Satisfaction with Life, Big-Five Personality Traits and Posttraumatic Growth Among People Living with HIV

Abstract

The current study explored the level of posttraumatic growth (PTG), treated as the explained variable, and its relationship with the level of satisfaction with life (SWL) and the Big Five personality traits, while controlling for several socio-medical variables, among people living with HIV. Participants were 470 individuals with a confirmed diagnosis of HIV infection. Participants filled out the following questionnaires: the Posttraumatic Growth Inventory, the Satisfaction with Life Scale and the NEO Five-Factor Inventory. Additionally, sociodemographic as well as medical data were obtained. Extraversion and SWL were the most important correlates of the level of PTG among participants. Personality traits (neuroticism) and socio-medical variables (antiretroviral treatment, education, relationship status) were moderators of the relationship between the level of SWL and PTG intensity in this patient group. Taking into account significant health-related benefits associated with PTG among people living with HIV, it is important to further explore psychosocial and clinical factors contributing to this positive phenomenon in this patient group.

Full text

RESEARCH PAPER
Satisfaction with Life, Big-Five Personality Traits
and Posttraumatic Growth Among People Living
with HIV
Marcin Rzeszutek
1
•Włodzimierz Oniszczenko
1
•Ewa Gruszczyn
´ska
2
Published online: 2 November 2017
The Author(s) 2017. This article is an open access publication
Abstract The current study explored the level of posttraumatic growth (PTG), treated as
the explained variable, and its relationship with the level of satisfaction with life (SWL)
and the Big Five personality traits, while controlling for several socio-medical variables,
among people living with HIV. Participants were 470 individuals with a confirmed diag-
nosis of HIV infection. Participants filled out the following questionnaires: the Posttrau-
matic Growth Inventory, the Satisfaction with Life Scale and the NEO Five-Factor
Inventory. Additionally, sociodemographic as well as medical data were obtained.
Extraversion and SWL were the most important correlates of the level of PTG among
participants. Personality traits (neuroticism) and socio-medical variables (antiretroviral
treatment, education, relationship status) were moderators of the relationship between the
level of SWL and PTG intensity in this patient group. Taking into account significant
health-related benefits associated with PTG among people living with HIV, it is important
to further explore psychosocial and clinical factors contributing to this positive phe-
nomenon in this patient group.
Keywords HIV Posttraumatic growth Satisfaction with life Big Five
personality traits
&Marcin Rzeszutek
marcin.rzeszutek@psych.uw.edu.pl
Włodzimierz Oniszczenko
wlodek@psych.uw.edu.pl
Ewa Gruszczyn
´ska
egruszczynska@swps.edu.pl
1
Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
2
Faculty of Psychology, University of Social Sciences and Humanities, Chodakowska 19/31,
03-815 Warsaw, Poland
123
J Happiness Stud (2019) 20:35–50
https://doi.org/10.1007/s10902-017-9925-3
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1 Introduction
There is a massive body of literature showing that experiencing traumatic events may
significantly deteriorate various aspects of functioning of trauma survivors, resulting in
many psychological disorders, out of which posttraumatic stress disorder (PTSD) is the
most prevalent (e.g. Brewin et al. 2009; Foa et al. 2007; McFarlane 2000; Ozer et al. 2003;
van der Kolk and McFarlane 1996). The negative consequences of traumatic events are not
only intuitively obvious, but also extremely well documented. However, relatively recently
some paradoxical, positive outcomes of trauma experiences have been observed, which
comprise the phenomenon of posttraumatic growth (PTG), first introduced to the literature
by Tedeschi and Calhoun (1996). The term ‘‘posttraumatic growth’’ relates to the set of
positive changes in relations with others, self-perception and existential beliefs, in the form
of greater appreciation of life and openness to spirituality, which can result from attempts
at dealing with an experienced traumatic or highly stressful life event (Tedeschi and
Calhoun 2004). According to Tedeschi and Calhoun (2004), PTG stems from attempts to
adapt to a serious adverse life event. However, it does not mean that only people who
experience a traumatic event in accordance with psychiatric criteria (e.g. American Psy-
chiatric Associations 1994,2013) may experience such a growth after trauma. PTG appears
also in the aftermath of situations that are not necessarily life-threatening, but are serious
enough to require adaptation to a new and unexpected reality (e.g. the diagnosis of a
serious illness). In addition, PTG may lead to the transformation of life, characterizing
improved psychosocial well-being, which requires modification of the individual’s current
beliefs and worldview (Tedeschi and Calhoun 2004).
Numerous studies have been conducted on the relationship between PTG and well-
being, but, contrary to common sense suggesting that finding benefits from the adverse life
events should entail good consequences, research in this area is very ambiguous. On the
one hand, indeed, some authors have observed a positive association between PTG and
well-being operationalised by health-related quality of life among cancer patients, resulting
in a stronger immune system and better mental functioning (Bower et al. 2005; Lechner
and Antoni 2004). A positive association between the abovementioned constructs was
noted especially among women with breast cancer, who, thanks to finding benefits in the
aftermath of cancer, experienced less psychological distress, fewer depressive symptoms
and better overall quality of life even 8 years following a breast cancer diagnosis (Carver
and Antoni 2004). Moreover, Mols et al. (2009) showed that the level of satisfaction with
life (SWL) predicted the intensity of PTG among women with breast cancer, a finding that
was also observed among patients with myocardial infarction (Oginska-Bulik 2014; Petrie
and Corter 2009). Nevertheless, other studies on women with breast cancer did not provide
evidence for the relationship between PTG and well-being, operationalized as health-
related quality of life (Cordova et al. 2001; Sears et al. 2003). The lack of a linkage
between these two constructs was also confirmed in a meta-analytic review (Helgeson et al.
2006). Finally, several authors have observed a negative (Tomich and Helgeson 2002)or
curvilinear (Kleim and Ehlers 2009) association between PTG and well-being.
According to Nolen-Hoeksema and Davis (2004), these conflicting results may be
attributed to the multidimensional character of well-being, which usually consists of three
components: quality of life, the level of SWL and a combination of positive and negative
affect (e.g. Diener et al. 1985,2009; Fredickson 2013; The WHOQOL Group 1995). All
these components may be uniquely related to PTG, but many authors used them inter-
changeably, which confuses the relationship between PTG and well-being. In addition, in a
meta-analytic review, Park (2004) mentioned that the link between PTG and well-being
36 M. Rzeszutek et al.
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may depend on the time from the traumatic event, i.e. this association becomes stronger the
more time has elapsed after such an event. Furthermore, the aforementioned author sug-
gested that to obtain a thorough picture of the relationship between PTG and well-being,
additional moderating variables, especially personality traits, should be reconsidered
(Jaks
ˇic
´et al. 2012; Knaevelsrud et al. 2010; Linley and Joseph 2004).
There has been a rich literature on the relationship between eudemonic well-being and
PTG, since the concept of eudaimoinic well-being may serve as a primary explanation for
the meaning-based changes observed in PTG (Joseph and Hefferon 2013). However, in the
light of new analysis, eudaimonic well-being and hedonic well-being are correlated but
also relatively independent constructs (Bojanowska and Zalewska 2016; Disabato et al.
2016; Joshanloo 2016). According to the theory (Tedeschi and Calhoun 1996), PTG should
incorporate these two aspects of well-being: trauma-triggered changes have a potential to
make life more meaningful but also more satisfactory. This notion has not been studied yet.
To fill this gap, in our study, we focused on the link between the cognitive aspect of
hedonic well-being, i.e. the level of satisfaction with life, the Big Five personality traits
and the intensity of PTG among people living with HIV (PLWH). The level of satisfaction
with life refers to a cognitive judgment of one’s life, which reflects the degree to which an
individual judges the overall quality of his or her life as a whole in a favourable way
(Diener et al. 1985).
Numerous authors have indicated that being diagnosed with an HIV infection may be
considered a traumatic event, which induces symptoms of PTSD (Beckerman and Auer-
bach 2010; Machtinger et al. 2012; Rzeszutek et al. 2012,2015). More specifically, the rate
of PTSD among this patient group ranges between 30 and 64% (Olley et al. 2005; Sherr
et al. 2011). HIV-related PTSD symptoms stem mostly from an awareness of a risk of
premature death, but they also result from the unpredictable course of HIV progression,
side effects of treatment and social stigmatization (Breet et al. 2014; Sanjua
´n et al. 2013).
Nevertheless, positive changes were also observed among PLWH, comprising the phe-
nomenon of PTG, and these changes may entail important clinical as well as psychological
advantages (Milam 2004,2006; Murphy and Hevey 2013; Rzeszutek et al. 2017). Par-
ticularly, PTG among PLWH individuals predicted improvement in clinical variables (CD4
count and viral load; Milam 2006) and was associated with lower perceived social
stigmatization (Murphy and Hevey 2013). However, to date no research on the link
between SWL and PTG among PLWH has been conducted.
Similarly, there are no studies on the role of the Big Five personality traits and PTG
among PLWH. Nevertheless, some authors found that PLWH’s well-being may be influ-
enced greatly by the Big Five traits. For example, high neuroticism and low extraversion
predicted faster HIV progression, poor adherence to treatment as well as low mental
functioning (Burgess et al. 2000; Erlen et al. 2009). In addition, high extraversion was
positively related to health-related quality of life (Penedo et al. 2003), high conscien-
tiousness seemed to protect against a drop in the CD4 count (O’ Cleirigh et al. 2007) and
high openness to experience was associated with less intense stigmatization (McCrae et al.
2007). Several authors have observed that other personality dimensions that are highly
correlated with the Big Five personality traits may increase risky behaviour leading to HIV
infection (Moore et al. 2005) and are associated with HIV-related trauma symptoms
(Rzeszutek et al. 2012; Rzeszutek and Oniszczenko 2013).
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123
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2 Current Study
The current study explored the level of PTG, treated as the explained variable, and its
relationship with the level of SWL and the Big Five personality traits, while controlling for
several socio-medical variables among people living with HIV. To our knowledge, no
studies have been conducted that we could use as a direct source of relevant hypotheses in
reference to SWL, the Big Five personality traits and their relation to PTG in this patient
group. Thus, an exploratory approach has been employed in this study. However, basing on
studies similar to the aforementioned, but conducted among other patients, we expected a
positive association between the level of SWL and the intensity of PTG among our par-
ticipants. Second, we assumed that a lower level of neuroticism and higher levels of
conscientiousness, openness to experience and extraversion would be associated with a
higher level of PTG. Finally, we expected the Big Five personality traits and socio-medical
variables to be potential moderators of the relationship between the level of SWL and PTG
intensity in this patient group.
3 Method
3.1 Participants and Procedure
The sample consisted of 470 adults with a medical diagnosis of HIV infection. In par-
ticular, of the 650 patients eligible for the study, 470 (72%) agreed to fill out questionnaires
and indicated in the Posttraumatic Growth Inventory (PTGI, see Measures) that the
diagnosis of HIV infection was a traumatic event for them, 96 (15%) declined and 84
(13%) returned incomplete questionnaires (i.e. some missing data and no mention of HIV
infection in the PTGI as a traumatic event), which precluded their inclusion into the
statistical analysis.
The study participants completed the paper-and-pencil version of the inventories and
participated in the study voluntarily; and there was no remuneration for participation. The
questionnaires were distributed by the authors of this study and professional interviewers to
the patients of the outpatient clinic of the state hospital of infectious diseases. Medical
doctors as well as hospital psychologists assisted in the recruitment process.
The eligibility criteria were 18 years of age or older, a confirmed medical diagnosis of
HIV?and receiving care from the hospital where the study was conducted. The exclusion
criteria were HIV-related cognitive disorders, which were screened by medical doctors.
The study protocol was approved by the local ethics commission. Table 1summarizes the
socio-medical variables.
As shown, the sample consisted of people aged from 18 to 76 years, mostly men. A
majority of participants were in stable relationships, had higher university degrees and
stayed professionally active. Participants had been diagnosed with HIV for 1–32 years, and
the length of antiretroviral treatment (ART) ranged between 1 and 31 years. Their CD4
count ranged from 100 to 2000, and the mean CD4 count was comparable to healthy
population (EACS 2017). Finally, 16% of study subjects were in the AIDS phase.
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4 Measures
To measure the intensity of PTG, a Polish adaptation of the PTGI was used (Tedeschi and
Calhoun 1996). It is important to underline the fact that although the original PTGI
comprises five specific domains of PTG (‘‘relating to others’’, ‘‘new possibilities’’, ‘‘per-
sonal strength’’, ‘‘spiritual change’’ and appreciation of life’’), the Polish adaptation of the
PTGI assesses only four domains of PTG. Exploratory and confirmatory factor analyses
revealed a four-factor structure for the PTG, including changes in the perception of oneself
(‘‘perceiving new possibilities, feeling of personal strength’’), changes in one’s relation-
ships with others (‘‘feelings of greater connection with other people, increase in empathy,
altruism’’), greater appreciation for life (‘‘changes in life philosophy and current life goals,
greater appreciation for every day’’) and spiritual changes (‘‘better understanding of
spiritual issues, increase in religiousness’’). In the PTGI, participants rate 21 positive
statements that describe various changes resulting from traumatic or highly stressful
events, which are mentioned at the beginning of the inventory. Participants were instructed
to focus on their HIV infection as the example of a traumatic experience. A global PTG
score is obtained when one calculates all items of the inventory. The Cronbach coefficient
for the whole scale in the current study was .82 and for the four subscales varied between
.81 and .84.
Table 1 Socio-medical variables in the studied sample (N =470)
Variable N (%)
Gender
Male 388 (82.6%)
Female 82 (17.4%)
Age in years (M ±SD) 40.02 ±10.70
Relationship status
Stable relationship 269 (62.8%)
Single/widowed/divorced 201 (37.2%)
Education
Elementary 73 (15.5%)
Secondary 147 (31.3%)
University degree 250 (53.2%)
Employment
Full employment 334 (71.1%)
Unemployment 60 (12.8%)
Retirement 21 (4.5%)
Sickness allowance 55 (11.6%)
HIV/AIDS status
HIV?only 394 (83.8%)
HIV/AIDS 76 (16.2%)
HIV infection duration in years (M ±SD) 7.90 ±6.99
Antiretroviral treatment (ART) duration in years (M ±SD) 6.11 ±5.65
CD4 count 593.12 ±228.63
Mmean, SD standard deviation
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SWL was measured with a Polish adaptation of the Satisfaction with Life Scale (SWLS;
Diener et al. 1985). The SWLS consists of five items; respondents evaluate each item on a
seven-point scale ranging from 1 (strongly disagree)to7(strongly agree). Therefore, a
higher total score on this scale indicates a higher level of SWL. Cronbach’s alpha coef-
ficient for the SWLS in the studied sample was .83.
Personality traits were evaluated with a Polish adaptation of the NEO Five-Factor
Inventory (NEO-FFI) questionnaire by Costa and McCrae (1992). The NEO-FFI consists
of 60 items (12 per each personality trait), to which participants respond on a five-point
scale. Five indices were obtained: neuroticism, extraversion, openness to experience,
agreeableness and conscientiousness. A higher score on each indicates a higher level of
each trait. The Cronbach’s alpha for the current study ranged from .74 to .81.
5 Results
The statistical analysis of the data was conducted using IBM SPSS 24 statistical software
(SPSS Inc. 2016). First, a correlational matrix between all analyzed variables was calcu-
lated using the Pearson product-moment correlation procedures. Further analyses were
performed only for the global PTG score, as particular subscales in the PTGI questionnaire
were highly intercorrelated. The results are shown in Table 2.
To analyze the relationship between the intensity of PTG with the level of SWL and the
Big Five personality traits, while controlling for several socio-medical variables among
PLWH, a regression analysis was performed. PTG was treated as an explained variable.
Other variables were analyzed as correlates. The analysis was performed in a hierarchical
model. In the first step, sociodemographic variables (sex, age, stable relationship, higher
education and professional activity) were analyzed with the use of a stepwise method. In
the second step, the same method was used to analyze medical characteristics (CD4 level,
HIV duration, years of treatment, AIDS). In the third step, personality traits were analyzed,
and in the fourth step SWL was entered. In the final step, the stepwise method was applied
to test interactions between personality traits, socio-medical variables and the level of
SWL and PTG intensity in this patient group. The meaning of interactions was determined
with simple effects analysis (Darlington and Hayes 2017). The significance in each test was
calculated with the use of bootstrapping, as the distributions of analyzed variables sig-
nificantly differed from the normal distribution (see Table 2).
The regression coefficients of the final model are presented in Table 3. There were
positive associations between PTG and extraversion and SWL. Extraversion explained
4.7% of PTG variance, and SWL explained an additional 10.3%. Three interactions were
observed. Neuroticism was negatively associated with PTG, but only in the group of
patients with a longer period of treatment (5–31 years), b=-.22, p\.01; B =-.84;
95% CI B (-1.30; .35), SE B =.25. It explained 4.9% of the PTG variance. The asso-
ciation between neuroticism and PTG in the group of patients with a shorter period of
treatment (1–4 years) was not statistically significant, b=.04; p[.05; B =.11; 95% CI
B(-.25; .51), SE B =.19 (see Fig. 1).
SWL was weakly positively related to PTG in the whole sample, but the association was
stronger in the group of single participants, B =1.58 (1.04 72.15), SE B =.28,
b=.39, p\.01 than in the group of participants in stable relationships, B =.71
(.16 71.20), SE B =.25, b=.19, p\.01 (see Fig. 2). SWL explained 14.6% of the
40 M. Rzeszutek et al.
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Table 2 Descriptive statistics and Pearson’s Correlations of the study variables among participants (N =470)
Variable M SD Range Skewness Kurtosis Fe Age Rel. H.E. P.A. CD4 HIV Treat AIDS SWL N E O A C
Satisfaction
with
life
20.43 6.41 5–35 -.40 -.39 -.02 .02 .20 .19 .20 .20 -.04 -.03 .04 1
Neuroticism 24.05 7.60 1–47 -.46 .26 .05 -.13 -.06 -.08 -.08 -.06 -.03 .01 .02 -.33 1
Extraversion 22.83 4.78 9–38 .02 .63 -.04 -.04 .03 .04 .13 .07 -.04 -.05 .01 .29 -
.36
1
Openness 24.01 5.32 10–42 .73 .29 -.04 -.01 -.09 .13 .04 -.03 -.01 -.04 -.05 -.01 -
.30
.14 1
Agreeableness 26.29 5.96 11–42 .29 -.40 .04 .12 -.05 .05 .01 -.01 .04 .02 -.03 .05 -
.45
.09 .36 1
Conscien-
tiousness
27.00 5.02 7–39 -.29 .23 .01 .01 .06 .05 .01 .11 .05 .11 .09 .17 .29 .25 -
.15
-
.32
1
Posttraumatic
growth
57.32 24.51 0–105 -.34 -.69 .12 -.06 .05 .01 .07 -.01 .08 .01 .02 .29 -
.07
.22 .12 .07 .08
All the correlations of absolute values higher than .09 are significant at least at p\.05
Fe female, Rel. stable relationship, H.E. higher education, P.A. professional activity, HIV HIV duration, Treat years of treatment, SWL satisfaction with life, Nneuroticism,
Eextraversion, Oopenness to experience, Aagreeableness, Cconscientiousness, PTG posttraumatic growth
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Table 3 Summary of hierarchical regression analysis for post-traumatic growth as explained variable among participants (N =470)
Predictor Model 1 Model 2 Model 3 Model 4 Model 5
B 95% CI SE
B
bB 95% CI SE
B
bB 95% CI SE
B
bB 95% CI SE
B
bB 95% CI SE
B
b
Stable relationship 1.31 (-.95;
3.68)
1.18 .05 1.32 (-.93;
3.71)
1.18 .05 1.18 (-.97;
3.42)
1.14 .05 -.05 (-2.18;
2.24)
1.12 .00 .06 (-2.10;
2.19)
1.09 .00
Higher education .26 (-2.01;
2.31)
1.10 .01 .30 (2.07;
2.55)
1.12 .01 .17 (-2.20;
2.31)
1.12 .01 -.97 (-3.07;
1.12)
1.06 -
.04
-.84 (-2.99;
1.26)
1.06 -.03
Years of treatment .03 (-.33;
.44)
.20 .01 .08 (-.29;
.46)
.19 .02 .05 (-.30; .43) .18 .01 .04 (-.30; 43) .19 .01
Neuroticism .04 (-.30;
.35)
.16 .01 .24 (-.09; .56) .17 .07 .16 (-.17; .47) .16 .05
Extraversion 1.16 (.65;
1.64)
.25 .23** .89 (.38; 1.43) .26 .17** .79 (.31; 1.30) .26 .15**
Satisfaction with life 1.04 (.65; 1.45) .21 .27** 1.02 (.62; 1.43) .21 .27**
Neuroticism 9years of
treatment
-2.56 (-4.96;
-.24)
1.21 -.10*
Satisfaction with life 9
stable relationship
-2.16 (-4.60;
.20)
1.23 -.09
#
Satisfaction with life 9
higher education
-3.07 (-5.39;
-.71)
1.20 -.12*
R
2
.01 .01 .05 .11 .15
F for change in R
2
.69 .03 12.01*** 31.01*** 6.63***
*p\.05; ** p\.01; *** p\.001;
#
p\.1. Values in brackets show 95% confidence intervals for regression coefficients acquired in bootstrapping
42 M. Rzeszutek et al.
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PTG variance in the group of single participants, but only 3.3% in the group of participants
in stable relationships.
The association between SWL and PTG was also stronger in the group of participants
with less education, B =1.66 (1.18 72.16), SE B =.25, b=.45, p\.001 than in the
group of participants with higher education, B =.53 (-.06 71.10), SE B =.29,
b=.13, p\.1 (see Fig. 3). It explained 20.1% of the PTG variance in the group of
participants without higher education, but only 1.2% in the group of participants with
higher education.
Fig. 1 Relationship between neuroticism and post traumatic growth in the group of participants treated for
1–4 years and in the group treated for 5–31 years. Note 1–4 years: y= .114*x ?53.606; 5–31 years: y =
0.843*x ?78.892
Fig. 2 Relationship between satisfaction with life and posttraumatic growth in the group of participants in
stable relationship and in the group of single participants. Note Single: y = 1.580*x ?25,903; in
stable relationship: y = 0.714*x ?43.057
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123
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6 Discussion
The results of our study were partially consistent with the first hypothesis. More specifi-
cally, after controlling for sociodemographic, clinical and personality variables, SWL was
positively, but weakly related to PTG in the whole sample. To date, no studies have been
performed on the link between PTG and life satisfaction among PLWH. Nevertheless,
some authors have proven that SWL is associated with several aspects of psychosocial
functioning among PLWH, i.e. lower levels of HIV-related distress and more satisfying
interpersonal relationships (Eller and Mahat 2007), as well as a lower intensity of HIV-
related stigma (Greeff et al. 2010). This finding may also be discussed in relation to Diener
et al. (1985) and Diener (2009) theory, i.e. the ‘‘top-down’’ approach to well-being, in
which life satisfaction is a relatively stable feature, despite a changeable environment. In
other words, people who are highly satisfied with their lives will maintain relatively high
well-being despite adverse life events. Furthermore, those individuals may benefit from
such events to a greater extent than people who are generally dissatisfied with their lives. In
the light of these remarks, PLWH who are satisfied with their lives could experience
growth despite HIV-related trauma.
However, sociodemographic factors also play an important role in the link between life
satisfaction and PTG (Davis et al. 1998; Park 2004). More specifically, we found that the
association between SWL and PTG was stronger in the group of single participants than in
the group of participants in stable relationships. Several authors noted that for PLWH,
being in a stable relationship is an important source of life satisfaction, which is addi-
tionally positively related to affective well-being (Abramowitz et al. 2009; Mavandadi
et al. 2009). Therefore, perhaps the role of SWL for PTG may be not as important as for
single participants, but more research is needed to verify this assumption. In addition, we
also noticed that the association between SWL and PTG was stronger in the group of
participants with less education than in those with higher education. It is known that
PLWH with higher education usually have better social status, which is an important
source of life satisfaction and helps them to cope with HIV-related distress (O’Leary et al.
2014). This may explain the weaker link between SWL for PTG among more highly
Fig. 3 Relationship between satisfaction with life and posttraumatic growth in the group of participants
with higher education and in the group participants without higher education. Note Lower education: y =
1.665*x ?25.196; higher education: y = 0.526*x ?46.207
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educated participants, but we should treat this hypothesis with caution, as highly educated
PLWH may sometimes be especially vulnerable to HIV-related stigma and distress
(Halkitis et al. 2005).
Not only SWL, but also Big Five personality traits were related to PTG among our
participants. More specifically, extraversion was positively related to PTG, which was
partly in accordance with our second hypothesis. This result corresponds with other
studies, which proved that extraversion promotes PTG among various samples after
traumatic events (Jaks
ˇic
´et al. 2012; Sheikk 2004). In addition, extraversion is highly
correlated with optimism as personality traits, and this personality dimension happened to
be one of the most significant personality variables promoting PTG in several meta-
analytic reviews, independently of the type of trauma and the time elapsed from a trau-
matic event (e.g. Park 2004; Prati and Pietrantoni 2009). Although no studies on the Big
Five and PTG among PLWH have been conducted, several authors have proved the
importance of extraversion in maintaining good overall and HIV-specific quality of life,
slower disease progression, as well as satisfactory social relationships, despite HIV-related
stigma (Ironson and Hayward 2008; Kumar 2015; Penedo et al. 2003).
Apart from the direct link between Big Five personality and PTG, we also found a
significant interaction effect for neuroticism. Namely, neuroticism was negatively asso-
ciated with PTG, but only in the group of patients with a longer period of treatment.
Neuroticism was negatively related to PTG across many groups of trauma survivors
(Linley and Joseph 2004). In addition, neuroticism was also negatively associated with
various aspects of well-being among PLWH, i.e. health-related quality of life (Burgess
et al. 2000), medication adherence (Penedo et al. 2003) and mental health functioning
(Lockenhoff et al. 2009). Importantly, the impact of neuroticism on the abovementioned
well-being dimensions was independent of medical and sociodemographic variables. In our
sample, however, the negative association between neuroticism and PTG started 5 years
after the beginning of antiretroviral treatment. It seems that in the first few years of HIV
infection, PLWH are trying to adapt to this new and adverse life event and during that time,
social status, i.e. intimate relationships and employment, is becoming a primary concern
for them. Several authors observed the positive effect of social integration on psycho-
logical health and medication adherence among recently diagnosed PLWH (Campbell
et al. 2013; Garrido-Hernansaiz and Alonso-Tapia 2017). Social status is especially
important for PLWH due to a constant threat of stigmatisation and social rejection (Samson
et al. 2009). Perhaps after this adaptation period, when their social status has been clarified
and stabilized, the effect of neuroticism is more visible, but longitudinal studies are needed
to precisely depict the nature of this association.
In contrast to sociodemographic factors, we did not observe any direct relationship
between medical variables and PTG among our participants. In other words, positive
changes following HIV-related trauma did not depend on the HIV infection itself (e.g. CD4
count, AIDS phase), which, as assumed, was potentially their source. This result was
intriguing, as previous studies proved that PTG among PLWH is related mainly to clinical
variables (e.g. Milam 2004,2006; Sherr et al. 2011). Nevertheless, this finding can be
discussed in the light of great advances in antiretroviral therapy, which substantially
improved the health status of PLWH (Samji et al. 2013). Currently, the majority of HIV?
individuals are not as concerned with their HIV infection and have changed their attitude
towards this disease from a fatal to a chronic medical condition (Deeks et al. 2013). In the
light of our findings, as well as the aforementioned studies, one may assume that objective
health status is no longer as important for psychosocial functioning in this patient group.
However, this finding should also be treated with caution, as several authors highlighted
Satisfaction with Life, Big-Five Personality Traits and…45
123
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that PTGI does not assess changes in the perception of somatic symptoms; thus, it may not
fully capture illness-course aspects of trauma and related growth (Barskova and Oester-
reich 2009; Casellas-Grau et al. 2017; Hefferon et al. 2009; Siegel et al. 2005).
7 Limitations
This study had several limitations. First, the cross-sectional design precludes causal
interpretations of the associations between variables found among our participants. Second,
a significant underrepresentation of HIV?women can be observed in our study, but the
gender ratio was rather typical for research conducted in this patient group (Bor et al.
2015). In addition, participants were characterized by a different length of HIV infection,
which could influence the nature of the relationship between PTG and the studied vari-
ables. Moreover, the PTGI questionnaire used in this study measures PTG retrospectively,
and some authors underline that this method of assessment may reflect positive illusions
instead of real growth (Zoellner and Maercker 2004). Moreover, a lack of measurement of
eudemonic well-being makes it impossible to verify, even after adjusting for personality
dimensions, if the observed effects of SWL go above and beyond what can be concluded
directly from meaning changes. Finally, in future studies it would be advisable to control
for more demographic data (e.g. religious affiliation, sexual orientation) and clinical
variables (e.g. HIV transmission), which may be related to PTG among PLWH.
8 Conclusions
One may conclude that not HIV infection itself and its clinical outcomes, but psychosocial
variables are directly related to PTG among people living with HIV. However, this result
should be treated with caution since we observed relatively weak associations between
PTG, SWL and personality traits. Therefore, longitudinal studies are needed to obtain a
thorough picture of the determinants of PTG in this patient group. Nevertheless, clinicians
should focus more on pre-existing well-being and personality, especially neuroticism, of a
person being diagnosed with HIV infection, as these psychological characteristics may be
crucial for long-term trajectories of adaptation to this chronic medical condition.
Acknowledgements This work was supported by the University of Warsaw, Faculty of Psychology under
Grant BST 1777-01-2016.
Compliance with Ethical Standards
Conflict of interest The author declares that they have no conflict of interest.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 Inter-
national License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution,
and reproduction in any medium, provided you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons license, and indicate if changes were made.
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