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A Longitudinal Study of Secondary Posttraumatic Growth in Wives of Ex-POWs
Abstract and Figures
Objective:
The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wives of former prisoners of war (ex-POWs) and its association to husbands' captivity, husbands' posttraumatic stress disorder (PTSD), and husbands' PTSD trajectories; and (b) the bidirectional relationships over time between wives' posttraumatic stress symptoms (PTSS) and PTG.
Method:
The study compared 116 wives of Israeli ex-POWs from the 1973 Yom Kippur War with 56 wives of a matched control group of non-POW combat veterans. Wives were divided into groups according to husbands' captivity status, husbands' PTSD status, and husbands' PTSD trajectories; and ANOVAs and MANOVAs were conducted to assess group differences in PTSS and PTG, both cross-sectionally and longitudinally. Autoregressive cross-lag modeling was also used to assess bidirectional relationships between wives' PTSS and PTG over time.
Results:
Wives of ex-POWs with PTSD reported significantly higher PTG compared with wives of ex-POWs without PTSD and wives of controls. While PTG and PTSS remained stable over time, importantly, the Time 1 (T1) level of PTG predicted avoidance symptoms at Time 2 (T2); the higher the wives' PTG at T1, the higher their avoidance symptoms at T2, but not vice versa.
Conclusions:
These findings support the notion that "secondary PTG" exists. They also strengthen the theory that growth and distress can co-occur. Finally, the finding that PTG predicted subsequent avoidance symptoms suggests that PTG does not prevent the future development of distress.
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... Understanding reports of PTG in light of dissociation (Lahav, Bellin, et al., 2016), might clarify the mixed findings in the literature (Helgeson et al., 2006;Linley & Joseph, 2004;Liu et al., 2017;Shakespeare-Finch & Lurie-Beck, 2014), including relations between PTG and lower levels of negative outcomes in some cases (Frazier et al., 2001;Lee et al., 2019;Lev-Wiesel & Amir, 2003) and relations between PTG and elevated levels of negative outcomes (Greene et al., 2015;Hamam et al., 2020;Lahav, Bellin, et al., 2016;Lahav, Kanat-Maymon, et al., 2017;, in others. The former findings might reflect an authentic positive transformation, which could be adaptive, whereas the latter might reflect dissociation-based beliefs of PTG, which could exacerbate survivors' distress (Lahav, Bellin, et al., 2016). ...
Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators , and thus might be maladaptive. ARTICLE HISTORY
... Thus, parents' secondary PTSS may shake their world assumptions (Janoff-Bulman, 2010) and ignite emotional distress (e.g., feeling of guilt, shame, and fear), that, after deliberate elaboration, may result in experience of growth. Moreover, both the severity of veterans' PTSS (Lahav et al., 2017) and their chronic and delayed PTSD trajectories were associated with spouses' highest SPTG (Greene et al., 2015). A question remains regarding the unique contribution of veterans' PTSS, compared with parents' own secondary PTSS, to parents' SPTG. ...
Objective: Indirect exposure to traumatized combat veterans may facilitate positive transformations in the form of posttraumatic growth (PTG) among family members. We aimed to use a dyadic approach to explore the association between veterans’ and parents’ posttraumatic stress symptoms (PTSS) and their PTG and that of their parents’ secondary PTG (SPTG), as well as to examine the moderating role of distress tolerance (DT) in these associations. Method: A volunteer sample of 102 dyads of Israeli combat veterans and their parents responded to online validated self-report questionnaires. Results: Veterans’ PTG was positively correlated with parents’ SPTG. Moreover, parents’ secondary PTSS was associated with higher levels of their own SPTG and their veteran offspring’s PTG. Furthermore, veterans’ DT contributed to lower levels of their own PTSS and their PTG, but the moderation effects of DT were not found. Conclusions: Parents’ experience of secondary PTSS, which refers to their offspring’s military service, may be also associated with their offspring higher levels of PTG.
... With that major caveat in place, we can point out that there is some evidence that PTG is "transmissible" to close others, and even to larger groups and social systems [66,103]. For example, life partners, siblings and/or caregivers of cancer patients or cancer survivors have reported PTG in various studies [104][105][106][107]. Related to this research is so-called vicarious (or secondary) PTG wherein first responders, healthcare workers and/or those who spend extended time with trauma survivors, experience PTG [108][109][110][111]. Research drawn from military, first responder and healthcare professions (where the likelihood of direct and vicarious exposure to trauma is common) has resulted in organizational responses that might facilitate PTG [112]. ...
Planetary health is a broad multidisciplinary effort that attempts to address what has been described as “Anthropocene Syndrome”—the wicked, interrelated challenges of our time. These include, but are not limited to, grotesque biodiversity losses, climate change, environmental degradation, resource depletion, the global burden of non-communicable diseases (NCDs), health inequalities, social injustices, erosion of wisdom and civility, together with the many structural underpinnings of these grand challenges. The ultimate aim of planetary health is flourishing along every link in the person, place and planet continuum. The events of “2020” have illuminated the consequences of “mass trauma” and how sub-threshold anxiety and/or depressive symptoms erase the rigid lines between mental “health” and mental “disorders”, and unmasked the systemic forms of injustice, discrimination, and oppression that have too often escaped discourse. Here, we query the ways in which post-traumatic growth research might inform the larger planetary health community, especially in the context of a global pandemic, broadening socioeconomic inequalities, a worsening climate crisis, and the rise of political authoritarianism. The available research would suggest that “2020” fulfills the trauma criteria of having a “seismic impact on the assumptive world”, and as such, provides fertile ground for post-traumatic growth. Among the many potential positive changes that might occur in response to trauma, we focus on the value of new awareness, perspective and greater wisdom.
... To date, all studies have relied on a maximum of two waves of measurement. For example, Greene, T., Lahav, Kanat-Maymon, and Solomon (2015) found positive associations between two measurements of Israeli veterans' spouses' reports of secondary PTSS over a seven-year period. Despite this important finding, it cannot be viewed as a valid test of linear changes in secondary PTSD as a function of time. ...
Objective: War-related trauma may indirectly affect veterans’ spouses both in terms of secondary posttraumatic stress symptoms (PTSS) and negative perceived health. The present study aimed to examine trajectories of secondary PTSS over a twelve-year period and its association with various measures of subjectively perceived health, among spouses of war veterans.
Methods: Spouses of war veterans (n = 155) were assessed prospectively 30 (T1, 2003), 37 (T2, 2010), and 42 (T3, 2015) years after the 1973 Yom Kippur War. Participants completed self-report questionnaires of PTSS at the three waves of measurements, while perceived health measures were assessed only at T3.
Results: Most spouses were classified to the “resilient” trajectory with low and stable secondary PTSS over time, followed by recovered, chronic, and delayed onset PTSS trajectories. Importantly, spouses in the “chronic” and “delayed” secondary PTSS trajectories reported a higher severity of general negative subjective health perceptions and health-related social malfunctioning.
Conclusion: Veterans’ spouses who were grouped in the “chronic” and “delayed” PTSS trajectories should be considered as at-risk populations for both PTSS and negative perceived health perceptions, which might negatively affect their medical conditions and ability to cope with the aging process.
... 7 The relationship between posttraumatic stress symptoms (PTS) and PTG is unclear. 8 Levine et al. 9 found curvilinear associations between the two, with the highest levels of PTG among those with moderate levels of PTS, while others found that PTG is prevalent among those who screen positive for PTS and showed positive linear associations between PTS and PTG. 10,11 In a meta-analysis, Shakespeare-Finch and Lurie-Beck 12 found a significant linear relationship between PTG and PTS symptoms but also a significantly stronger curvilinear relationship. ...
Objectives
Social media provides an opportunity to engage in social contact and to give and receive help by means of online social networks. Social support following trauma exposure, even in a virtual community, may reduce feelings of helplessness and isolation, and, therefore, reduce posttraumatic stress symptoms (PTS), and increase posttraumatic growth (PTG). The current study aimed to assess whether giving and/or receiving offers of help by means of social media following large community fires predicted PTS and/or PTG.
Methods
A convenience sample of 212 adults living in communities that were affected by large-scale community fires in Israel (November 2016) completed questionnaires on giving and receiving offers of help by means of social media within 1 mo of the fire (W1), and the PTSD checklist for DSM-5 (PCL-5) and PTG questionnaire (PTGI-SF), 4 mo after the fire (W2).
Results
Regression analyses showed that, after controlling for age, gender, and distance from fire, offering help by means of social media predicted higher PTG ( β = 0.22; t = 3.18; P < 0.01), as did receiving offers of help by means of social media ( β = 0.18; t = 2.64; P < 0.01). There were no significant associations between giving and/or receiving offers of help and PTS.
Conclusions
Connecting people to social media networks may help in promoting posttraumatic growth, although might not impact on posttraumatic symptoms. This is one of the first studies to highlight empirically the advantages of social media in the aftermath of trauma exposure.
... A few studies relating to indirectly traumatized wives of veterans (Lahav et al., 2017) and former prisoners of wars' wives (Dekel, 2007), also found a positive correlation between primary survivors' PTSS and spouses' SPTG. Wives of veterans with chronic and delayed PTSD trajectories reported the highest SPTG, as compared with more resilient trajectories (Greene, Lahav, Kanat-Maymon, & Solomon, 2015). Some studies emphasized different manifestations of SPTG resulting from the struggle with veterans' PTSD symptoms and related behaviors, such as increased experiences of humble acceptance, gratitude, and love (McCormack et al., 2011). ...
Objective:
Positive psychological and behavioral transformations in the form of posttraumatic growth (PTG) after indirect exposure to a traumatized family member, have been reported mainly among combat veterans' spouses and offspring (secondary posttraumatic growth; SPTG). To date, no studies have examined SPTG among veterans' siblings, and the conditions in which secondary posttraumatic symptoms (secondary PTSS) may contribute to the development of SPTG remain unexplored. In the present study, we aimed to explore the association between secondary PTSS and SPTG among siblings of combat veterans and to examine the moderating role of distress tolerance in this association.
Method:
A volunteers' sample of 106 dyads of Israeli combat veterans and their close-in-age siblings responded to online validated self-report questionnaires in a cross-sectional study. Analysis included actor-partner interdependence modeling (APIM) and moderation analyses.
Results:
Veterans' PTG was positively correlated with siblings' SPTG. Moreover, two actor effects were revealed wherein veterans' PTSS contributed to their own PTG, and siblings' secondary PTSS positively predicted their own SPTG. Importantly, analysis of moderation revealed that under high levels of secondary PTSS, the more siblings reported distress tolerance, the higher their own levels of SPTG.
Conclusion:
Exposure to a traumatized veteran brother or sister might entail psychological distress but also positive changes among siblings. The ability to withstand the emotional valence of negative or stressful events might hold a promise for the facilitation of higher levels of SPTG in the face of secondary PTSS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Many studies have indicated a paradoxical "double-edge sword", in which higher levels of both peritraumatic and posttraumatic symptoms are associated with greater PTG (Boals & Schuettler, 2011;Goral et al., 2020;Greene et al., 2015). However, some studies have questioned whether PTG is genuine personal growth, or whether it is illusory (Frazier et al., 2009;Jayawickreme & Blackie, 2016;Maercker & Zoellner, 2004). ...
Objective: This study examined whether attributing a cause of a community fire to a human-made vs. natural disaster moderated the association between peritraumatic distress (PD) and posttraumatic stress (PTSD) symptoms, as well as between PD and posttraumatic growth (PTG).
Method: Participants lived in Israeli communities affected by wide-scale fires in November 2016. At Time 1 (within one month of the fires), 390 participants completed measures. At Time 2 (four months after the fires), 223 of the original participants completed follow-up-questionnaires. Participants reported their PD symptoms at Time 1, and their beliefs regarding the cause of the fire, PTSD symptoms, and PTG at Time 2.
Results: Higher levels of PD at Time 1 were associated with higher levels of both PTSD symptoms and PTG at Time 2. Participants who believed that the fires were more of a human-made than natural disaster had stronger associations between PD and PTSD symptoms, and stronger associations between PD and PTG.
Conclusions: Attributions regarding the cause of a disaster may be related to both PTSD symptoms as well as PTG. Balanced and responsible public announcements regarding the causes of traumatic events may reduce the deleterious effects in the aftermath of a traumatic event.
Post-traumatic stress disorder (PTSD) results from exposure to stressful or traumatic events. Secondary Traumatic Stress (STD) refers to those emotions and behaviors caused by observing or learning of a traumatic event experienced by another. Changes in memory and other cognitive functions, as well as differences in anatomical areas, were seen in PTSD. Few investigations studied impairment in both episodic memory and working memory in PTSD, and this was not studied in STDs. The aim of the study was to study, through a systematic review, the consequences on episodic and working memory in patients with PTSD and STDs. We carried out a systematic review, including studies on PTSD and STDs, following the guidelines of the PRISMA declaration. A bibliographic search of papers and publications in specialized databases was carried out. Studies in PTSD suggest that episodic memory is impaired and there is a bias for recall of negative material. In addition, they have difficulty suppressing memories of negative stimuli, and an imprecise and negative metamemory. STD studies show high prevalences in some populations. The results indicate the importance of studying memory in PTSD, since they would be factors that can contribute to the appearance, maintenance and treatment of the disorder. In addition, in relation to STD, the lack of findings, as opposed to its high prevalence, highlights the importance of having studies on this pathology.
Traumatic events may lead to post‐traumatic growth (PTG). Nevertheless, little is known about the mechanisms leading to PTG, especially among older adults. This study sought to examine the direct relationship between world assumptions and PTG and the indirect relationship between them via two possible mediation pathways: post‐traumatic stress symptoms (PTSS) and meaning in life. One hundred fifty‐nine Holocaust survivors participated in the study (mean age = 82.34, SD = 5.81). Participants completed questionnaires of world assumptions, meaning in life, PTSS and PTG. The findings showed that world assumptions were positive and were positively associated with meaning in life and PTG and negatively associated with PTSS. The results of the multiple mediation model suggest that meaning in life and PTSS partially mediated the relations between world assumptions and PTG. Positive world assumptions were associated with higher meaning in life, which was associated with higher PTG. In contrast, despite the direct association between PTSS and PTG, the mediating effect of PTSS was negative, thus the more positive the world assumptions, the higher the PTG mediated by lower PTSS. The results suggest that the relationship between world assumptions and PTG may be direct and indirect. These findings suggest possible mechanisms underlying PTG, especially in old age.
Background
Polygenic risk scores (PRS) derived from genome-wide association studies (GWAS) of posttraumatic stress disorder (PTSD) may inform risk for this disorder. To date, however, no known study has examined whether social environmental factors such as attachment style may moderate the relation between PRS and PTSD.
Methods
We evaluated main and interactive effects of PRS and attachment style on PTSD symptoms in a nationally representative sample of trauma-exposed, European-American U.S. military veterans (N=2,030). PRS were derived from a GWAS of PTSD re-experiencing symptoms (N=146,660) in the Million Veteran Program cohort. Using one-sample Mendelian randomization (MR) with data from the UK Biobank (N=115,099), we evaluated the effects of re-experiencing PRS and attachment style on PTSD symptoms.
Results
Higher re-experiencing PRS and secure attachment style were independently associated with PTSD symptoms. A significant PRS-by-attachment-style interaction was also observed (β=-0.11, p=0.006) with a positive association between re-experiencing PRS and PTSD symptoms observed only among veterans with an insecure attachment style. One-sample MR analyses suggested that the association between PTSD symptoms and attachment style is bidirectional. PRS enrichment analyses revealed a significant interaction between attachment style and a variant mapping to the IGSF11 gene (rs151177743; p=2.1×10-7), which is implicated in regulating excitatory synaptic transmission and plasticity.
Conclusions
Attachment style may moderate polygenic risk for PTSD symptoms, and a novel locus implicated in synaptic transmission and plasticity may serve as a possible biological mediator of this association. These findings may help inform interpersonally-oriented treatments for PTSD for individuals with high polygenic risk for this disorder.
Secondary traumatization describes the phenomenon whereby those in proximity to trauma survivors develop psychological symptoms similar to those experienced by the direct survivor. The current study examined secondary trauma (ST) and generalized distress symptoms (general psychiatric symptomatology, functional disability, and self-rated health) in wives of former prisoners of war (ex-POWs). The study compared wives of Israeli ex-POWs from the 1973 Yom Kippur War with wives of a matched control group of non-POW Yom Kippur War combat veterans (CVs). The wives also were divided into groups based on their husbands' current posttraumatic stress disorder (PTSD) status and PTSD trajectory (i.e., chronic, delayed), and their outcomes were compared with resilient CVs. We found that wives of ex-POWs with PTSD reported higher ST and generalized distress than wives of ex-POWs and non-POW CVs without PTSD. Wives of ex-POWs with chronic PTSD reported the highest levels of functional disability. We also found that the relationships between husbands' prior captivity, and wives' ST and general psychiatric symptomatology were fully mediated by the husbands' PTSD symptoms. These findings indicate that it is exposure to a partner with PTSD that leads to overall ST and other distress symptoms, and not simply to a trauma survivor. Furthermore, the more severe their husbands' PTSD, the more wives are at risk for ST and general psychiatric symptomatology. Wives of partners with PTSD should therefore be considered high-risk groups for ST and distress that may require targeted interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Objective: This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction. Method: Veterans (N=214) from the 1982 Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated 1, 2, 3, and 20 years after the war. Results: Combat stress reaction is an important vulnerability marker. Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder (PTSD) at all four measurements, their PTSD was more severe, and they were at increased risk for exacerbation/reactivation. A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction. In both groups, the course fluctuated; PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD. Conclusions: These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. The implications of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed.
Severe diseases such as cancer although generate high stress and emotional distress in survivors and their significant others, can also be a stimulus to promote posttraumatic growth. The mechanisms of this post-traumatic growth (vicarious vs secondary) in significant others have not been studied. This review examines the evidence and relationship between posttraumatic growth in cancer survivors and their significant others, mainly in their partners and parents, regarding these vicarious or secondary growth transmission mechanisms. We conclude that, in general, posttraumatic growth in significant others is a vicarious experience closely linked to the cancer survivor's growth. However, being a woman, mother or suffer an advanced cancer facilitate secondary posttraumatic growth processes insignificant others.
Resumen Las enfermedades graves como el cáncer, aunque generan elevado malestar emocional y estrés en los super-vivientes y en sus otros signiicativos, también pueden suponer un estímulo en la generación de crecimiento postraumático en ambos. Los mecanismos de cómo se produce este crecimiento postraumático (vicario vs. secundario) en los otros signiicativos no se han estudiado. En esta revisión se analizan la evidencia y relación del crecimiento post-traumático en supervivientes de cáncer y en sus otros signiicativos, princi-palmente sus parejas, madres y padres, en relación a estos mecanismos de transmisión vicario o secundario. Se concluye que, en general, el crecimiento post-traumático en los otros signiicativos es una experiencia vicaria íntimamente ligada al crecimiento del superviviente en cáncer, aunque ser mujer, madre o sufrir un cáncer avanzado facilitan procesos de crecimiento post-traumático secundario en los otros signiicativos, que se diferencian del superviviente. Palabras clave: crecimiento post-traumático vicario, crecimiento post-traumático secundario, otros signiicativos, parejas, padres. Abstract Severe diseases such as cancer although generate high stress and emotional distress in survivors and their signiicant others, can also be a stimulus to promote posttraumatic growth. The mechanisms of this post-traumatic growth (vicarious vs secondary) in signiicant others have not been studied. This review examines the evidence and relationship between posttraumatic growth in cancer survivors and their signiicant others, mainly in their partners and parents, regarding these vicarious or secondary growth transmission mechanisms. We conclude that, in general, posttraumatic growth in signiicant others is a vicarious experience closely linked to the cancer survivor's growth. However, being a woman, mother or suffer an advanced cancer facilitate secondary posttraumatic growth processes insigniicant others.