Gratitude Moderates the Mediating Effect of Deliberate Rumination on the Relationship Between Intrusive Rumination and Post-traumatic Growth

Posttraumatic growth in palliative care settings: A scoping review of prevalence, characteristics and interventions

BACKGROUND

Posttraumatic growth refers to positive psychological change following trauma. However, there is a need to better understand the experience of posttraumatic growth in the palliative care setting as well as the availability and efficacy of interventions that target this phenomenon.

AIMS

To provide a review of the prevalence, characteristics and interventions involving posttraumatic growth in adults receiving palliative care and to collate recommendations for future development and utilisation of interventions promoting posttraumatic growth.

DESIGN

We performed a systematic scoping review of studies investigating posttraumatic growth in palliative care settings using the Arksey and O'Malley six-step scoping review criteria. We used the PRISMA guidelines for scoping reviews.

DATA SOURCES

Articles in all languages available on Ovid Medline [1946-2022], Embase [1947-2022], APA PsycINFO [1947-2022] and CINAHL [1981-2022] in November 2022.

RESULTS

Of 2167 articles located, 17 were included for review. These reported that most people report low to moderate levels of posttraumatic growth with a decline towards end-of-life as distress and symptom burden increase. Associations include a relationship between posttraumatic growth, acceptance and greater quality-of-life. A limited number of interventions have been evaluated and found to foster posttraumatic growth and promote significant psychological growth.

CONCLUSION

Posttraumatic growth is an emerging concept in palliative care where although the number of studies is small, early indications suggest that interventions fostering posttraumatic growth may contribute to improvements in psychological wellbeing in people receiving palliative care.

Contribution of rumination and psychological resilience to post-traumatic growth of front-line healthcare workers in mobile cabin hospitals under Normalized epidemic Prevention and Control Requirements

To understand the level of post-traumatic growth (PTG) and influencing factors among front-line healthcare workers (HCWs) working in mobile cabin hospitals treating patients with Coronavirus Disease 2019 (COVID-19) under the Normalized Epidemic Prevention and Control Requirements adopted in China. A random sampling method was used to select 540 HCWs of the Chongqing-aid-Shanghai medical team from April to May 2022 as the study participants. Participants completed a general information questionnaire, the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) and the Chinese Event Related Rumination Inventory (C-ERRI). Among the 540 included HCWs, 83.15 % were nurses and 78.89 % were women. The average scores for PTG (62.25 ± 16.73) and psychological resilience (64.22 ± 15.38) were at moderate levels, and the average score for rumination was low (21.62 ± 10.77). Pearson correlation analysis showed that CD-RISC and C-ERRI scores were positive with the PTGI-C score (r = 0.528, 0.316, P < 0.001). Multiple linear regression analysis identified psychological training or intervention during the COVID-19 epidemic (β = 2.353, P = 0.044), psychological resilience (β = 0.525, P < 0.001) and deliberate rumination (β = 0.732, P < 0.001) as factors significantly associated with the PTG of front-line HCWs, which together explained 36.8 % of the total variance in PTG (F[5,539] = 63.866, P < 0.001). In general, psychological resilience and deliberate rumination can promote PTG among HCWs and can be improved by strengthening psychological training and interventions for HCWs working under the Normalized Epidemic Prevention and Control Requirements.

Effects of Profession-Related Support from Different Sources on Subjective Well-Being Among Chinese Tuition-Free Normal University Students: The Mediation of Intrinsic Motivation for Teaching and Moderation of Dispositional Gratitude

Background

Tuition-free normal university students (TFNUS) have become an important group in Chinese normal university. The subjective well-being of TFNUS not only affects their own mental health, and decisions to stay in the teaching profession, but also can significantly influence their future student's perception of stress, learning motivation and academic achievement. However, little attention has been paid to the relationship between positive factors and TFNUS's subjective well-being and the underlying mechanism and boundary condition. The purpose of this study is to examine whether, how and when profession-related support from different sources influences TFNUS's subjective well-being.

Methods

Based on the Conservation of Resource Theory and Self-Determination Theory, a time-lagged design was used to collect two wave data (N=526), and we use dominance analysis to examine the relative importance of profession-related support from significant others (eg, government, teachers, and parents) in relation to subjective well-being among Chinese tuition-free normal university students, and propose a moderated mediation model to reveal the mediating (intrinsic motivation for teaching) and moderating (dispositional gratitude) effects of this relation.

Results

Profession-related government, teacher, and parent support were all positively related to subjective well-being, in a descending order of relative importance were as follows: teacher, parent and government. Furthermore, intrinsic motivation for teaching mediated the relationship between profession-related support and subjective well-being. In addition, dispositional gratitude only moderated the relationship between two sources (teacher and parent, respectively) of profession-related support and intrinsic motivation for teaching. Moreover, dispositional gratitude moderated the strength of the indirect effect of profession-related teacher support and parent support on subjective well-being (through intrinsic motivation for teaching), and the mediated relationship was stronger for those with high (vs low) dispositional gratitude.

Conclusion

The profession-related support had positive direct effect on tuition-free normal university students' subjective well-being, as well as indirect effect through intrinsic motivation for teaching. Dispositional gratitude moderated the relationship between of profession-related teacher, parent support and intrinsic motivation for teaching, and the strength of the indirect effect of this support on subjective well-being.

Rumination, Basic Beliefs, and Posttraumatic Growth in Cancer Patients: A Moderated Mediation Model

BACKGROUND

Cancer is a highly distressing and traumatic experience that can significantly impact individuals' psychological well-being. Whereas many cancer patients may experience negative psychological outcomes, such as posttraumatic stress symptoms, a subset of individuals also reports positive psychological changes known as posttraumatic growth.

OBJECTIVE

To contribute to theory-driven development of these treatments by exploring the role of deliberate rumination in posttraumatic growth, along with the basic beliefs that might shape it.

METHODS

A sample of cancer patients (n = 139) completed self-report measures assessing rumination, basic beliefs, and posttraumatic growth. Multiple linear regression analyses and moderated mediation models were conducted to analyze the data.

RESULTS

Findings support the hypothesis that intrusive rumination, deliberate ruminating, and disruption in basic beliefs strongly predict posttraumatic growth in cancer survivors. The results of this simple mediation indicate that deliberate rumination has a full mediating role. The results show that at all levels of basic beliefs, there is a positive and statistically significant indirect effect of intrusive rumination on posttraumatic growth.

CONCLUSIONS

These findings highlight the importance of addressing rumination and core beliefs in interventions aimed at promoting posttraumatic growth among cancer patients. Further research is needed to explore additional factors that may influence the relationship between rumination, basic beliefs, and posttraumatic growth.

IMPLICATIONS FOR PRACTICE

Oncology nurses can assist individuals in recognizing and managing intrusive rumination, as well as advocating deliberate rumination as a constructive cognitive process for making sense of a traumatic event and fostering growth.

The impact of COVID-19 trauma on healthcare workers: Examining the relationship between stress and growth through the lens of memory

The COVID-19 pandemic constituted tremendous traumatic stress among the frontline healthcare workers. In the present study, we investigated relationships of two types of rumination, namely brooding and reflection, with traumatic stress and post-traumatic growth and the mediating role of recollective experience in these relationships. A total of 88 healthcare workers (75% female, Mage  = 54.91) actively providing service to COVID-19 patients reported two memories of events that impacted them the most at the first peak of the pandemic and rated their recollective experience (i.e., phenomenological characteristics of memories). We used structural equation modelling to test whether recollective experience mediated the link of brooding and reflection with post-trauma reactions of stress and growth. The findings showed that brooding and reflection were associated with higher levels of traumatic stress and post-traumatic growth. Importantly, recollective experience mediated the relationship of rumination with traumatic stress but this differed for the type of rumination. Higher brooding was associated with greater traumatic stress and that relationship was independent of how well the memories were recollected, while for reflection, high reflection was associated with stronger recollective experience, which predicted higher traumatic stress and post-traumatic growth. The present study shows the functional dimensions of reflective rumination and presents novel findings that demonstrates the discrete mnemonic mechanisms underlying the association between brooding, reflection, and post-trauma reactions.

Post-traumatic Growth: The Roles of the Sense of Entitlement, Gratitude and hope

People believe that they are entitled to well-being and safety, and their responses to unexpected traumatic events reveal individual differences. Their reactions vary, from feeling blocked and distressed to feeling proactive towards new growth, depending on their personal resources. The current study sought to identify the role of entitlement in explaining post-traumatic growth (PTG) while considering the role of gratitude and hope as personal resources. We used a community-based sample of Israeli adults (n = 182) who reported experiencing a traumatic event during the preceding year. The relationships between PTG and their sense of entitlement, gratitude, and hope were examined. A stepwise multiple hierarchical regression revealed that all the three variables were associated with PTG. However, the effect of hope turned insignificant with the inclusion of sense of entitlement and gratitude in the regression. Sense of entitlement and gratitude were independently associated with PTG. The theoretical contribution of these findings is discussed, as well as their interventional implications and future directions.

The influence of deliberate rumination on the post-traumatic growth of college students during the COVID-19 pandemic and the moderating role of self-efficacy

Objective

To understand the relationship between deliberate rumination and post-traumatic growth and the mechanisms affecting this relationship, we constructed an adjustment model to test the impact of deliberate rumination on the post-traumatic growth of college students and the moderating role of self-efficacy during the 2019 COVID-19 pandemic.

Study design and setting

A total of 881 college students from a university of science and technology in Guangdong Province, China, completed a questionnaire that measured deliberate rumination, post-traumatic growth, and self-efficacy. SPSS (version 26) and the PROCESS plug-in (version 4.0) were used for correlation and moderation analyses.

Results

The correlation analysis showed that deliberate rumination was positively correlated with post-traumatic growth (r = 0.353, P < 0.01) and self-efficacy (r = 0.261, P < 0.01). Self-efficacy was also positively correlated with post-traumatic growth (r = 0.466, P < 0.01). In addition, we found that self-efficacy had a regulatory effect on the relationship between deliberate rumination and post-traumatic growth (R ² = 0.287, P < 0.001) and that this effect was significant.

Conclusion

The results show that deliberate rumination can be a positive predictor of post-traumatic growth and can play a certain role in fostering such growth. In addition, self-efficacy is a moderator that plays a buffer role between deliberate rumination and post-traumatic growth. These results contribute to a more comprehensive understanding of the mechanisms that affect post-traumatic growth.

Factors associated with posttraumatic growth: gratitude, PTSD and distress; one year into the COVID-19 pandemic in Lebanon

Almost one year since the COVID-19 was declared a global pandemic, mental distress remains elevated with high prevalence of post-traumatic stress disorder (PTSD). Yet studies suggest these challenging circumstances might be conducive of post-traumatic growth (PTG). This study aims to investigate the factors associated with growth after the original trauma. A sample of 252 Lebanese adults filled an online survey to determine levels of PTG, PTSD and gratitude using validated self-rating scales. Participants also subjectively evaluated the sources of their distress such as the COVID-19 pandemic, the Beirut port explosion and/or their deteriorating financials. The PTGi-SF evaluated dimensions of growth while the IES-R_22 measured the degree of distress post-trauma. The GQ-6 was used to measure the proneness to experience gratitude daily. Results indicated 41% of participants scored above the cutoff for PTSD symptomatology. Yet, PTSD was positively correlated, alongside gratitude and accumulated subjective distress, with higher levels of PTG. A forward linear regression taking PTG scores as the dependent variable further showed that more gratitude (Beta = 0.57), a higher impact of events (Beta = 0.16), and knowing anyone who died from COVID-19 (Beta = 3.93) were significantly associated with more growth. The study highlights elevated levels of PTSD symptoms in a context of a global pandemic worsened by financial and socio-political instabilities. It mostly identifies personal factors, including high initial symptomatology post-trauma and gratitude, related to the capacity for growth in spite of these accumulating hardships. As such, it advocates the need to investigate and bolster silver linings amidst unprecedented traumas.

Cumulative Risk and Mental Health of Left-behind Children in China: A Moderated Mediation Model

Based on the dual-factor model of mental health (DFM) and the cumulative risk (CR) model, this study aimed to investigate the impact of CR on left-behind children's mental health and the underlying mechanism involved, specifically the mediating role of coping style and the moderating role of gratitude in the relationship between CR and mental health. The random cluster sampling method was applied to collect data on CR, coping style, gratitude, life satisfaction, and depression from 705 left-behind children (374 boys, Mage = 12.20 ± 1.25). The moderated mediation analyses indicated that: (1) the moderated mediation model of CR and depression was significant: coping style mediated the relationship between CR and depression, and gratitude moderated this mediating effect with gratitude strengthening the negative association between CR and coping style; and (2) gratitude moderated the relationship between CR and life satisfaction and it also strengthened the negative association between CR and life satisfaction. The findings suggest that the mechanisms of coping style may differ in the relationships between CR and positive and negative indicators of mental health in left-behind children and that gratitude as a protective factor has limited capacity to buffer the negative effect of accumulated risk. These findings provide evidence for differentiated intervention approaches to promote disadvantaged children's life satisfaction and depression.

A meta-analysis of the association between event-related rumination and posttraumatic growth: The Event-Related Rumination Inventory and the Posttraumatic Growth Inventory

Trauma can disrupt an individual's core beliefs about themselves, others, and the world. Posttraumatic growth (PTG) is thought to be the outcome of a reconstruction process involving ruminative processing. This meta-analysis examined the strength of the associations between event-related intrusive and deliberate rumination and PTG. The moderating effects of variables including age, time since trauma exposure, and trauma type were examined. Eight databases were searched for English-language, peer reviewed studies examining the associations between PTG and types of event-related rumination in adults. Effect sizes (Pearson's r) were extracted and analyzed, and study quality was assessed using the Study Quality Assessment Tool for Observational and Cohort studies. In total, 46 studies were included based on the inclusion and exclusion criteria. A significant main effect was observed for the association between retrospectively reported deliberate rumination that occurred soon after a traumatic event and PTG, r = .45, 95% CI [.41, .49]. There was significant variability in effect sizes, and the strength of this association differed according to age. The association between intrusive rumination and PTG was not significant and varied in direction. Deliberate rumination that occurred relatively soon following trauma exposure was shown to be positively associated with PTG. The findings highlight the importance of supporting trauma survivors to engage in the deliberate cognitive processing of their experiences to encourage PTG. Longitudinal research is needed to further delineate the temporal role of event-related rumination in PTG development.

Empathy and Post-Traumatic Growth among Chinese Community Workers during the COVID-19 Pandemic: Roles of Self-Disclosure and Social Support

Given the prolonged nature of the COVID-19 pandemic and its long-term psychological impacts, this study aimed to explore how empathy leads to post-traumatic growth (PTG) among Chinese community workers. Guided by the revised PTG model, this study identified the relation between empathy and PTG using a multiple mediation model that included self-disclosure and social support as hypothesized mediators. This study utilized data from 414 Chinese adults aged 20 years or older who completed an online survey during the pandemic. Self-disclosure and social support were measured as mediating variables. The study variables were positively correlated with PTG. Empathy was positively correlated with self-disclosure and social support. After controlling for demographic covariates, the results indicated that self-disclosure and social support mediated the link between empathy and PTG in both parallel and sequential fashion. Empathy, self-disclosure, and social support played important roles in the growth of Chinese community workers. The present findings have been useful in increasing our understanding, policy programs, and interventions by governments or regional bodies to ameliorate community workers' PTG.

Intolerance of Uncertainty, Acculturative Stress, Gratitude, and Distress: A Moderated Mediation Model

Based on Berry’s (1997) model of acculturation, the current study examined whether gratitude would moderate the association between intolerance of uncertainty (IU) and acculturative stress (i.e., moderation hypothesis), and mitigate the positive association between IU and psychological distress through acculturative stress (i.e., moderated mediation hypothesis). Participants were 171 international students with Chinese heritage from a Midwest public university. Results from PROCESS supported these hypotheses. First, the positive association between IU and acculturative stress was attenuated to a greater extent at higher compared to lower levels of gratitude. Second, the mediation effect of IU on psychological distress through acculturative stress was weaker among those with higher compared to lower levels of gratitude. Findings demonstrate the protective role of gratitude and the role of IU as a risk factor for psychological distress through acculturative stress. Implications for practice, training, and research are discussed.

Trauma Survivors' Experiences of Kundalini Yoga in Fostering Posttraumatic Growth

The prevalence of traumatic events in South Africa is considerably high due to a history of political violence and the ongoing cycle of interpersonal, community-based, and socioeconomic violence. While conventional therapeutic techniques have been found to support trauma survivors in the local context, alternative approaches that focus on the mind-body connection have become increasingly popular. However, studies reporting on the use of these approaches remain scarce. This study aimed to add to the body of knowledge on yoga as a non-conventional therapy to support trauma survivors and foster posttraumatic growth. Semi-structured interviews were conducted with a sample of seven Kundalini yoga practitioners who had been exposed to trauma. A thematic analysis confirmed that Kundalini yoga was beneficial in fostering posttraumatic growth. Overall, the study findings, evidence a pocket of success in relation to value of such an intervention within a low socio economic black South African context.

Self-Disclosure and Post-traumatic Growth in Korean Adults: A Multiple Mediating Model of Deliberate Rumination, Positive Social Responses, and Meaning of Life

Background

To explore how self-disclosure leads to post-traumatic growth (PTG) in adults who have experienced traumatic events, this study identified the relationship between self-disclosure and post-traumatic growth in Korean adults. We examined a parallel multiple mediating model for this relationship.

Methods

Participants were 318 Korean male and female adult participants aged 20 years or older who had experienced trauma. We measured deliberate rumination, positive social responses, and the meaning of life as mediating variables.

Results

The results revealed that the study variables positively correlated with PTG. Self-disclosure was positively correlated with deliberate rumination, positive social responses, and meaning of life. In the multiple mediating model, deliberate rumination, positive social responses, and meaning of life mediated the relationship between self-disclosure and PTG.

Conclusion

Self-disclosure, deliberate rumination, positive social responses, and meaning of life play an important role in the growth of adults who have experienced traumatic events. The findings of this study should provide valuable information for future research and for mental health professionals who want to promote the PTG of their clients.

Post accidental injury: Mediating roles of emotional expressivity, rumination, and posttraumatic growth

This study explored the relationship between rumination (deliberate or intrusive), emotional expressivity (positive or negative), and posttraumatic growth among patients within 1 month after an accidental injury. Using a cross-sectional design, 313 patients were investigated in two comprehensive hospitals. The results revealed that intrusive rumination had a significant positive effect on posttraumatic growth, partly through four different pathways: (i) the mediating role of deliberate rumination; (ii) the chain mediating role of deliberate rumination and negative emotional expressivity; (iii) the chain mediating role of negative emotional expressivity and positive emotional expressivity; and (iv) the chain mediating role of negative emotional expressivity, positive emotional expressivity, and deliberate rumination. Interventions to encourage emotional expressivity and facilitate the transition from intrusive rumination to deliberate rumination may promote posttraumatic growth soon after an accidental injury.

Post-traumatic Stress and Growth Among the Children and Adolescents in the Aftermath of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has enkindled many mental health problems across the globe. Prominent among them is the prevalence of post-traumatic stress (PTS) with hosts of its precipitating factors being present in the surrounding. With India witnessing severe impact of the second wave of COVID-19, marked by a large number of hospitalizations, deaths, unemployment, imposition of lockdowns, etc., its repercussions on children and adolescents demand particular attention. This study aims to examine the direct and the indirect exposure of COVID-19-related experiences on children and adolescents and its subsequent relationship with PTS and post-traumatic growth (PTG). The direct exposure was operationalized in terms of death or hospitalization in the family, while the indirect exposure was gauged in terms of exposure to media reports of the COVID situation. Data from 412 children and adolescents aged 9–20 years, collected online, revealed 68.9% of them with PTS. Interestingly, 39.8% of those reporting PTS were also experiencing PTG. Arousal appeared to be the most frequently reported characteristics of trauma. The multivariate analysis of variance (MANOVA) endorses significant difference between those with direct and indirect exposures to hospitalization. Those with direct exposure to hospitalization reported higher PTS. The indirect exposure of COVID-19-related news through electronic media was also significantly associated with higher PTS. Exposure through print media did not lead to significant difference in PTS, but those reading only magazines reported significantly higher PTG than not reading magazines. The findings are analyzed in the light of unfolding of events during the second wave of COVID-19 in India.

Post-traumatic Stress and Growth Among the Children and Adolescents in the Aftermath of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has enkindled many mental health problems across the globe. Prominent among them is the prevalence of post-traumatic stress (PTS) with hosts of its precipitating factors being present in the surrounding. With India witnessing severe impact of the second wave of COVID-19, marked by a large number of hospitalizations, deaths, unemployment, imposition of lockdowns, etc., its repercussions on children and adolescents demand particular attention. This study aims to examine the direct and the indirect exposure of COVID-19-related experiences on children and adolescents and its subsequent relationship with PTS and post-traumatic growth (PTG). The direct exposure was operationalized in terms of death or hospitalization in the family, while the indirect exposure was gauged in terms of exposure to media reports of the COVID situation. Data from 412 children and adolescents aged 9–20 years, collected online, revealed 68.9% of them with PTS. Interestingly, 39.8% of those reporting PTS were also experiencing PTG. Arousal appeared to be the most frequently reported characteristics of trauma. The multivariate analysis of variance (MANOVA) endorses significant difference between those with direct and indirect exposures to hospitalization. Those with direct exposure to hospitalization reported higher PTS. The indirect exposure of COVID-19-related news through electronic media was also significantly associated with higher PTS. Exposure through print media did not lead to significant difference in PTS, but those reading only magazines reported significantly higher PTG than not reading magazines. The findings are analyzed in the light of unfolding of events during the second wave of COVID-19 in India.

Did we learn something positive out of the COVID-19 pandemic? Post-traumatic growth and mental health in the general population

Background

When facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG).

Methods

Understanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth.

Results

The majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of “appreciation of life” (2.3 ± 1.4), while the lowest level was found in the “spiritual change” (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p < .002) and appreciation for life (p < .007) compared to male participants, while no significant association was found with age. At the multivariate regression models, weighted for the propensity score, only the initial week of lockdown (between 9-15 April) had a negative impact on the dimension of “relating to others” (B = −.107, 95% CI = −.181 to −.032, p < .005), while over time no other effects were found. The duration of exposure to lockdown measures did not influence the other dimensions of PTG.

Conclusions

The assessment of the levels of PTG is of great importance for the development of ad hoc supportive psychosocial interventions. From a public health perspective, the identification of protective factors is crucial for developing ad-hoc tailored interventions and for preventing the development of full-blown mental disorders in large scale.

A Brief Gratitude Writing Intervention Decreased Stress and Negative Affect During the COVID-19 Pandemic

Exploring ways to mitigate the stress of the COVID-19 pandemic is important for long-term health. Expressive and gratitude-focused writing are effective methods to help individuals process traumatic or stressful events. Gratitude-focused writing may yield additional benefits because it helps individuals appraise events positively. We hypothesized that an online gratitude writing intervention would yield greater benefits than an expressive writing intervention or control group. Participants were randomized to one of three groups and completed assessments one-week and one-month post-intervention. The gratitude writing group maintained gratitude levels and decreased stress and negative affect at one-month post-intervention. The expressive writing group decreased in gratitude and showed no changes in stress or negative affect at one-month post-intervention. The control group decreased in gratitude and negative affect and showed no changes in stress at one-month post-intervention. Gratitude writing may be a better resource for dealing with stress and negative affect than traditional expressive writing methods under extremely stressful situations with uncertain trajectories.

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak

BACKGROUND

During the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses.

METHODS

A cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress.

RESULTS

The mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (β = 0.829, p < 0.001).

CONCLUSIONS

Psychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.

Korean Christian Young Adults' Religiosity Affects Post-traumatic Growth: The Mediation Effects of Forgiveness and Gratitude

This study examines the mediation effects of forgiveness and gratitude in the association between Korean Christian young adults' religiosity and post-traumatic growth. The participants are 296 Christian young adults in Korea. We hypothesize that the association between young Christian young adults' religiosity and post-traumatic growth is mediated by forgiveness and gratitude. The hypothesized model is tested by structural equation modeling. Results confirm that the religiosity of Christian young adults affects post-traumatic growth through forgiveness and gratitude. Adding a direct path from religiosity to post-traumatic growth significantly improved the model fit, which suggests partial mediation of forgiveness and gratitude in the association between religiosity and post-traumatic growth.

Predictors of posttraumatic growth of the family members of neurosurgical intensive care unit patients: A cross-sectional study

OBJECTIVES

Confronted with the potentially traumatic experience of a patients intensive care unit hospitalisation, family members may show positive changes associated with growth in addition to negative impact. This study aimed to identify the level of posttraumatic growth of the family members of neurosurgical intensive care unit patients and to explore its relation to positive personality characteristics, such as gratitude, resilience and hope.

DESIGN AND SETTING

A cross-sectional study involving 340 family members of patients admitted to the neurosurgical intensive care unit at a general tertiary hospital in Shanghai, China.

METHODS

Before the patients' hospital discharge, the participants completed questionnaires, assessing posttraumatic growth (PTG Inventory), social support (Social Support Rating Scale), resilience (Chinese version of the Connor-Davidson Resilience Scale), hope (Herth Hope Index) and gratitude (Gratitude Questionnaire Six-Item Form).

RESULTS

The mean total posttraumatic growth score was 73.38 (14.02). Hope, gratitude, resilience and social support showed a positive correlation with the posttraumatic growth Inventory scores. There were significant differences in the posttraumatic growth scores of the family members of neurosurgical intensive care patients with respect to their different religious beliefs, payment methods, family relationship quality and presence of chronic diseases among family members. Multiple linear regression analysis showed that gratitude, resilience and social support were independent predictors of the posttraumatic growth Inventory score.

CONCLUSION

Family members may experience some degree of posttraumatic growth during hospitalisation of patients in the neurosurgical intensive care units. Gratitude, social support and resilience are predictive factors for posttraumatic growth.

The Impact of General Self-Efficacy on Psychological Resilience During the COVID-19 Pandemic: The Mediating Role of Posttraumatic Growth and the Moderating Role of Deliberate Rumination

Purpose: This study used a moderated mediation model to explore the relationship between general self-efficacy (GSE) and psychological resilience (PR) and the associated mechanisms, the mediating role of posttraumatic growth (PTG), and the moderating role of deliberate rumination (DR) during the coronavirus disease 2019 (COVID-19) pandemic. Knowledge of the relationship between these four variables examined further understanding of the PR improvement mechanism of college students and even the general public. Methods: The college students who participated in this study came from an independent college in Guangdong Province, China. A total of 918 college students completed the survey, and the final data sample size was 881. SPSS 23.0 and PROCESS (version 3.3) were used to conduct Pearson's correlation analysis and hierarchical regression linear analysis on the data. Results: (1) The correlation analysis showed that GSE and PR were positively correlated and that PTG was positively correlated with GSE and PR. DR was positively correlated with GSE, PTG, and PR. (2) The results of mediation analysis showed that GSE had a direct predictive effect on DR, and PTG partially mediated the relationship between the two. (3) The results of moderating effect analysis showed that DR hindered the effect of GSE on PTG but enhanced the positive impact of PTG on PR. Conclusions: General self-efficacy can improve PR under the mediating influence of PTG. DR played a positive moderating role in the relationship between GSE and PTG, and played a negative moderating role in the relationship between PTG and PR. These results advance the understanding of the mechanism between GSE and PR.

The impact of strict and forced confinement due to the COVID-19 pandemic on positive functioning variables, emotional distress, and posttraumatic growth in a Spanish sample

Background: The adverse consequences of the COVID-19 pandemic on mental health have been widely studied in recent months. However, few studies have examined the protective psychological factors that may explain how individuals are coping with the COVID-19 pandemic and its forced confinements. Objective: This study analyzes the impact of confinement due to the COVID-19 pandemic on positive functioning variables (resilience, meaning of life, gratitude, compassion, life satisfaction), emotional distress (depression, anxiety, perceived stress, affect), and posttraumatic growth (PTG). The impact was measured during and after the first month of strict and obligatory confinement in Spain. Methods: The sample was composed of 438 Spanish residents (78.3% women) between the ages of 18 and 68 (M = 35.68; SD = 13.19) during the first stage (first two weeks) of confinement. The sample was reduced to 197 participants during the second stage (fifth week) of confinement. Several online self-reported questionnaires were administered to assess positive functioning variables, emotional distress, and PTG. Results: Women, youths, individuals without a partner, with lower monetary incomes, or diagnosed with a mental disorder or chronic illness experienced lower scores in positive functioning variables and greater emotional distress during the first stage of confinement. Linear mixed models showed that scores on positive functioning variables, emotional distress, and PTG worsened in the second stage of confinement. Nevertheless, a structural equations model showed that increases in positive functioning variables in the second stage were associated with increases in life satisfaction (R² = .450) and related to decreases in emotional distress (R² = .186), leading in turn to increases in PTG (R² = .061). Conclusions: Individuals could experience PTG during strict and mandatory confinement. The increase in PTG during this adverse event was indirectly associated with increases in positive functioning variables (i.e. gratitude, presence of meaning, resilience), through improvements in life satisfaction and emotional distress.

Depression and Creativity During COVID-19: Psychological Resilience as a Mediator and Deliberate Rumination as a Moderator

Purpose: The pandemic of coronavirus disease 2019 (COVID-19), which has had a significant impact on people’s lives, has apparently increased the incidence of depression. Although the topic of how depression affects creativity is contested, previous research has revealed a significant relationship between the two. The purpose of this study is to further investigate the relationship and the mechanisms that operate between depression and creativity.

Methods: A total of 881 students at an independent college in China completed a questionnaire consisting of the Self-Reported Depression Scale, Runco Ideational Behavior Scale, Psychological Resilience Scale, Deliberate Rumination Scale and demographic information. Among the respondents, 317 (36.0%) were male and 564 (64.0%) were female, all of whom were from the same grade. Correlation analyses were conducted, and then the researchers carried out mediation analysis and developed a moderated mediation model.

Results: The results indicated that (a) depression was positively related to creativity (r = 0.085, p < 0.05); (b) psychological resilience mediated the relationship between depression and creativity; specifically, psychological resilience was negatively related to depression (r = −0.462, p < 0.01), which in turn was positively related to creativity (r = 0.198, p < 0.01); and (c) deliberate rumination moderated the relationship between depression and psychological resilience, showing a significant negative correlation with depression (r = 0.138, p < 0.01), psychological resilience (r = 0.078, p < 0.05), and creativity (r = 0.288, p < 0.05); specifically, higher levels of deliberate rumination strengthened the negative correlation between psychological resilience and depression.

Conclusion: The results suggest that depression is a positive predictor of creativity and may promote creativity to some extent. Further, individuals with greater psychological resilience are more creative than those with less psychological resilience, as it is a question of whether they can and to what extent they can effectively use depression as an emotional resource. Last, an individual’s level of deliberate rumination moderates the mediating process, especially at the stage where depression is associated with psychological resilience. These findings advance understanding of the mechanisms that operate between depression and creativity.

How Incivility and Academic Stress Influence Psychological Health Among College Students: The Moderating Role of Gratitude

Many students suffer from academic stress and uncivil behaviors at colleges and there is a need to identify to what extent these negative phenomena might impact students' mental health. The main purpose of this study is to examine the relationships between incivility, academic stress, and psychological health, as well as investigate the moderating role of gratitude. The study design of this research is cross-sectional. The final sample consisted of 895 university students in China; The Statistical Package for the Social Sciences (SPSS) version 22 was utilized to conduct statistical analysis. Sample t-tests were used to examine whether there were gender differences in terms of four continuous variables: incivility, stress, gratitude, and psychological wellbeing. We also used multiple hierarchical linear regression analysis to test the relationships between the aforementioned four variables and the moderating effect of gratitude. The results of our study indicate that academic stress and incivility are positively associated with psychological distress, and gratitude moderates the relationship between incivility and psychological distress. However, no significant moderating effect of gratitude was found in the relationship between academic stress and psychological distress.