 'loss of control' ranked highest on centrality in the IGD network. Two bridge symptoms emerged within the combined PTSD and IGD network model: 'concentration difficulties' and 'conflict due to gaming' from among the PTSS and IGD symptoms, respectively. These findings reveal novel associations between PTSS and IGD symptoms and provide an empirically-based hypothesis for how these two disorders may co-occur among individuals exposed to natural disasters.
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Affiliation(s)
- Guangzhe Frank Yuan
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, People's Republic of China.
| | - Jon D Elhai
- Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA; Department of Psychiatry, University of Toledo, 3000 Arlington Ave., Toledo, OH 43614, USA
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Kay Chang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.
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Constantinou M, Gloster AT, Karekla M. I won't comply because it is a hoax: Conspiracy beliefs, lockdown compliance, and the importance of psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021; 20:46-51. [PMID: 34754723 PMCID: PMC8567736 DOI: 10.1016/j.jcbs.2021.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic has brought unprecedented situations (government lockdowns, quarantines, etc.) and stressors (a seemingly “phantom” virus that can be lurking anywhere) causing uncertainty for the future, uncontrollable and unpredictable situations. It appears that especially during times of uncertainty and high stress, conspiracy theories flourish and these can affect the way individuals behave, especially in response to governmental recommendations for social isolation and quarantine. Psychological flexibility, we hypothesized, may act as a protective factor in the relation between COVID-19 distress, conspiracy theory beliefs and consequent behaving. In this respect, the aim of this paper was to examine how conspiracy theory beliefs, COVID-19 distress, adherence behavior, and psychological flexibility interact. Participants were 1001 individuals (802 women; Mage = 35.59years, SD = 10.07), who completed an online survey approximately one month after the first governmental measures of self-isolation and quarantine were enforced. Psychological flexibility was found to mediate the relation between conspiracy theory beliefs and compliance behavior. Further, being highly stressed appeared to increase the probability that a person will believe conspiracy theories, while such beliefs influenced whether a person would follow public health recommendations. Psychological flexibility appeared to be a protective factor at low and moderate distress levels. However, at high levels of COVID-19 distress, individuals prone to conspiracy theory beliefs would be less likely to conform to governmental public health recommendations irrespective of their psychological flexibility levels.
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Affiliation(s)
- Marios Constantinou
- Department of Social Sciences, University of Nicosia, 46 Makedonitissas Avenue, 1700, Nicosia, Cyprus
| | - Andrew T Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Missionsstrasse 62 A, 4055 Basel, Switzerland
| | - Maria Karekla
- ACThealthy Laboratory, Department of Psychology, University of Cyprus, P.O. Box 20537, Nicosia 1678, Cyprus
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Na PJ, Tsai J, Southwick SM, Pietrzak RH. Factors associated with post-traumatic growth in response to the COVID-19 pandemic: Results from a national sample of U.S. military veterans. Soc Sci Med 2021; 289:114409. [PMID: 34537394 PMCID: PMC8445520 DOI: 10.1016/j.socscimed.2021.114409] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
Rationale The COVID-19 pandemic has had numerous negative effects globally, contributing to mortality, social restriction, and psychological distress. To date, however, the majority of research on the psychological impact of the COVID-19 pandemic has focused on negative psychological outcomes, such as depression, anxiety, and posttraumatic stress disorder (PTSD). Objective Although there is debate about the constructive vs. illusory nature of post-traumatic growth (PTG), it has been found to be prevalent in a broad range of trauma survivors, including individuals affected by the COVID-19 pandemic. The objective of this study was to identify pre- and peri-pandemic factors associated with pandemic-related PTG in a national sample of U.S. veterans. Methods Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative cohort of 3078 U.S. veterans. A broad range of pre-pandemic and 1-year peri-pandemic factors associated with pandemic-related PTG were evaluated. Curve estimation and receiver operating characteristic curve analyses were conducted to characterize the association between pandemic-related PTSD symptoms and PTG. Results Worries about the effect of the pandemic on one's physical and mental health, PTG in response to previous traumas (i.e., new possibilities and improved interpersonal relationships), and pandemic-related avoidance symptoms were the strongest correlates of pandemic-related PTG. An inverted-U shaped relationship provided the best fit to the association between pandemic-related PTSD symptoms and endorsement of PTG, with moderate severity of PTSD symptoms optimally efficient in identifying veterans who endorsed PTG. Conclusions Results of this study suggest that psychosocial interventions that promote more deliberate and organized rumination about the pandemic and enhance PTG in response to prior traumatic events may help facilitate positive psychological changes related to the COVID-19 pandemic in U.S. military veterans. Longitudinal studies on functional correlates of PTG may help inform whether these changes are constructive vs. illusory in nature.
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Affiliation(s)
- Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL, USA; School of Public Health, University of Texas Health Science Center at Houston, TX, USA; U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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9
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Yuan G, Park CL, Birkeland SR, Yip PSY, Hall BJ. A Network Analysis of the Associations Between Posttraumatic Stress Symptoms and Posttraumatic Growth Among Disaster-Exposed Chinese Young Adults. J Trauma Stress 2021; 34:786-798. [PMID: 33843120 DOI: 10.1002/jts.22673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) have been shown to coexist following exposure to a traumatic event, but consensus about what accounts for this association is lacking. Network analysis is a novel analytic method that can explain this linkage. In a sample of 1,809 Chinese college students (66.1% female, age range: 16-35 years) who were directly exposed to a typhoon, we investigated the network structure of PTSS and PTG, along with bridge symptoms and elements, to elucidate how distress and growth coexist. The seven strongest edges found in the model included two between elements in the PTSS cluster, one between elements of PTG, and four between elements of PTSS and PTG. Eight bridge symptoms and elements emerged: intrusive thoughts, emotional cue reactivity, hypervigilance, self-destructive or reckless behavior, nightmares, and physiological cue reactivity among PTSS, and changed priorities and stronger religious faith among PTG elements. These findings reveal connections between PTSS and PTG that explain how these constructs may coexist in individuals exposed to natural disasters. The network perspective provides a novel way to conceptualize the association between PTSS and PTG and contributes to the field's understanding of recovery after traumatic events.
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Affiliation(s)
- Guangzhe Yuan
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), People's Republic of China
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Samuel R Birkeland
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), People's Republic of China
| | - Paul S Y Yip
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University Shanghai, Shanghai, People's Republic of China.,School of Global Public Health, New York University, New York, USA
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Thomas EA, Owens GP, Keller EM. Relationships among non-interpersonal and interpersonal trauma types, posttraumatic stress, and posttraumatic growth. J Clin Psychol 2021; 77:2592-2608. [PMID: 34062610 DOI: 10.1002/jclp.23190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
METHODS Adults seeking behavioral health or medical treatment (N = 158) were recruited from a community healthcare agency and a residential support program in the southeastern United States. RESULTS Individuals who reported interpersonal trauma had significantly higher total PTS severity and symptom clusters. No significant difference was found in perceived PTG based on trauma type. No significant curvilinear relationship between PTS and perceived PTG was found. A significant negative linear relationship was observed between PTS and perceived PTG for non-interpersonal trauma, but not interpersonal trauma. CONCLUSION Trauma type may influence the PTS and perceived PTG relationship and, while associated with PTS, seems less important to reporting of perceived PTG.
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Affiliation(s)
- Elizabeth A Thomas
- Department of Psychology, University of Tennessee - Knoxville, Knoxville, Tennessee, USA
| | - Gina P Owens
- Department of Psychology, University of Tennessee - Knoxville, Knoxville, Tennessee, USA
| | - Emily M Keller
- Department of Psychology, University of Tennessee - Knoxville, Knoxville, Tennessee, USA
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Jacobson IG, Adler AB, Roenfeldt KA, Porter B, LeardMann CA, Rull RP, Hoge CW. Combat Experience, New-Onset Mental Health Conditions, and Posttraumatic Growth in U.S. Service Members. Psychiatry 2021; 84:276-290. [PMID: 34340639 DOI: 10.1080/00332747.2021.1929770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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12
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Yaakubov L, Hoffman Y, Rosenbloom T. Secondary traumatic stress, vicarious posttraumatic growth and their association in emergency room physicians and nurses. Eur J Psychotraumatol 2020; 11:1830462. [PMID: 33408806 PMCID: PMC7747932 DOI: 10.1080/20008198.2020.1830462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Emergency room personnel are indirectly exposed to many traumas. Few studies have examined secondary traumatic stress in emergency room nurses and only a single study examined emergency room physicians. The extent of vicarious post-traumatic growth, i.e., the growth associated with such trauma, has also hitherto not been examined in emergency room personnel. Objective: Our first goal was to examine secondary traumatization in both emergency room nurses and physicians. Our second goal was to examine vicarious post-traumatic growth in emergency room personnel. Finally, we also address the association (linear and curvilinear) between secondary traumatization and vicarious traumatic growth. Methods: A questionnaire comprising demographic variables, secondary traumatic stress and vicarious post-traumatic growth was administered electronically to a sample of emergency room personnel from the Wolfson Hospital, Holon, Israel. Results: There were no differences between nurses and physicians in overall secondary trauma or vicarious post-traumatic growth levels. For physicians, there was both a linear and a curvilinear association between secondary trauma and vicarious post-traumatic growth; for nurses, there was no overall association. Further sub-group analyses revealed that emergency room nurses with low workload, in conjunction with low work experience, did show a linear association. Conclusion: Results indicate that while vicarious post-traumatic growth is linked to secondary traumatic stress for emergency room physicians, it is not so for nurses. Theoretical implications concerning the role of trauma symptoms in vicarious post-traumatic growth are discussed. Clinical implications are raised regarding the identification of excessive secondary traumatic stress levels and the need for interventions to both decrease stress levels, and to increase vicarious post-traumatic growth levels.
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Affiliation(s)
- Lyuba Yaakubov
- Department of Management, Bar-Ilan University, Ramat Gan, Israel
| | - Yaakov Hoffman
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Tova Rosenbloom
- Department of Management, Bar-Ilan University, Ramat Gan, Israel
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Whealin JM, Pitts B, Tsai J, Rivera C, Fogle BM, Southwick SM, Pietrzak RH. Dynamic interplay between PTSD symptoms and posttraumatic growth in older military veterans. J Affect Disord 2020; 269:185-191. [PMID: 32339132 DOI: 10.1016/j.jad.2020.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Posttraumatic growth (PTG) refers to positive psychological changes that may occur after experiencing a traumatic event. While cross-sectional studies have suggested that posttraumatic stress disorder (PTSD) is associated with greater PTG, few longitudinal studies have evaluated interrelationships between PTSD and PTG. Further, little is known about which specific symptom clusters of PTSD and coping mechanisms may drive PTG over time. METHODS We evaluated interrelationships between PTSD symptoms and PTG using data from a 4-year, nationally representative, prospective cohort study of 2,006 older trauma-exposed U.S. veterans. RESULTS Autoregressive cross-lagged panel regression analyses revealed that greater severity of PTSD symptoms was associated with greater PTG over time. Specifically, greater severity of the avoidance and anxious arousal (e.g., hypervigilance) symptoms at Wave 1 predicted greater PTG at Wave 2; and greater severity of avoidance and lower severity of dysphoric arousal (e.g., sleep disturbance) at Wave 2 predicted greater PTG at Wave 3. Engagement in active coping and religious coping were associated with greater subsequent PTG above and beyond autoregressive associations between PTSD and PTG. LIMITATIONS The self-report nature of the assessments, discrete assessment periods assessed, and focus on older military veterans are study limitations. CONCLUSIONS Greater severity of PTSD symptoms, particularly avoidance and hyperarousal symptoms, may contribute to and maintain PTG over time in older veterans. Interventions that promote deliberate, constructive attempts to manage chronic PTSD symptoms via active coping and religious coping may help veterans better manage PTSD symptoms and experience greater PTG in late-life.
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Affiliation(s)
- Julia M Whealin
- VA Pacific Islands Health Care System, 459 Patterson Road, Honolulu, HI 96819, USA; Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI 96813, USA.
| | - Barbara Pitts
- VA Pacific Islands Health Care System, 459 Patterson Road, Honolulu, HI 96819, USA; Department of Psychological Sciences, Kansas State University, 492 Bluemont Hall 1114 Mid-Campus Dr North, Manhattan, Kansas 66506-5302, USA
| | - Jack Tsai
- VA National Center on Homelessness Among Veterans, Tampa, FL, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Caleb Rivera
- Department of Psychology, University of Hawaii, 200W Kawili St, Hilo, HI 96720, USA
| | - Brienna M Fogle
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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14
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Pease D MA, Guillén H. Constructing Collective Memories regarding Conflicto Armado Interno in Perú (1980-2000): Psychologýs Role and Contributions Based upon Experiences of Collective Reprocessing of Memories in Educational Contexts. J Prev Interv Community 2019; 49:366-384. [PMID: 31524102 DOI: 10.1080/10852352.2019.1664713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The construction of collective memory with regard to Conflicto Armado Interno (Internal Armed Conflict CAI) -violence that occurred in Perú between 1980 and 2000- is still a challenge that produces disputes and tension. It has been studied mostly by social scientists, from the point of view of 'memory' studies. Despite the great explanatory power of Psychology in understanding these type of processes, its contribution has mainly focused on mental health. Education has been the least researched area, despite the role the Truth and Reconciliation Committee attributed to education in schools and universities, in constructing memories about war. In this context, we reflect on the role of Psychology on constructing collective memory in educational settings. Starting from Hallbach´s classic theory of collective memory, to contributions from cognitive psychology and post-traumatic growth studies, we analyze two experiences in educational contexts with the purpose of proposing some guidelines for research and intervention.
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Affiliation(s)
| | - Henry Guillén
- Department of Psychology, Pontificia Universidad Católica Del Perú, Lima, Perú
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15
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Eisma MC, Lenferink LIM, Stroebe MS, Boelen PA, Schut HAW. No pain, no gain: cross-lagged analyses of posttraumatic growth and anxiety, depression, posttraumatic stress and prolonged grief symptoms after loss. ANXIETY STRESS AND COPING 2019; 32:231-243. [DOI: 10.1080/10615806.2019.1584293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Lonneke I. M. Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Margaret S. Stroebe
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
- Arq Psychotrauma Expert Group, Diemen, the Netherlands
| | - Henk A. W. Schut
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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16
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Ochoa Arnedo C, Sánchez N, Sumalla EC, Casellas-Grau A. Stress and Growth in Cancer: Mechanisms and Psychotherapeutic Interventions to Facilitate a Constructive Balance. Front Psychol 2019; 10:177. [PMID: 30778323 PMCID: PMC6369350 DOI: 10.3389/fpsyg.2019.00177] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022] Open
Abstract
Post-traumatic stress and growth are common responses to adverse life events such as cancer. In this article, we establish how cancer becomes a "fertile land" for the emergence of stress and growth responses and analyze the main mechanisms involved. Stress-growth responses on adjusting to cancer is potentially determined by factors like the phase of the illness (e.g., initial phases vs. period of survivorship), patient's coping strategies, meaning-making, and relationships with significant others. We also review the mechanisms of constructive and adaptative stress-growth balances in cancer to study the predictors, interrelated associations, triggering mechanisms, long-term results, and specific trajectories of these two responses to cancer. Finally, we update the evidence on the role of these stress-growth associations in psychologically adjusting to cancer. Together with this evidence, we summarize preliminary results regarding the efficacy of psychotherapeutic interventions that aim to facilitate a constructive psychological balance between stress and growth in cancer patients. Recommendations for future research and gaps in knowledge on stress-growth processes in this illness are also highlighted. Researchers are encouraged to design and use psychotherapeutic interventions according to the dynamic and changeable patients' sources of stress and growth along the illness. Relevant insights are proposed to understand the inconsistency of stress-growth literature and to promote psychotherapeutic interventions to facilitate a constructive balance between these key responses in cancer.
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Affiliation(s)
- Cristian Ochoa Arnedo
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain
| | | | - Enric C Sumalla
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casellas-Grau
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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17
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An Y, Yuan G, Zhang N, Xu W, Liu Z, Zhou F. Longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth in adolescents following the Yancheng tornado in China. Psychiatry Res 2018; 266:334-340. [PMID: 29622275 DOI: 10.1016/j.psychres.2018.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 01/21/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
Treatment of posttraumatic stress symptoms and facilitation of posttraumatic growth are two encouraging areas of research, yet little is understood about the relationships between trait mindfulness, posttraumatic stress symptoms, and posttraumatic growth. Previous work suggests the linkages among these variables, but most studies have been conducted in adult samples. The aim of this study was to examine longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth among adolescent survivors of the 2016 Jiangsu tornado in China. Data was collected at two secondary schools located in Yancheng city, where the severe catastrophic damage occurred during the tornado. The sample included 247 adolescent survivors (59.5% girls) aged 12-14 years who were directly affected by the tornado. Participants self-reported their trait mindfulness, posttraumatic stress symptoms, and posttraumatic growth at two time points: 6-month (T1) and 9-month post-tornado (T2; attrition rate 17.4%). Cross-lagged structural equation modelling analyses were conducted. Results showed that posttraumatic stress symptoms at T1 significantly predicted reduced trait mindfulness at T2 but not posttraumatic growth; trait mindfulness at T1 did not significantly predict posttraumatic stress symptoms nor posttraumatic growth at T2; and posttraumatic growth at T1 did not predict trait mindfulness nor posttraumatic stress symptoms at T2. These findings suggested that posttraumatic stress symptoms may negatively influence the development of trait mindfulness in disaster-affected adolescents in China, and that posttraumatic growth may have unique implications for this young population which was not associated with posttraumatic stress symptoms or trait mindfulness.
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Affiliation(s)
- Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Guangzhe Yuan
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Na Zhang
- Department of Family Social Science, University of Minnesota -Twin Cities, MN, USA
| | - Wei Xu
- School of Psychology, Nanjing Normal University, Nanjing, PR China.
| | - Zhen Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Feng Zhou
- Funing Country Banhu Junior Middle School, Yancheng, PR China
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18
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Hou WK, Canetti D, Ma TW, Hall BJ, Lau KM, Ng SM, Hobfoll SE. What predicts threat perceptions toward people opposing to the government? A population-based study following Umbrella Movement, Hong Kong. JOURNAL OF SOCIAL AND POLITICAL PSYCHOLOGY 2018. [DOI: 10.5964/jspp.v6i2.791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We examined the incidence and predictors of threat perceptions toward people who oppose government action (i.e., protestors) following the Umbrella Movement in Hong Kong (September 28th to December 15th, 2014). A population-representative sample of 1,208 citizens (mean age = 46.89 years; 52.4% female) was recruited two months after the conclusion of the Movement using random digit dialing. Upon giving their informed consent, respondents reported sociodemographics, perceived threats of protestors to the prospects of democracy, ways of life, and the economy, anxiety symptoms (STAI), and depressive symptoms (PHQ-9). More than half disagreed that protestors threatened the prospects of democracy (54.7%, 95% CI = .52, .57), ways of life (52.2%, 95% CI = .49, .55), and the economy (51.4%, 95% CI = .49, .54). Regression analyses revealed that male sex was associated with lower odds of perceiving threats to the prospects of democracy and ways of life. Being unmarried was associated with lower odds of perceiving threats to the economy. Secondary education level and depressive symptoms were associated with higher odds of perceiving threats to ways of life and the economy, respectively. This is one of the first population-based studies that measured socioeconomic and mental health correlates of political attitudes immediately following pro-democracy movements.
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19
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Xu X, Hu ML, Song Y, Lu ZX, Chen YQ, Wu DX, Xiao T. Effect of Positive Psychological Intervention on Posttraumatic Growth among Primary Healthcare Workers in China: A Preliminary Prospective Study. Sci Rep 2016; 6:39189. [PMID: 27995960 PMCID: PMC5171914 DOI: 10.1038/srep39189] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/18/2016] [Indexed: 12/20/2022] Open
Abstract
Posttraumatic growth (PTG) is defined as positive psychological change in the wake of highly challenging circumstances. Healthcare workers in particular are more vulnerable to stressors and trauma than the general population. The current study examined the use and effectiveness of a novel positive psychological intervention based on Chinese traditional culture to improve PTG in hospital healthcare workers. The intervention was provided to 579 healthcare workers at hospitals in Guilin, Shenzhen and Xiangtan. Scores on the Posttraumatic Growth Inventory (PTGI) and its subscales were significantly higher after intervention than before (p < 0.001). Of the five aspects of PTG, the aspect of "new possibilities" benefited the most from intervention (Cohen's d = 0.45). PTG in women, nurses and college graduates increased to a greater extent than other participants after intervention. It was concluded that our novel intervention is effective at improving PTG in medical staff.
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Affiliation(s)
- Xin Xu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Mu-Li Hu
- Research Office, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yu Song
- Research Office, People's Hospital of Hunan Province, Changsha, P. R. China
| | - Zhang-Xiu Lu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - You-Qiao Chen
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Da-Xing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Tao Xiao
- Research Office, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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20
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Zalta AK, Gerhart J, Hall BJ, Rajan KB, Vechiu C, Canetti D, Hobfoll SE. Self-reported posttraumatic growth predicts greater subsequent posttraumatic stress amidst war and terrorism. ANXIETY STRESS AND COPING 2016; 30:176-187. [PMID: 27575750 DOI: 10.1080/10615806.2016.1229467] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE This study tested three alternative explanations for research indicating a positive, but heterogeneous relationship between self-reported posttraumatic growth (PTG) and posttraumatic stress symptoms (PSS): (a) the third-variable hypothesis that the relationship between PTG and PSS is a spurious one driven by positive relationships with resource loss, (b) the growth over time hypothesis that the relationship between PTG and PSS is initially a positive one, but becomes negative over time, and (c) the moderator hypothesis that resource loss moderates the relationship between PTG and PSS such that PTG is associated with lower levels of PSS as loss increases. DESIGN AND METHOD A nationally representative sample (N = 1622) of Israelis was assessed at three time points during a period of ongoing violence. PTG, resource loss, and the interaction between PTG and loss were examined as lagged predictors of PSS to test the proposed hypotheses. RESULTS Results were inconsistent with all three hypotheses, showing that PTG positively predicted subsequent PSS when accounting for main and interactive effects of loss. CONCLUSIONS Our results suggest that self-reported PTG is a meaningful but counterintuitive predictor of poorer mental health following trauma.
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Affiliation(s)
- Alyson K Zalta
- a Departments of Behavioral Sciences and Psychiatry , Rush University Medical Center , Chicago , IL , USA
| | - James Gerhart
- b Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Brian J Hall
- c Global and Community Mental Health Research Group, Department of Psychology , University of Macau (SAR) , Macau , People's Republic of China.,d Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Kumar B Rajan
- e Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA
| | - Catalina Vechiu
- f Department of Psychology , University of Nevada , Reno , NV , USA
| | - Daphna Canetti
- g School of Political Science , University of Haifa , Haifa , Israel
| | - Stevan E Hobfoll
- b Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
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21
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Abstract
In the present study, we examined posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) responses among a nonclinical sample of 202 participants. Instruments included the PTSD Checklist for the DSM-5 (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) and Posttraumatic Growth Inventory. Confirmatory factor analysis demonstrated the most support for the 6-factor DSM-5 PTSD model and 5-factor PTG model, previously supported in the literature. Canonical correlation analysis evidenced a strong relationship between PTSD and PTG subscales. Path analysis results demonstrated that PTSD's re-experiencing subscale was related to PTG's appreciation for life subscale. Posttraumatic stress disorder's avoidance was related to PTG's personal strength subscale. We also tested curvilinear relationships between PTSD and PTG subscales. Results and implications are discussed in the context of the constructs of PTSD and PTG.
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22
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Asi YM, Unruh L, Liu X. Life under occupation: citizenship and other factors influencing the well-being of university students living in the West Bank. Med Confl Surviv 2016; 32:112-137. [PMID: 27737560 DOI: 10.1080/13623699.2016.1242049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is substantial evidence that individuals affected by conflict suffer poor physical and mental outcomes, particularly in indicators of well-being. This study assesses the health-related quality of life (HRQoL), perceived stress and insecurity of Palestinian young adults in the West Bank. We surveyed 398 university students from Nablus (mean age = 20.1) using the SF-36 to measure HRQoL, the PSS-4 to assess stress and a context-specific insecurity instrument. A third of participants reported Israeli citizenship, and the results indicated better outcomes in these individuals in several outcomes, with the noteworthy exception of insecurity. This study is one of the first to assess citizenship of West Bank Palestinians as a potential covariate to predict measures of well-being. Because citizenship is such a meaningful issue for Palestinians and is related to individual freedom and access to resources, this study suggests that there are complex dynamics outside of typical demographic variables that contribute to well-being.
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Affiliation(s)
- Yara M Asi
- a College of Health and Public Affairs , University of Central Florida , Orlando , FL , USA
| | | | - Xinliang Liu
- a College of Health and Public Affairs , University of Central Florida , Orlando , FL , USA
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23
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Tsai J, Mota NP, Southwick SM, Pietrzak RH. What doesn't kill you makes you stronger: A national study of U.S. military veterans. J Affect Disord 2016; 189:269-71. [PMID: 26454187 DOI: 10.1016/j.jad.2015.08.076] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/12/2015] [Accepted: 08/28/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posttraumatic growth (PTG) is commonly observed among trauma survivors. However, few studies have treated PTG as multi-dimensional and examined how different PTG dimensions may be protective against the negative effects of future trauma. METHODS Using a nationally representative web-based survey of 1057 U.S. military veterans followed for two years, we examined whether different PTG dimensions had a protective effect on the severity and diagnosis of posttraumatic stress disorder (PTSD) in the face of new traumatic life events. RESULTS Greater scores on the Personal Strength domain of the PTG Inventory-Short Form at baseline was associated with reduced severity (β=-.05, p<.05) and incidence (OR=.68, 95% CI=.50-.93) of PTSD at a two-year follow-up. LIMITATIONS Results are associational and causality cannot be inferred so replication is needed. CONCLUSIONS This study highlights the multi-dimensional nature of PTG and demonstrates a salubrious effect of trauma-related gains in personal strength on incident PTSD.
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Affiliation(s)
- Jack Tsai
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Natalie P Mota
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Steven M Southwick
- Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA
| | - Robert H Pietrzak
- Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA
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24
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Affiliation(s)
- Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau (SAR), People's Republic of China.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; ;
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Arq Psychotrauma Expert Group, Diemen, The Netherlands
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