Post-traumatic growth in psychosis: a systematic review and narrative synthesis.

BACKGROUND AND OBJECTIVE: People with psychosis report experiences of highly traumatic events. Positive change or post-traumatic growth (PTG) can occur as a result of traumatic experiences. Yet there is limited attention on PTG in psychosis, possibly due to the negative impact of psychotic symptoms on functioning and quality of life. The aim of this review was to identify significant correlates and mediators of PTG in psychosis, and to develop a conceptual framework synthesising facilitators of PTG in psychosis. METHOD: Ten electronic databases were searched in seven languages, and five journals and grey literature were searched in English. Quantitative studies were eligible if examining correlates, mediators, or the temporal relationship between PTG and one or more variables. Qualitative studies were eligible if describing PTG arising from experiences of psychosis. Findings from quantitative papers were grouped by analysis method, with significant correlates, mediators, and temporal relationships descriptively reported upon. Narrative synthesis was conducted on findings in qualitative papers. RESULTS: Thirty-seven papers were included. Significant correlates and mediators of PTG were identified. Mediators of PTG in psychosis included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. No studies describing the temporal relationship between PTG and psychosis were identified. The narrative synthesis identified seven facilitators of PTG in psychosis: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, and Relationships, giving the acronym PROSPER. CONCLUSIONS: Individuals with psychosis can be supported to grow from traumatic experiences. Clinicians can support PTG through the provision of trauma-informed care that supports positively valued identity changes. For researchers, the findings provide an evidence-based theoretical framework for conceptualising PTG, which can be validated through longitudinal cohort studies and underpin the development of new clinical interventions.

Post-Traumatic Stress Disorder and Identity Transformation After Experiences of Psychological Abuse: A Mixed-Methods Approach.

Psychological abuse (PA) is being associated with the development of post-traumatic stress disorder (PTSD). However, few studies have focused exclusively in this type of abuse. This study aimed to examine the relationship between PA and PTSD symptoms according to gender and understand the impact of severe PA in identity transformation, in a Portuguese university sample. Using a mixed-methods approach, 158 students answered an e-survey containing closed and open-ended questions. Results indicated a positive correlation between PA and PTSD symptoms. Women were significantly different from men concerning PA, contrarily to PTSD symptoms that did not present significant gender differences. The qualitative analysis revealed two different forms of adjustment, in both genders: positive-indicating personal growth-and negative changes-impacting relationships and emotional states. The more negative changes were described, the more PTSD symptoms were presented, regardless gender. Raising awareness can help young recognize themselves as victims and prevent the development of detrimental mental health status.

Association between resiliency and posttraumatic growth in firefighters: the role of stress appraisal.

The purpose of this study was to establish the relation between resiliency and the level of positive changes, comprising posttraumatic growth in a group of firefighters experiencing job-related traumatic events and the mediating role of stress appraisal in this relation. The study was performed on a group of 100 firefighters from firefighting and rescue brigades, out of which 75 admitted to experiencing a traumatic event. Firefighters covered by the study were on average 31.51 years old (SD = 6.34). A Polish version of Posttraumatic Growth Inventory, the Resiliency Assessment Scale and Stress Appraisal Questionnaire were used in the study. The results have shown that 22.7% of firefighters displayed low, 58.6% average and 18.7% high intensity of positive changes resulting from a traumatic event. Resiliency poorly correlates with posttraumatic growth expressed in changes in self-perception, and strongly correlates with stress appraisal, negatively correlates with threat and harm/loss and positively correlates with challenge. Appraisal of stress as a threat and challenge appeared to be mediators of the relationship between resiliency and posttraumatic growth.

The promotive and protective effects of parents' perceived changes during the COVID-19 pandemic on emotional well-being among U.S. households with young children: an investigation of family resilience processes.

Introduction: The COVID-19 pandemic may constitute a traumatic event for families with young children due to its acute onset, the unpredictable and ubiquitous nature, and the highly distressing disruptions it caused in family lives. Despite the prevalent challenges such as material hardships, child care disruptions, and social isolation, some families evinced remarkable resilience in the face of this potentially traumatic event. This study examined domains of changes perceived by parents of young children that were consistent with the post-traumatic growth (PTG) model as factors that facilitate family resilience processes. Methods: This study drew data from the RAPID project, a large ongoing national study that used frequent online surveys to examine the pandemic impact on U.S. households with young children. A subsample of 669 families was leveraged for the current investigation, including 8.07% Black, 9.57% Latino(a), 74.44% non-Latino(a) White families, and 7.92% households of other racial/ethnic backgrounds. In this subsample, 26.36% were below 200% federal poverty level. Results: Approximately half of the parents reported moderate-to-large degrees of changes during the pandemic, and the most prevalent domain of change was appreciation of life, followed by personal strengths, new possibilities, improved relationships, and spiritual growth. Black and Latino(a) parents reported more changes in all five domains than White parents and more spiritual growth than parents of the other racial/ethnic groups. Moreover, parent-reported improved relationships were found to indirectly reduce young children's overall fussiness/defiance and fear/anxiety symptoms through reducing parents' emotional distress. Perceived changes in the new possibilities, personal strengths, and appreciation of life domains were found to serve as protective factors that buffered the indirect impacts of material hardship mean levels on child behavioral symptoms via mitigating parents' emotional distress. Discussion: These findings shed light on resilience processes of a family system in a large-scale, disruptive, and stressful socio-historical event such as the COVID-19 pandemic. The five PTG domains could inform therapeutic and intervention practices in the face of future similar events. Importantly, these findings and the evinced family resilience should not negate the urgent needs of policy and program efforts to address material hardships, financial instabilities, and race/ethnicity-based structural inequalities for families of young children.

Perceived Changes in Family Life During COVID-19: The Role of Family Size.

OBJECTIVE: The current study was aimed at exploring Italian parents' perceived negative and positive changes in family life during the COVID-19 pandemic, taking into account the role of the stage of the family life and family size. BACKGROUND: During the emergency of the COVID-19 pandemic, millions of families drastically changed their daily life and routines. Little evidence exists on how family characteristics, such as family size or presence of children, are related to families' experience of family change. METHOD: A large sample of 1,407 Italian parents (70.1% mothers) filled in an anonymous online survey during the third week of the lockdown period (between March 30 and April 7, 2020). RESULTS: Results showed that parents reported perceiving more positive changes than negative ones, especially in terms of feeling more emotionally close to their children and spending more fun time with them. Interestingly, parents with two or more children reported more positive changes in family life compared with parents who had one child, showing a greater relational regenerative capacity in the face of COVID-19 lockdown. CONCLUSION AND IMPLICATIONS: Investing in family relationships, especially for larger families, is an effective coping strategy to deal with traumatic situations and promote positive family changes in stressful situations.

Positive changes among patients with advanced colorectal cancer and their family caregivers: a qualitative analysis.

OBJECTIVE: This study assessed positive changes in patients with advanced colorectal cancer and their family caregivers following diagnosis. We compared self-reported positive changes within patient-caregiver dyads as well as self-reports and patient reports of positive changes in caregivers. DESIGN: Individual, semi-structured qualitative interviews were conducted with 23 patients with advanced colorectal cancer and 23 caregivers. A theoretical thematic analysis of interview transcripts was framed by posttraumatic growth theory. RESULTS: Patients and caregivers described five positive changes: closer relationships with others, greater appreciation of life, clarifying life priorities, increased faith, and more empathy for others. Additionally, only caregivers reported better health habits following the cancer diagnosis, and a minority of patients and caregivers reported no positive changes. In about half of cases, patients reported at least one positive change that was identical to that of their caregiver. However, in most cases, patient and caregiver reports of the caregiver's positive change were discrepant. CONCLUSION: Findings suggest that positive changes are a shared experience for many patient-caregiver dyads and obtaining both patient and caregiver reports of caregiver positive changes provides a more comprehensive understanding of their experience. Interventions may capitalise on positive changes to promote meaningful living in the context of advanced cancer.

Mixed Psychological Changes Following Mastectomy: Unique Predictors and Heterogeneity of Post-traumatic Growth and Post-traumatic Depreciation.

Objectives: Post-traumatic growth (PTG) and its opposite-post-traumatic depreciation (PTD)-may be treated as important indicators of the patient quality of life. In the absence of studies on both, PTG and PTD in cancer patients, we investigated (1) coping strategies and support effectiveness as predictors of PTG and PTD in post-mastectomy women, (2) homogeneous classes with different intensity of PTG and PTD symptoms, and (3) correlates of class membership. Methods: Coping strategies (Brief COPE), support effectiveness (SSE-Q), PTG (PTGI), and PTD (negatively reworded items of PTGI) were measured in 84 post-mastectomy women (mean age = 62.27, SD = 8.38). Multiple regression, two-step cluster, and multinomial logistic regression were applied. Results: PTG and PTD had unique predictors: time since diagnosis and positive emotion-focused coping predicted PTG (R2 = 0.24), while negative emotion-focused and avoidance-focused coping and low support effectiveness were linked to PTD (R2 = 0.14). Four groups of PTG × PTD symptoms were identified: high PTG low PTD group (52.4%), low PTG low PTD group (17.9%), high PTG high PTD group (15.5%), and low PTG high PTD group (14.3%). Higher emotion- and avoidance-focused coping was characteristic for the high PTD low PTG group (R2 = 0.41). Conclusion: Our findings shed light on the coexistence and unique predictors of PTG and PTD after mastectomy, indicating heterogeneity in PTG and PTD levels among post-mastectomy women.

Positive changes after breast cancer: A qualitative study.

INTRODUCTION: Traumatic events such as breast cancer along with negative effects on patients also have positive effects. These cases have been studied less in Iran. Therefore, this study was conducted with the aim of explanation of positive changes after breast cancer by using a qualitative approach. MATERIALS AND METHODS: This qualitative study was conducted in 2012 in one of the specialized centers for cancer affiliated to Isfahan University of Medical Sciences. In this study, it was interviewed with 19 women with breast cancer about positive changes after cancer by using individual, open and deep methods. The interviews were analyzed with conventional content analysis method. RESULTS: The titles of the three major categories were included as behavioral changes to maintain and promote health (acquisition of health information and adopting promoting health behaviors), spiritual development (attention to the God and sense of meaning in life, revising the values and priorities, strengthening moral and behavioral traits) and personal growth and flourish (feeling empowerment, confidence and efforts to achieve the goals and desires). These three categories have led to emerge themes in this study as the "Awakening after cancer." CONCLUSIONS: The results of this study indicated positive changes after breast cancer. Considering such changes while providing care and consulting to patients with breast cancer in addition to facilitate and accelerate positive changes will be prompted to provide care and proper and influential consulting to promote patient health.

Diagnostic performance of rising, falling, or rising and falling kinetic changes of high-sensitivity cardiac troponin T in an unselected emergency department population.

BACKGROUND: Current ESC guidelines for the diagnosis of myocardial infarction consider a rise and/or fall of cardiac biomarkers. However, whether rising or falling patterns of high-sensitivity cardiac troponin T (hs-cTnT) improve the discrimination of ST-elevation myocardial infarction (non-STEMI) from non-acute coronary syndromes (ACS) has not been evaluated yet. METHODS: We compared protocols of rising and falling absolute and relative hs-cTnT changes in an unselected emergency department population. RESULTS: A total of 635 patients with unstable angina pectoris (UAP), non-STEMI, or acute symptoms and increased hs-cTnT (>99th percentile) were enrolled. Of these, 572 patients met the inclusion criteria of consistently rising patterns (n=254, 44.4%), consistently falling patterns (n=224, 39.2%), or falling patterns after an initial rise (n=94, 16.4%). Final diagnoses included 66 (11.5%) patients with UAP, 141 (24.7%) patients with non-STEMI, and 365 (63.8%) patients with hs-cTnT elevations not due to ACS. Rising values were found more frequently in patients with non-STEMI, as compared to non-ACS (OR 3.69, 95% CI 2.46-5.53; p<0.0001), and falling patterns were observed more frequently in patients with non-ACS conditions (OR 3.56, 95% CI 2.24-5.63; p<0.001). Addition of rising but not falling changes increased diagnostic performance of hs-cTnT concentrations at presentation: positive: AUC 0.680 (95% CI 0.618-0.742) vs. 0.861 (95% CI 0.822-0.900; p<0.0001), negative: AUC 0.678 (95% CI 0.545-0.812) vs. 0.741 (95% CI 0.635-0.847). A 20% criterion as proposed by ESC guidelines performed equally for positive and negative changes only when admission hs-cTnT values were considered: AUC 0.785 (95% CI 0.726-0.845) vs. AUC 0.763 (95% CI 0.681-0.845); p=ns. CONCLUSIONS: Detection of rising but not falling hs-cTnT values improves discrimination of non-STEMI from non-ACS in an unselected emergency department population.