Thoughts and emotions evoked by thinking about own death: American versus Japanese undergraduates.

The prompts "What emotions does the thought of your own death arouse in you?" and "What will happen to you when your body dies?" have been used to induce anxiety in Terror Management Theory. The current study investigated how the responses to these prompts may reveal cross-national differences by using a text-mining approach. Undergraduates in the US (n = 298) and Japan (n = 212) participated in the study. Across both groups, anxiety was the most common emotion. Cross-national differences also emerged, such that students in the US were more likely to mention sadness, funeral, and religiosity for the first prompt, and acceptance, spiritual change, and religiosity for the second prompt. Students in Japan were more likely to mention regret for the first, and sadness, emptiness, and funeral for the second prompt. Results revealed differences and similarities in thoughts and emotions people associate with when thinking about own death.

Asymmetrical perceptions of tipping points in alcohol consumption: Lower perceived tolerance in oneself versus peer.

Objective: The current study investigated how tipping points, a phenomenon in which an individual's threshold for perceiving a change has been exceeded, may be asymmetrical between self-tipping points and those applied to others and how experiences with alcohol affect these judgments. Participants: Undergraduates (N = 300). Methods: Participants reported their drinking frequency, quantity, and parental alcohol use, and evaluated tipping points by assessing how many drinks over the course of how many days they would perceive as problematic alcohol use in an online survey. Results: Participants, on average, reported lower tipping points indicative of problematic drinking behaviors for themselves, as compared to their peers. Results also revealed that quantity of alcohol consumption as well as parental alcohol use and participant age contributed to determining problematic consumption tipping points. Conclusions: Considerations should be given to how these tipping point judgments may affect drinking behaviors. Additionally, there is evidence that current consumption may cloud these judgments.

Longitudinal associations between post-traumatic stress and post-traumatic growth among older adults 11 years after a disaster.

AIMS: Previous studies have reported inconsistent findings regarding the association between post-traumatic stress (PTS) and post-traumatic growth (PTG). Three major issues could account for this inconsistency: (1) the lack of information about mental health problems before the disaster, (2) the concept of PTG is still under scrutiny for potentially being an illusionary perception of personal growth and (3) the overlooking of PTS comorbidities as time-dependent confounding factors. To address these issues, we explored the associations of PTS and PTG with trauma-related diseases and examined the association between PTS and PTG using marginal structural models to address time-dependent confounding, considering pre-disaster covariates, among older survivors of the 2011 Japan Earthquake and Tsunami. METHODS: Seven months before the disaster, the baseline survey was implemented to ask older adults about their health in a city located 80 km west of the epicentre. After the disaster, we implemented follow-up surveys approximately every 3 years to collect information about PTS and comorbidities (depressive symptoms, smoking and drinking). We asked respondents about their PTG in the 2022 survey (n = 1,489 in the five-wave panel data). RESULTS: PTG was protectively associated with functional disability (coefficient -0.47, 95% confidence interval (CI) -0.82, -0.12, P < 0.01) and cognitive decline assessed by trained investigators (coefficient -0.07, 95% CI -0.11, -0.03, P < 0.01) and physicians (coefficient -0.06, 95% CI -0.11, -0.02, P < 0.01), while PTS was not significantly associated with them. Severely affected PTS (binary variable) was associated with higher PTG scores, even after adjusting for depressive symptoms, smoking and drinking as time-dependent confounders (coefficient 0.35, 95% CI 0.24, 0.46, P < 0.01). We also found that an ordinal variable of the PTS score had an inverse U-shaped association with PTG. CONCLUSION: PTG and PTS were differentially associated with functional and cognitive disabilities. Thus, PTG might not simply be a cognitive bias among survivors with severe PTS. The results also indicated that the number of symptoms in PTS had an inverse U-shaped association with PTG. Our findings provided robust support for the theory of PTG, suggesting that moderate levels of psychological struggles (i.e., PTS) are essential for achieving PTG, whereas intense PTS may hinder the attainment of PTG. From a clinical perspective, interventions that encourage social support could be beneficial in achieving PTG by facilitating deliberate rumination.

Roles of values in the risk factors of passive suicide ideation among young adults in the US and Japan.

The present study examined how the importance of values and perceived value congruence with families, friends, and country would be associated with the risk factors of passive suicide ideation. Specifically, the study investigated the associations that the values and perceived congruence had with thwarted belongingness and perceived burdensomeness during the COVID-19 pandemic after controlling for the impact of depression levels. The data from the US and Japan demonstrated that the values such as cherishing family and friends and value congruence played a protective factor for Japanese participants; however, the associations differed among those in the US. Values such as enduring challenges played a protective factor for perceived burdensomeness in Japan whereas values such as cherishing family and friends played a protective factor and improving society was a risk factor for thwarted belongingness for those in the US. These results can be used to further understand the roles of values in mental health.

Relationship between posttraumatic growth and help-seeking behavior in use of psychosocial support services among patients with cancer.

PURPOSE: Cancer survivors who used psychosocial support services often report posttraumatic growth (PTG). This refers to positive psychological changes that may occur as the five domains as a result of the challenges they face. Opposing relationship also might exist. This study aimed to examine the relationship between PTG and help-seeking behavior (HSB). METHODS: In total, 710 participants completed an online survey at Time1. Of those, 395 who reported not using any psychosocial support services at Time1 were asked to participate in the Time2 survey and completed a questionnaire. The participants provided demographic information, the experiences of using psychosocial support services, and the overall and five domains of PTG. RESULTS: Those who experienced HSB at Time1 reported a higher PTG, and two of the PTG domains, Appreciation of Life and New Possibilities, than those who did not used services. Mixed ANOVAs showed the main effects of the HSB on the overall PTG, Appreciation of Life, and New Possibilities. Hierarchical logistic regression analyses showed that Appreciation of Life at Time1 was significantly related to the engaging in HSB at Time2. CONCLUSION: Those who received psychosocial support services reported a higher PTG. Participants may have also engaged in HSB because they had experienced PTG. People who are likely to seek help and experience PTG may share common characteristics. IMPLICATIONS FOR CANCER SURVIVORS: Support for those who do not fit the existing PTG and the use of psychosocial support services should also be considered.

Reliability and Validity of the Japanese Version of the Short Form of the Expanded Version of the Posttraumatic Growth Inventory (PTGI-X-SF-J): A Cross-Sectional Study.

A Japanese version of the short form of the expanded Posttraumatic Growth Inventory (PTGI-X-SF-J) was developed in this study, as the extended version captures broader, more diverse personal growth perspectives, such as existential spiritual growth. We collected cross-sectional data from 408 (first sample) and 284 (second sample) Japanese university students using the expanded version of the Posttraumatic Growth Inventory (PTGI-X-J). Exploratory factor analysis (EFA) was performed with the first sample and confirmatory factor analysis (CFA) with the second; reliability and validity were examined. The short-form version resulting from the EFA and CFA comprised 10 items and five factors. Cronbach's alpha for the PTGI-X-SF-J total and subscale scores ranged from 0.671 to 0.875. The intraclass correlation coefficient for the total and subscale scores between the PTGI-X-J and PTGI-X-SF-J ranged from 0.699 to 0.821. Regarding external validity, no significant correlation was found between posttraumatic growth and posttraumatic stress disorder checklists. Due to its brevity, the PTGI-X-SF-J can help assess diverse spiritual and existential personal growth experiences among clients, patients, and trauma survivors while reducing physical and psychological burdens.

Role of Peer Support in Posttraumatic Growth Among Adolescent and Young Adult Cancer Patients and Survivors.

Purpose: Adolescents and young adults (AYA) who undergo cancer treatment sometimes report posttraumatic growth (PTG). Although the importance of peer support has been suggested, its association with PTG, especially its five distinct domains, needs to be investigated further in AYA cancer survivors. The present study examined the role of demographics and peer support in PTG among AYA cancer patients and survivors. Methods: The present, multicenter, cross-sectional, web-based study enrolled AYA cancer patients and survivors (median age: 28 years). Of 549 AYA patients recruited, 212 from 11 cancer centers and 12 cancer patient communities agreed to participate by completing a self-reported measure of PTG (Extended Version of the Posttraumatic Growth Inventory-Japanese) and providing information about their diagnosis, treatment, peer support (affiliation with an AYA patient community or friendship with other AYA patients), and social status. Multiple regression analysis was used to identify significant correlations overall and in the five PTG domains. Results: PTG was positively associated with male sex, having a confidant, and friendship with other AYA patients, and negatively associated with cranial radiation. Friendship with other AYA patients was positively associated with four of the five PTG subscales. For the five subscale scores, "cranial radiation" was negatively associated with "relating to others"; "belonging to a religion" was positively associated with "spiritual change"; and "having a confidant" was positively associated with "relating to others" and "new possibility." Conclusion: "Having a confidant" and "friendship with other AYA patients" were positively associated with PTG. Psychosocial interventions mobilizing peer support may contribute to promoting PTG in AYA patients. UMIN000035439.

Posttraumatic Growth and Second Victim Distress Resulting From Medical Mishaps Among Physicians and Nurses.

Medical mishaps are well-known sources of distress. However, some mishaps may give medical professionals an opportunity to experience personal growth. We examined the associations between medical mishaps, second victim distress, and posttraumatic growth. A total of 157 physicians and 139 nurses completed a survey that included questions about mishaps, Second Victim Experience and Support Tool and the Posttraumatic Growth Inventory. Overall, 82.8% of the physicians and 48.9% of the nurses experienced at least one mishap. Lack of training, rumination, and impact of mishaps were associated with distress among nurses, whereas rumination, impact, and stressfulness were associated with distress among physicians. On the other hand, the impact of mishaps is the only factor that was associated with posttraumatic growth among nurses, whereas none with physicians. This study suggests that the posttraumatic growth from medical mishaps is not associated with the theory-driven event-related factors, and highlights the importance of further investigation.

The impact of multiple stressful life events on posttraumatic growth in adolescence.

OBJECTIVE: Posttraumatic growth (PTG) has been primarily recognized as a result of experiencing a single life crisis. The current study investigated how PTG may be attributed to experiences of a multitude of highly stressful life events, and how PTG is correlated with PTSD symptoms, the severity of the event, and the total number of childhood traumas experienced. METHOD: Adolescents (N = 139) participated in a survey that assessed six major life events of childhood trauma and rated the severity of each event, posttraumatic stress symptoms (PTSS), and PTG. RESULTS: The majority of adolescents attributed their PTG experiences to one event, despite experiencing multiple traumas. However, experiencing more events was associated with greater PTSS and some forms of PTG such as changed priorities, increased self-reliance, and establishing a new path in life. Results from regression analyses also showed that trauma severity and PTSS were linearly correlated with PTG, and thus, a curvilinear relationship was not identified. CONCLUSIONS: Cumulative traumatic events may lead to increases in a sense of personal growth, while also increasing distress, in nonclinical adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Expanded version of the Posttraumatic Growth and Depreciation Inventory: Scale validation and refinement among Italian adults.

OBJECTIVE: The main aim of this study was to investigate the psychometric properties of the Italian version of the newly-developed Posttraumatic Growth and Depreciation Inventory (PTGDI-X) in a heterogeneous sample of Italian adults who had experienced a traumatic event. METHOD: The instrument was translated following the forward-backward method and completed by 601 participants who met the inclusion criteria. The factorial structure of the PTGDI-X was assessed by means of multiple confirmatory factor analyses (CFA). Convergent and discriminant validity and reliability were also evaluated. RESULTS: The results of the CFA revealed that the original 5-factor model was the best fit for the growth (PTG) dimension of the PTGDI-X, whereas it poorly fit the data with respect to the depreciation (PTD) component. With regard to convergent and divergent validity, positive correlations were found between the PTG scores and the core belief disruption and rumination scores, whereas the PTG factors correlated negatively with depressive and posttraumatic symptom measures. Conversely, positive correlations were identified between the PTD total score and all the other investigated constructs. Finally, the total scales and subscales of the PTG/PTD dimensions revealed good to excellent internal consistency. CONCLUSIONS: The current findings indicate that the Italian version of the PTGDI-X appears to be a valid assessment tool for the multidimensional structure of the PTG component. Future research is needed, on the other hand, to confirm the validity of the PTD dimension in the Italian population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Distinguishing between resilience and posttraumatic growth: perceptions of and attitudes toward depression.

The current study investigated differences between resilience and posttraumatic growth (PTG) by examining their distinctive roles in perceptions of and attitudes toward depression. A series of mixed ANOVAs analyzed the differences in individuals' perceptions of and attitudes towards depression. College students (N = 300) completed a survey including the Brief Resilience Scale and the short form of the PTG Inventory and then read and evaluated vignettes describing an individual with either modern-type or traditional-type depression. Those high in resilience found individuals with depression, especially modern-type, less familiar and were less likely to think therapy would effectively help them. Those high in PTG found depressed individuals more familiar and were more willing to provide support regardless of depression type. These results suggest differing attitudes toward mental disorders based on levels of PTG and resilience, displaying critical differences in their nature.

A short form of the posttraumatic growth and posttraumatic depreciation inventory - expanded (PTGDI-X-SF) among German adults.

BACKGROUND: After experiencing trauma, people often report both negative and positive changes, which can be operationally defined as posttraumatic growth (PTG) and posttraumatic depreciation (PTD). However, there is no brief measure for assessing both posttraumatic changes simultaneously. OBJECTIVE: This study describes the short form of the expanded version of the Posttraumatic Growth and Depreciation Inventory (PTGDI-X-SF) among German Adults. METHOD: Using a sample of 253 German adults, the dimensionality of the PTGDI-X-SF was examined by confirmatory factor analyses. Internal consistencies were determined. The relation of PTG and PTD was investigated. Regression analyses explored the relationships to established predictors as previously found for the full-scale version of the PTGDI-X. RESULTS: Findings indicate a 5-factor structure for the PTGDI-X-SF equivalent to the PTGDI-X as well as high reliability for PTG (α = .88) and PTD (α = .88). Participants reported more PTG (M = 2.53, SD = 1.20) than PTD (M = 1.41, SD = 1.16). PTG and PTD were weakly associated (r = -.148, p = .018). PTG was positively related to disruption of core beliefs (ß = .25, p < .001) and deliberate rumination directly after the trauma (ß = .38, p < .001). PTD was positively associated with recent rumination irrespective of whether it was intrusive (ß = .21, p < .05) or deliberate (ß = .33, p < .01). CONCLUSIONS: Overall, results support the applicability of the PTGDI-X-SF as a valid and efficient measure to assess PTG and PTD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Differences Between Posttraumatic Growth and Resiliency: Their Distinctive Relationships With Empathy and Emotion Recognition Ability.

Posttraumatic growth (PTG) and resiliency have been observed among people who experienced life crises. Given that the direct relationships between PTG and resiliency have been equivocal, it is important to know how they are different in conjunction with cognitive ability. The purpose of this study is to examine how perceived PTG and resiliency would be, respectively, associated with empathy and emotion recognition ability. A total of 420 college students participated in an online survey requiring them to identify emotions based on photographs of facial expressions, report their traumatic experiences, and respond to the PTG Inventory, Brief Resilience Scale, and Questionnaire of Emotional Empathy. The results suggest that perceived PTG was not associated with empathy but significantly predicted increased emotion recognition, whereas resiliency showed a negative relationship with empathy but no significant relationship with emotion recognition. These findings demonstrate that self-perceived PTG may be associated with cognitive ability, which could be due to one's growth within relationships and social interactions. Even though growing after trauma may promote resilient characteristics, the current results indicate that PTG and resiliency may foster different outcomes. Since empathy and emotion recognition are affected by other contextual factors, future studies should assess how empathy and the type of errors in emotion recognition may be associated with situational factors that are beyond personal factors such as post-traumatic life experiences or personality.

Post-traumatic Growth and Resilience among American Medical Students during the COVID-19 Pandemic.

The ongoing COVID-19 pandemic has caused significant psychological impact on medical professionals, including medical students, many who have been caring for patients on the frontlines. Understanding how medical students perceive their stressful life experiences is important as the mental health of these future physicians directly impacts their ability to care for patients. We assessed for post-traumatic growth and resilience in the face of traumatic events among a cohort of medical students that attended a medical school located in an early epicenter of the COVID-19 pandemic. Between October 29, 2020 and December 1, 2020, medical students at the Icahn School of Medicine at Mount Sinai in New York City were surveyed on various stressful life events, including COVID-19. We identified specific resilience behaviors, including establishing a supportive social network, relying on a moral compass, and using cognitive flexibility, that medical students commonly used to cope with traumatic experiences. Compared with students who perceived COVID-19 as their most stressful life event, students who perceived other events, such as family issues or serious illness, as most stressful experienced less COVID-related stress (t = -2.2, p = .03), greater posttraumatic growth (t = 4.3, p < .001), and demonstrated more resilient behaviors including establishing and nurturing a supportive social network (t = 2.2, p = .03), developing brain fitness (t = 2.2, p = .03), and finding meaning and purpose in things (t = 2.9, p = .006). This suggests that stressful experiences prior to or in parallel with COVID-19 encouraged posttraumatic growth and development of resilience behaviors that were protective to COVID-19-related stress.

Influence of perceived trauma on the cognitive processing model of posttraumatic growth among university students.

This study examined whether perceiving an event as a trauma influenced a cognitive processing model explaining posttraumatic growth (PTG). A cross-sectional questionnaire survey was conducted with 311 university students from eight universities in Japan. The participants provided information about the most stressful event they had experienced and completed the expanded version of the PTG Inventory, Core Belief Inventory, Event Related Rumination Inventory, and Cognitive and Emotional Processing from Disclosure Inventory. A multi-group structural equation modeling was conducted by dividing the participants into two groups depending on whether they identified the most stressful event as a trauma. The model with no constraint showed a good fit. The model with partial constraint showed a better fit than the models with no constraint or full constraint. The difference of the model was seen as a covariance between the Event Related Rumination Inventory and the Cognitive and Emotional Processing from Disclosure Inventory. The results demonstrated configural invariance and partial metric invariance. This indicated that PTG would be recognized irrespective of whether the event was perceived as a trauma. This study also indicated that different factors out of the model could be associated with the ruminative process and disclosure process. The importance of focusing on the process of PTG, regardless of an individual's perception of the event, was emphasized, especially for factors related to rumination and disclosure.

The Chinese version of Posttraumatic Growth and Depreciation Inventory-Expanded version (PTGDI-X) for cancer survivors.

Many patients with cancer report positive changes often referred to as posttraumatic growth (PTG). Some of these self-reported PTG may represent maladaptive illusions created by individuals to cope with the illness. A recently established Posttraumatic Growth and Depreciation Inventory - Expanded version (PTGDI-X) includes both PTG and posttraumatic depreciation (PTD) items. This inventory may provide a more balanced picture of the phenomenological world of cancer survivors. We examined the Chinese version of the PTGDI-X's applicability to cancer patients, and how PTG and PTD were related to posttraumatic stress symptoms. Two hundred sixty-five cancer survivors in Taiwan completed the Chinese version of the PTGDI-X, along with the PTSD Checklist for the DSM-5 to measure posttraumatic stress disorder (PTSD) symptoms. Confirmatory factor analysis showed that the factor structure of the PTGDI-X established in a multi-national study fit our data from cancer patients modestly well. The PTD score had a significant and positive correlation with PTSD symptoms, whereas the PTG and PTSD showed a significant curvilinear relationship in the form of an inverted U-shape. This study's results indicate that PTG and PTD are separated constructs with differential relationships with cancer outcomes. The Chinese version of the PTGDI-X is a viable instrument for psycho-oncological research. The PTD scores can provide useful information to guide cognitive interventions to reduce distorted cognitions. In contrast, the PTG scores can provide further information on the phenomenological world of cancer survivors. In this study, clinical implications and future studies were considered.

Roles of Reexamination of Core Beliefs and Rumination in Posttraumatic Growth Among Parents of Children With Cancer: Comparisons With Parents of Children With Chronic Disease.

BACKGROUND: Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG). OBJECTIVE: To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness. METHODS: Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis. RESULTS: Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs. CONCLUSIONS: For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs. IMPLICATIONS FOR PRACTICE: Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.

Post-Traumatic Growth and Resilience Among Medical Students After the March 2011 Disaster in Fukushima, Japan.

In March of 2011, an earthquake, tsunami, and nuclear accident struck northern Japan causing profound damage to the surrounding area and lasting effects to all those who lived there. Fukushima Medical University (FMU), the closest hospital that remained open during the disaster, was greatly impacted and its students rallied to help the cause. Many of them were directly affected as their neighborhoods were ruined and family and friends were injured or killed. Our study sought to better understand how this disaster impacted their posttraumatic growth and resilience in the wake of the disaster and today, 8 years later. There were three goals of this study. First, we aimed to replicate previous research that showed positive effects of disaster volunteerism on medical students' posttraumatic growth. Second, we sought to better understand the role of resilience in the wellbeing of these students. Finally, we wanted to explore the advantages to our newly created 10-Factor Resilience Behavioral Scale, which we used alongside the Davidson Trauma Scale (DTS), Posttraumatic Growth Inventory (PTGI-X), and Connor-Davidson Resilience Scale (CD-RISC). Overall, 579 responses were collected (response rate of 71.9%). Volunteers continued to show greater PTG as well as greater overall resilience. Furthermore, there were positive correlations between students' feelings of confusion, anger, sadness, guilt or anxiety and their sense of resilience, both at the time of the disaster and in the most recent month, suggesting that within Japanese culture difficult emotions may promote resilient behaviors and actions.

Perceptions of traditional and modern types of depression: A cross-cultural vignette survey comparing Japanese and American undergraduate students.

AIM: Depression is a heterogeneous disorder that has various subtypes. In Japan, however, a prevailing misunderstanding is that the term utsu-byo (clinical depression) indicates only the melancholic type. Consequently, a subtype called 'modern-type depression' (MTD), which has contrasting features to those of melancholic or traditional-type depression (TTD), is severely stigmatized in Japan these days. The present study conducted a cross-cultural comparison of perceptions of TTD and MTD between Japan and the USA to examine how the Japanese collectivistic culture contributes to negative biases toward MTD. METHODS: Undergraduate students in Japan (N = 303) and the Midwestern USA (N = 272) completed the survey. They read two vignettes that described the conditions of fictional individuals with either TTD or MTD, and then reported their perceptions of each vignette. RESULTS: Mixed analyses of variance revealed significant interactions between nation (Japan or the USA) and vignette (TTD or MTD) on most perception items. These interactions and subsequent analyses with Bonferroni corrections mainly indicate the following: (i) Japanese are more likely to suppose that conditions of MTD are milder compared with TTD; and (ii) Japanese are more likely to hold stronger aversive attitudes and weaker willingness to provide support toward people with MTD than toward those with TTD. CONCLUSION: These results indicate that people with MTD are more likely to be accepted in the US independent culture than in the Japanese collectivistic culture. Discussion highlights that cultural diversity education potentially reduces stigma of MTD in Japan.

Posttraumatic growth in bereaved family members of patients with cancer: a qualitative analysis.

BACKGROUND: The death of a loved one has great impact on family members even when the death was expected. While negative changes are reported, some individuals also report personal growth, known as posttraumatic growth (PTG). Many studies on PTG have been performed using quantitative methods and suggest that PTG may differ according to the traumatic event and cultural background. PURPOSE: This study aimed to explore how Japanese bereaved family members of patients with cancer express their experience of PTG after the patient's death by analyzing open-ended answers provided in a cross-sectional survey. METHODS: Qualitative data were collected through a survey, and thematic analysis was used to analyze the data. The present study was part of a larger cross-sectional survey of bereaved families of patients with cancer. Data analyzed in the current study were obtained from 162 bereaved family members of patients with cancer. RESULTS: We identified 18 sub-themes within five predefined major domains of PTG. Moreover, we also identified two additional themes: changed view of life and death, and awareness of health management. CONCLUSIONS: The experience of PTG of bereaved family members varied considerably. Future research on PTG experiences among groups from diverse cultural backgrounds would be beneficial for understanding the concept and its clinical implications.