ArticlePDF AvailableLiterature Review

Abstract

Objectives. The aim of this systematic review was to analyse, synthesise and review existing results on posttraumatic growth (PTG) among PLWH. In particular, we investigated the relationship of PTG with sociodemographic, HIV-related clinical variables, positive and negative psychological correlates as well as HIV-related social issues among PLWH. Method. A literature search was performed on Web of Science, PsyARTICLES, MedLine, Proquest and Scopus databases using appropriate descriptors for positive changes among PLWH. Articles were analysed by title, abstract, and full text. Results. We accepted a set of 24 articles for systematic review and analysis. Consistent findings were obtained with respect to the positive association between psychological and social correlates (optimism, resilience, positive reappraisal coping, positive affect, self-efficacy and social support) and PTG among PLWH. PTG was also negatively related to various aspects of HIV-related distress (depression, substance use, PTSD symptoms, HIV stigma). On the contrary, sociodemographic and especially HIV-related clinical variables were mostly unrelated to PTG among PLWH. Conclusions. The self-reported PTG among PLWH may be related to psychological variables rather than to objective characteristics of HIV infection itself. Nevertheless, several aspects of research on PTG among PLWH require modification, both theoretically and methodologically.
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Rzeszutek, M., & Gruszczyńska, E. (2018). Posttraumatic growth among people living
with HIV: A systematic review. Journal of Psychosomatic Research. 114, 81-91.
DOI: 10.1016/j.jpsychores.2018.09.006.
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RUNNING HEAD: Posttraumatic growth & HIV/AIDS
Posttraumatic growth among people living with HIV:
A systematic review
Marcin Rzeszutekª*, Ewa Gruszczyńskab
ªFaculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
Tel: +48 22 55 49 805, Fax: +48 22 63 57 991, e-mail: marcin.rzeszutek@psych.uw.edu.pl
bFaculty of Psychology, University of Social Sciences and Humanities, Chodakowska 19/31,
03-815 Warsaw, Poland. Tel: +48 22 517-98-56, Fax: +48 22 517 96 25, e-mail:
egruszczynska@swps.edu.pl
*To whom correspondence should be addressed
Marcin Rzeszutek
ªFaculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland, Tel: +48
22 55 49 805, Fax: +48 22 63 57 991, e-mail: marcin.rzeszutek@psych.uw.edu.pl
Conflict of interest/Ethical statement
Disclosure of potential conflicts of interest: the author declares that he has no conflict of
interest.
Ethical approval: This article does not contain any studies with human participants or animals
performed by any of the authors.
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Abstract
Objectives. The aim of this systematic review was to analyse, synthesise and review existing
results on posttraumatic growth (PTG) among PLWH. In particular, we investigated the
relationship of PTG with sociodemographic, HIV-related clinical variables, positive and
negative psychological correlates as well as HIV-related social issues among PLWH.
Method. A literature search was performed on Web of Science, PsyARTICLES, MedLine,
Proquest and Scopus databases using appropriate descriptors for positive changes among
PLWH. Articles were analysed by title, abstract, and full text.
Results. We accepted a set of 24 articles for systematic review and analysis. Consistent
findings were obtained with respect to the positive association between psychological and
social correlates (optimism, resilience, positive reappraisal coping, positive affect, self-efficacy
and social support) and PTG among PLWH. PTG was also negatively related to various
aspects of HIV-related distress (depression, substance use, PTSD symptoms, HIV stigma). On
the contrary, sociodemographic and especially HIV-related clinical variables were mostly
unrelated to PTG among PLWH.
Conclusions. The self-reported PTG among PLWH may be related to psychological variables
rather than to objective characteristics of HIV infection itself. Nevertheless, several aspects of
research on PTG among PLWH require modification, both theoretically and methodologically.
Keywords: Posttraumatic growth; HIV/AIDS; systematic review.
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Posttraumatic growth among people living with HIV:
A systematic review
Two decades have passed since Tedeschi and Calhoun (1996) devised the concept of
posttraumatic growth (PTG), which initiated a significant shift in trauma studies from
concentrating merely on the negative consequences of traumatic events to considering also
positive changes that may occur among people struggling with such events (Linley & Joseph,
2004). These changes encompass more satisfying interpersonal relationships, finding new
possibilities in life, greater appreciation of life, openness to spiritual issues and enhanced
perception of personal strength (Tedeschi, & Calhoun, 1996). In the meantime, alternative
terms have emerged to describe positive changes after aversive life events, such as stress-
related growth (Park et al., 1996), thriving (Carver, 1998), benefit finding (BF; Tennen, &
Affleck, 2002) and adversarial growth (Linley, & Joseph, 2004). Similarly to aforementioned
concepts, PTG does not arise only as a consequence of experiencing traumatic stressors,
leading to trauma-related disorders (e.g. posttraumatic stress disorder, PTSD; American
Psychological Association, 2013), but also as a result of being confronted with highly stressful
life events. However, in contrast to above mentioned, alternative terms, in order to such
defined growth to occur, this event must be serious enough to evoke transformational changes,
which does not mean a return to balance or the level of functioning before the crisis (Tedeschi,
& Calhoun, 2004).
PTG has become one of the leading research areas of the positive psychology field
(Seligman, & Csikszentmihalyi, 2000) and resulted in a plethora of studies on positive changes
among various populations after experiencing trauma (see e.g. Helgeson et al., 2006; Prati, &
Pietrantoni, 2009). A controversial, and yet still understudied research areas, is the analysis of
PTG in the context of the trauma related to struggling with life-threatening illness (Barskova,
& Oesterreich, 2009; Casellas-Grau et al., 2017; Sawyer et al., 2010).
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The analysis of PTG in the context of illness-related trauma requires some clarification
– that is, distinguishing PTG from other concepts associated with coping with disease (e.g.
illness adjustment), as well as specifying the specific nature of this potentially trauma-related
growth. First, PTG arising from struggling with disease is different from illness adjustment,
which may also entail some positive outcomes (Bostock et al., 2009). This latter term,
described in many models of psychological adaptation to disease (see de Ridder et al., 2008)
and referring to the stress and coping model of Lazarus and Folkman (1984), assumes a
regaining of control over the disease and life and, therefore, to a greater or lesser extent, a
return to pre-disease equilibrium (Samson, & Siam, 2008). In contrast, PTG describes
transformational changes, which go beyond the process of adaptation to the disease (Casellas-
Grau et al., 2017). Adaptation, therefore, would be a return to the level of well-being
characteristic of an individual (Diener et al., 2016), while PTG would include not only
quantitative but also qualitative transformations in functioning. This conceptual distinction is
important, as some authors use these terms interchangeably or apply the term “posttraumatic
growth” to any positive constructs related to coping with illness or illness adaptation (e.g.
Bostock et al., 2009; Updegraff et al., 2002).
The diagnosis and living with a potentially fatal somatic disease together constitute a
strong stressor, which has been classified as meeting the criterion of a traumatic event
necessary for the development of posttraumatic stress disorder (PTSD; APA, 1994; Kangas,
Henry, & Bryant, 2002; Moye, & Rouse, 2014). However, the nature of medical illness-related
trauma is complex and provokes much controversy (Kagee, 2008). Edmondson (2014)
proposed the Enduring Somatic Threat model of PTSD for analysing PTSD symptoms strictly
in the context of this type of traumatic stressor. The traumatic load accompanying seriously ill
patients has a complex etiology and dynamics. Although usually initiated at the moment of
diagnosis, it also results from a later struggle with a disease, including the often painful
awareness of a justified life threat, severity of somatic symptoms and their treatment, and
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sometimes various social stressors (Mundy, & Baum, 2004). In other words, trauma
experienced by such patients applies not only to the historical moment of diagnosis but is a
continuous process induced by an interaction of somatic, psychological and social factors,
leading to present and future stressors, including potential death. This distinguishes it from the
traditionally understood traumatic stressor as an external event operating in the past (see APA,
1994, 2013). Among the authors studying PTG in the medical context, there is no agreement on
the critical moment that can potentially trigger PTG or on how much time must elapse between
this event and the appearance of possible positive changes. Most researchers assume that this
critical moment constitutes receiving an official medical diagnosis, which has been observed
mainly in the context of cancer (Stanton et al., 2006). However, other authors have found that
positive changes may occur at different stages of the disease, sometimes many years after
diagnosis, which has been observed especially with chronic disease with a high level of
unpredictability, such as HIV/AIDS (Sawyer et al., 2010).
Psychological research among people living with HIV (PLWH) has been dominated by
findings highlighting only the negative consequences of living with HIV infection, pointing to
various aspects of HIV-related distress (e.g. Ciesla, & Roberts, 2001; Israelski et al., 2007).
However, the great progress in the treatment of HIV/AIDS has not only extended the life
expectancy of PLWH (Samji et al., 2013), but changed the nature of this disease from an fatal
condition to a chronic medical problem (Deeks et al., 2013). Thus, authors have increasingly
begun to focus on various positive psychological correlates among PLWH (Ironson et al.,
2008; Moskowitz et al., 2017). One area of this topic is research on determinants and
consequences of PTG in this patient group (Sawyer et al., 2010). However, the studies
conducted so far have presented a rather fragmentary and inconsistent picture of this
phenomenon for this group of patients among PLWH, especially when it comes to its clinical
and psychological correlates (Sawyer et al., 2010).
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Aim of the review
Taking the above into consideration, the main aim of this systematic review was to
synthesise, analyse and review existing results on PTG among HIV/AIDS patients. This review
was based mainly on Tedeschi and Calhoun’s (1996, 2004) model of PTG and the related
assessment tool (see PTG Measures) as the most frequent approach. We also referred to studies
dealing with already mentioned PTG-related constructs in order to capture a broader picture of
HIV-related socio-medical and psychosocial factors associated with PTG. Thus, the aim of our
review was threefold:
1. To investigate the relationship of PTG with sociodemographic and HIV-related clinical
variables among PLWH.
The insofar studies conducted have showed that gender and age are the most important
sociodemographic characteristics related to PTG (Helgeson et al., 2006; Prati, & Pietrantoni,
2009). However, among PLWH there may be significant differences in this respect due to
infection pathways, disease progress and treatment, as well as to a link between these
characteristics and social status (Sawyer et al., 2010). This raises the question of possible
specificity of the PTG-related clinical (see CD4 count, viral load, time since HIV diagnosis,
treatment adherence, AIDS phase) and social context (see also socioeconomic status, ethnicity)
in this patient group.
2. To investigate the relationship of PTG with positive and negative psychological correlates as
well as HIV-related social issues among PLWH.
Taking into an account the current advancement in the PTG research (Jayawickreme, &
Blackie, 2014), we adopted an empirically-driven approach to identify the most frequent
psychological correlates of PTG among PLWH. Specifically, when reviewing the articles two
judges independently coded all the examined correlates of PTG and divided them into
constructs describing positive (optimism, resilience, positive reappraisal coping, positive
affect, self-efficacy) and negative (depression, substance use, PTSD symptoms) aspects of
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functioning. They also identified the HIV-related social issues (HIV stigma and social support)
as a separate topic. Finally, the judges checked whether sociodemographic and clinical
variables were controlled in the analyses regarding these correlates to examine the plausibility
of the results obtained.
3. To provide research directions for future studies on PTG among PLWH.
Our focus was to report on the state of the art of PTG in this patient group, not an in-depth
critical analysis of the theoretical issues regarding the construct of posttraumatic growth itself.
However, in the discussion section we also referred to some controversies related to the PTG
operationalisation (Jayawickreme, & Blackie, 2014), especially in the context of chronic illness
(Casellas-Grau et al., 2017).
Method
Literature search strategy
This systematic review was conducted in accordance with the PRISMA guideliness
(Moher et al., 2009; see also Appendix) . A literature search was performed on 31 May 2018
using Web of Science, PsyARTICLES, MedLine, Proquest and Scopus databases. We used the
following keywords related to PTG: posttraumatic growth, stress-related growth, adversarial
growth, benefit finding and thriving, in conjunction with the health-related keywords, HIV and
AIDS. In Boolean algebra, the query had the following form:(“PTG” OR “posttraumatic
growth” OR “stress-related growth” OR “adversarial growth” OR “thriving” OR “benefit
finding”) AND (“HIV” OR “AIDS”). Furthermore, we searched only for papers wiritten in
English, but we did not apply any restrictions to the year of publication.
Study selection criteria
Apart from being written in English, the studies had to meet three criteria to be included
in the systematic review:
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(1) Type of study – we included only peer-reviewed, quantitative, emprical articles. We
excluded other systematic reviews or metanalyses, editorials, letters, and qualitative case
reports.
(2) Participants – we included studies dealing with HIV/AIDS patients, with no restriction on
age or stage of the disease. We also included studies in which the samples were composed of
HIV/AIDS patients and patients with other chronic illnesses. We eliminated those articles
which concentrated on caregivers of PLWH or their family members.
(3) Quality of study – we included only studies with clearly described PTG measurement,
comparable with other in the field, i.e. based on self-descriptive questionnaires directly
referring to the disease-related transformational changes in functioning.
Results
The database searches yielded a total of 2,567 abstracts: 449 hits on WoS, 7 hits on
PsycARTICLES, 53 hits on MedLine, 1986 hits on ProQuest and 72 hits on Scopus. These
were used to hand search references, which gave 30 additional records. The first part of the
review dealt with screening the abstracts for their fulfilment of the study selection criteria.
Each abstract was screened by two independent reviewers. After eliminating duplicates, 1,281
abstracts were left from five databases (see Figure 1). Subsequently, those records were
eliminated, which not meet full studied selection criteria, starting with the type of study and
participants. After accumulating 28 potentially relevant records, they were reviewed in detail to
check their methodological quality with respect to quantitative methods (Pluye et al., 2011).
Four studies were rejected. One study was excluded due to very small sample size (N = 45),
which was significantly lower compared to the sample sizes of other included studied to this
review. Three studies were rejected due to differently conceptualized PTG measurement, which
made them unsuitable for further comparisons. As a result, 24 articles were finally accepted for
systematic review. The PRISMA flow diagram illustrates the process of the articles selection
(see Figure 1).
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[Insert Figure 1 about here]
The information from the eligible 24 articles is presented in Tables 1–5, grouped
according to the aims of our review and to the PTG conceptualisation and tool for measuring it.
In particular, Tables 1 and 2 present the relationship between PTG and sociodemographics, as
well as HIV-related clinical variables. Tables 3–5 illustrate the relationship between PTG and
psychosocial aspects of the functioning of PLWH; they include selected positive psychological
correlates (optimism, resilience, positive reappraisal coping, positive affect, self-efficacy),
HIV-related distress (depression, substance use, PTSD symptoms) and HIV-related social
issues (HIV stigma, social support). In each table, we specify the nature of the relationship
between PTG and a particular variable, where ‘+’ indicates a statistically significant positive
relationship, ‘−’ means statistically significant negative relationship and ‘0’ points to the lack
of a significant relationship. The vast majority of the analysed studies (75%) were cross-
sectional. Only six studies presented longitudinal results on PTG in this patient group.
[Insert Tables 1–5 about here]
Posttraumatic growth measures
Most of the analysed articles (17/24, i.e., 71%) were based on Tedeschi and Callhoun’s
(1996, 2004) model of PTG and as a consequence used the Posttraumatic Growth Inventory
(PTGI; Tedeschi, & Calhoun, 1996). The PTGI comprises of 21 items to assess five domains of
growth, such as Relating to Others, New Possibilities, Personal Strength, Spiritual Change and
Appreciation of Life. The sum of all items constitutes the global PTG level. Each item is
assessed on a six-point scale, with values ranging from 0 (I did not experience this change as a
result of my crisis) to 5 (I experienced this change to a very great degree as a result of my
crisis). The psychometric properties of the PTGI, including especially its validity, are a subject
of a long debate in the literature (e.g. Frazier et al., 2009; Jayawickreme, & Blackie, 2014),
which topic will be also discussed further in this review.
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Five articles (21%) assessed the benefit finding (BF) and used the Benefit-Finding
Scale (BFS; Antoni et al., 2001). This tool consists of 17 items to measure perceived benefits
across a variety of domains, arising from experience of particular disease: its diagnosis and
treatment. Responses are provided on the scale ranging from not at all (1) to extremely (5). The
psychometric properties of this tool were discussed in some meta-analytic reviews (Helgeson et
al., 2006).
Two articles (8%) assessed benefit finding or stress-related growth measured with the
Psychological Thriving Scale (PTS). This 24-item questionnaire was developed by Abraido-
Lanza et al. (1998) and it is a combination of items derived from the Stress-Related Growth
Scale (Park et al., 1996) and PTGI (Tedeschi, &Calhoun, 1996). Participants are asked to
assess the degree to which they experienced each benefit as a result of their illness using a five-
point response scale ranging from 0 (this has not happened to me) to 4 (a great deal). Like in
BFS, the psychometric properties of this tool were discussed in some meta-analytic reviews
(Helgeson et al., 2006).
Posttraumatic growth and sociodemographic variables
All 24 reviewed articles provided the sociodemographic characteristics of the sample,
with information about participants’ gender, age and socioeconomic status. However, only
seven studies included participants’ gender in the main statistical analysis (see Table 1). In five
studies (5/7; 71%), HIV-infected women reported higher PTG compared to HIV-infected men,
whereas in two studies, no statistically significant gender differences were noted. The
participants’ age was analysed in 11 articles, and 10 of them (91%) showed no age differences
in PTG among PLWH. Only one study reported a positive association between PTG and age.
Three studies out of four (75%) affirmed no relationship between the level of education and
PTG, and two studies out of four (50%) showed no link between employment status and PTG
level. Four studies out of six reviewed in the context of ethnicity and PTG (66%) suggested
higher PTG among African American participants compared to White participants, whereas one
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study reported higher PTG among Hispanic participants compared to White and African
American participants. One study did not show a direct effect of ethnicity, but revealed its
moderation effect on relationship between PTG and negative affectivity measures (depression,
negative affect and anxiety): it was significantly negative only for White comparing with
African American PLWH.
Posttraumatic growth and HIV-related clinical variables
As in the case of sociodemographic variables, only 13 articles incorporated HIV-related
clinical variables into the statistical analysis. The HIV-related clinical variables were relatively
weakly associated with PTG (see Table 2). In three out of five studies (60%) there was no
relationship between CD4 count and PTG. One study demonstrated a positive relationship
between these variables, but only among Hispanic patients and those with low levels of
optimism. An association between PTG and viral load was examined in three studies: in one
study a null relationship was obtained, while two others documented a complex connection
between them. With respect to time since HIV diagnosis, 12 studies, which are 50% of all
identified studies, indicated lack of a statistically significant relationship between these
variables. Six studies out of eight documented (75%) no relationship between years of ART
treatment and/or treatment adherence and PTG, while two other studies observed a positive
link between these variables. Finally, three articles out of five (60%) did not find a difference
in PTG between HIV+ and HIV/AIDS patients. Conversely, Littlewood et al. (2008) observed
higher PTG among HIV/AIDS patients, while Rzeszutek (2017) found that PTG was higher
only among HIV+ participants, compared to HIV/AIDS patients.
Posttraumatic growth and positive psychological correlates
All together fourteen articles investigating this issue were identified (see Table 3). Two
studies explored the link between optimism and PTG. Milam (2004) observed a positive
relationship between optimism and PTG only in the cross-sectional part of his study – over
time this relationship was insignificant. However, in a second study, Milam (2006) found a
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positive longitudinal association between these variables, using the same assessment tools and
with a very similar sample size. 60% (3/5) of the cross-sectional studies showed a positive
association between resilience as a personality trats and PTG among PLWH. On the contrary,
two longitudinal studies demonstrated no (Garrido-Hernansaiz, & Alonso-Tapia, 2017) or even
a negative association between these two constructs (Garrido-Hernansaiz et al., 2017). Four
studies out of five (80%) indicated a positive correlation between coping through positive
reappraisal and PTG, while one study found no such relationship. In three studies (3/3; 100%)
a positive association between positive affect and PTG was found. Finally, in all two analysed
studies, a positive relationship between self-efficacy and PTG among PLWH was observed.
Posttraumatic growth and HIV-related distress
Thirteen studies examined the relationship between PTG and HIV-related distress.
Among them, 12 noted a significant association between various aspects of HIV-related
distress and PTG (see Table 4). Seven studies out of nine (78%) showed the negative
relationship between depression and PTG, while two studies found no such relationship. Two
studies out of three (66%) provided evidence for the negative link between substance use and
PTG, while one study found no such relationship. Interesting results were found for PTSD
symptoms and PTG. Namely, two studies out of four analysed (50%) reported a positive
association between these variables. One study found no relationship between PTSD symptoms
and PTG, while another observed the negative link between these constructs, however, only
among HIV-infected women.
Posttraumatic growth and HIV-related social issues
A negative relationship between HIV-related stigma and PTG was shown in three cross-
sectional studies (75%), whereas one longitudinal study showed the opposite effect (see Table
5). All six studies reviewed in this context documented a positive relationship between social
support and PTG among PLWH, i.e. social support promoted positive changes in this patient
group.
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Discussion
The main aim of this systematic review was to investigate PTG among PLWH in
relation to the socio-medical and psychological correlates among this group of patients.
Starting with an assessment of the consistency of the gathered empirical data, it can be noted
that the vast majority of studies (71%) were based on Tedeschi and Calhoun’s (1996, 2004)
model of PTG and its assessment tool (PTGI). Only seven studies were based on other PTG-
related constructs, such as benefit finding or stress-related growth, but still used tools that can
be regarded as comparable to PTGI, at least as far as a unitary PTG score is considered.
Consistency between the theoretical and measurement models of PTG was an important
selection criterion for two reasons. First, it minimises the interpretation bias resulting from
treating substantially different data as comparable. Second, it allows for a more in-depth
understanding of PTG, both universally and specifically in this group of patients.
When it comes to the sociodemographic correlates of PTG among PLWH, it seems that
in light of prior research, only two play some role – namely, gender and ethnicity. The higher
PTG among HIV-infected women compared to HIV-infected men is consistent with literature
on gender differences in PTG (Vishnevsky et al., 2010). However, in all the identified studies
(see Table 1), a significant underrepresentation of women has been observed, from two to even
six times less than men (e.g. Cieślak et al., 2009; Kamen et al., 2016; Milam, 2004; Zeligman
et al., 2017). Thus, although this ratio is rather typical for studies on PLWH population (Bor et
al., 2015), one should be careful about drawing a strong conclusion with regard to gender
differences in PTG, and future studies ought to be based on a more gender-balanced ratio of
participants. In addition, Hispanic and especially African American ethnicity was positively
related to PTG among PLWH. On one hand, this may indicate a need to examine cross-cultural
factors – a topic grossly neglected in the PTG literature (Pals, & McAdams, 2004). On the
other hand, this may lead some authors to formulate possible explanatory mechanisms, which
would require further studies. Namely, the minority stress theory suggesting that people from
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minority populations may be exposed to increase and more frequent stress resulting in
negative health consequences, but this may also provide chances for growth (Fekete et al.,
2016). The HIV-infected African Americans still face substantial economic and social
disparities and this greater adversity may stimulate more PTG (Pellowski et al., 2013).
The HIV-related clinical variables were relatively poorly associated with PTG among
PLWH (Table 2). If some medical parameters (e.g. CD4, viral load) describing HIV infection
progression may at all be related to psychological growth, this relationship would depend on
other variables, such as ethnicity or personality (Milam, 2004, 2006). Only three studies out of
nine showed the positive role of treatment duration or adherence in PTG (Milam, 2006;
Łuszczyńska et al., 2007, 2012). This resonates with the inconclusive results regarding PTG
following a struggle with life-threatening illness, which suggested no (Widows et al., 2005),
positive (Rahman et al. 2012) or negative (Mols et al., 2009) relationship between PTG and
these particular variables. Out of all HIV-clinical variables, there was a rather consistent picture
with regard to the lack of relationship between time since HIV diagnosis and PTG among
participants. There is no consensus in the general PTG literature on the time required for
growth to appear after trauma (Linley & Joseph, 2004), which is especially visible in research
on PTG in the case of health-related trauma: studies reported a positive (Sears et al., 2003),
negative (Guns et al. 2016) or no relationship (Bellizzi, & Blank, 2006) between time elapsed
since illness diagnosis and PTG. Tedeschi and Calhoun (1996, 2006) underlined that PTG is
not a static outcome but an ongoing, complex process, rather unlikely to develop shortly after a
traumatic event, which may somehow explain the inconclusive findings concerning the role of
time in the development of PTG. Łuszczyńska et al. (2012) clarified that PTG shortly after the
diagnosis of a potentially terminal illness may act as a palliative response to a life threat, and
only in the long term may be associated with more profound positive life changes. More
specifically, some studies observed the stability of these positive changes among cancer
patients, i.e. growth measured soon after diagnosis was still related to lower distress and
15
depression eight years later after controlling for the patient’s baseline assessment (Carver, &
Antoni, 2004). It is also important to mention again the uniqueness of illness-related trauma
(Edmondson, 2014), which often constitutes a complex process which challenges different
aspects of a patient’s life at different stages of the disease. This creates the problem of defining
the critical point which may trigger growth development (Barskova & Oesterreich, 2009). For
example, in this review, Littlewood et al. (2008) observed higher PTG among AIDS patients,
whereas Rzeszutek (2017) found higher PTG among HIV+ patients only, and three other
studies noted no differences between HIV+ and HIV/AIDS patients. Nevertheless, the
aforementioned inconclusive results can also be explained by the fact that PTGI was developed
as an operationalisation of positive changes after vast categories of traumatic events and,
therefore, may not sufficiently capture the above-mentioned distinctiveness of health-related
trauma (Casellas-Grau et al., 2017). In addition, PTG as operationalised by Tedeschi and
Calhoun (1996, 2004) refers also to the qualitative positive changes observed among trauma
survivors, but is measured only by purely quantitative inventory (Frazier et al., 2009).
More homogeneous findings were obtained with respect to the association between
psychological correlates and PTG among PLWH. The majority of reviewed studies found a
negative association between PTG and depression or substance use among PLWH. An
analogous trend was observed in other trauma survivors (Bensimon, 2012; Helgeson et al.,
2006; Prati & Pietrantoni, 2009). This may suggest that psychological factors outweighed the
role of clinical variables as PTG correlates not only among PLWH, but also in other patient
groups. However, such an assumption should be considered as premature. Casellas-Grau et al.
(2017) observed in a systematic review on PTG among cancer patients that PTG still lies
mainly in the interest of psychologists, and is neglected by medical journals, which was also
visible in our review. Perhaps a more complex assessment of objective health status may shed
more light on the role of psychological versus clinical factors related to PTG among various
somatically ill patients.
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Similarly, most studies showed that PTG was inversely related to perceived HIV-related
stigma and positively associated with social support. This latter variable was determined to be
one of the most important PTG correlates among various populations after trauma (Prati, &
Pietrantoni, 2009). Less agreement was reached with regard to the relationship between HIV-
related PTSD symptoms and PTG, where two studies showed the positive (Cieślak et al., 2009;
Nightingale et al., 2011), one negative (Rzeszutek et al., 2016) and another one the lack of a
direct association between these variables (Rzeszutek et al., 2017a). This corresponds to
inconclusive findings in the literature on the link between PTG and PTSD among various
trauma survivors (Tedeschi, & Calhoun, 2004). The latest meta-analytic review showed
curvilinear association between PTSD symptoms and PTG (Shakespeare-Finch & Lurie-Beck,
2014), which highlights the need for more longitudinal studies on PTG in cases of life-
threatening illness.
Limitations and future research directions
This systematic review is not free of limitations, which should be mentioned along with
some recommendations for future research on PTG among PLWH. First, although we adopted
clear study selection criteria, some bias was possible. More specifically, concentrating only on
quantitative results may hinder the possibility of obtaining a more comprehensive picture of
PTG in this patient group. Perhaps future studies could combine quantitative and qualitative
literature, especially as this latter type of research is also part of HIV/AIDS literature (e.g.
Siegel et al., 2000). Second, the reviewed literature was very heterogeneous with regard to
potential PTG issues, such as different statistical control of HIV-related clinical variables (see
e.g. various amounts of time from HIV diagnosis), as well as insufficient clarification of the
growth-inducing event (HIV diagnosis, AIDS phase, ongoing struggle with disease/stigma,
etc.). This suggests a necessity for a sharper focus on a homogeneous sample of PLWH with
respect to clinical data and perceived trauma relating to PTG. Furthermore, all reviewed studies
were based on retrospective, self-reported PTG measures only. It is vital to conduct interviews
17
with family and friends about the real changes in participants’ functioning, so as to avoid the
typical bias in retrospective PTG assessments representing, at least to a certain degree, positive
illusions of trauma survivors (Frazier et al., 2009). In addition, 75% of the studies were cross-
sectional, reflecting the fundamental problem of PTG research and precluding estimation of
valid size effects as they should describe the contribution of variables under study to the
process of change as defined by PTG (Anusic, & Yap, 2014). At present, it is unclear whether
these effects would indeed relate to this contribution or would rather relate to operational and
procedural confounders (see for instance a possibility of gender invariance; Jane et al., 2007).
It can only be concluded that these variables are related to the PTG assessment and as such
should be included and controlled in the future research. Therefore, longitudinal studies are
critical for examining PTG mechanisms, including both its mediators and moderators and
testing also other than just linear relationships. Additionally, it is important to elaborate on to
what extent PTG is a distinct theoretical construct and to what extent it shares variance with
similar psychological concepts (e.g. well-being, personality; Jayawickreme & Blackie, 2014).
Furthermore, further research will translate into higher quality of studies that may indeed be
interpreted in terms of substantially valid size effects. Finally, this systematic review was based
on a small number of studies (N = 24), many of them are likely not to have sufficient statistical
power to detect small effects and most did not control for important confounding variables
when analysed psychological correlates of PTG. This suggests that research on PTG among
PLWH is still in its infancy. Therefore, further research is needed on this phenomenon in this
patient group to differentiate between universal and HIV-specific correlates of PTG as well as
to elaborate on PTG as a construct distinct from others describing a spectrum of well-being.
Conclusion
18
The examined studies, although still very few in number, suggest that the self -reported
PTG among PLWH may be related more to psychological variables, rather than to
characteristics of HIV infection itself. Nevertheless, several aspects of the research on PTG
among PLWH require modification, both theoretically and methodologically. In addition, more
comprehensive interdisciplinary studies are needed to fully capture the health-related PTG
mechanisms and outcomes in this patient group.
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Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
flow diagram (from: Moher, Liberati, Tezlaff, & Altman, 2009).
31
Identifcation
Screening
Eligibility
Included
Records identied through
database searching
(n=2567)
(
Records screened
(n=1281)
Full-text articles assessed
for eligibility
(n=902)
Total full-text articles
excluded
(n=878):
Systematic reviews,
metanalyses, qualitative
studies, editorials or
letters
(n=436)
Caregivers or other
family members as
participants
(n=438)
Unclear PTG
measurement, small
sample size
Records excluded
following
title and abstract
screening
Records after duplicates
removed (n=1281)
Studies included in review
(n=24)
Additional records identied
through other sources
(n=30)
(
Appendix:
Preferred Reporting Items for Systematic Reviews (PRISMA checklists). From: Moher D,
Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for
Systematic Reviewsand Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097.
doi:10.1371/journal.pmed1000097
Section/topic # Checklist item Reported
on page
#
TITLE
Title 1 Identify the report as a systematic
review, meta-analysis, or both.
1
ABSTRACT
Structured
summary
2 Provide a structured summary
including, as applicable: background;
objectives; data sources; study
eligibility criteria, participants, and
interventions; study appraisal and
synthesis methods; results;
limitations; conclusions and
implications of key findings;
systematic review registration
number.
1
INTRODUCTION
Rationale 3 Describe the rationale for the review
in the context of what is already
known.
2-4
Objectives 4 Provide an explicit statement of
questions being addressed with
reference to participants,
interventions, comparisons,
outcomes, and study design
(PICOS).
5
METHODS
Protocol and
registration
5 Indicate if a review protocol exists, if
and where it can be accessed (e.g.,
Web address), and, if available,
provide registration information
including registration number.
N/A
Eligibility
criteria
6 Specify study characteristics (e.g.,
PICOS, length of follow-up) and
report characteristics (e.g., years
considered, language, publication
status) used as criteria for eligibility,
giving rationale
6-7 and Figure 1
Information
sources
7 Describe all information sources
(e.g., databases with dates of
coverage, contact with study authors
to identify additional studies) in the
search and date last searched
6-7 and Figure 1
Search 8 Present full electronic search strategy 6-7 and Figure 1
44
for at least one database, including
any limits used, such that it could be
repeated.
Study selection 9 State the process for selecting studies
(i.e., screening, eligibility, included
in systematic review, and, if
applicable, included in the meta-
analysis).
6-7 and Figure 1
Data collection
process
10 Describe method of data extraction
from reports (e.g., piloted forms,
independently, in duplicate) and any
processes for obtaining and
confirming data from investigators.
6-7 and Figure 1
Data items 11 List and define all variables for
which data were sought (e.g.,
PICOS, funding sources) and any
assumptions and simplifications
made.
6-7 and Figure 1
Risk of bias in
individual
studies
12 Describe methods used for assessing
risk of bias of individual
studies (including specification of
whether this was done at the study or
outcome level), and how this
information is to be used in any data
synthesis.
6-7 and Figure 1
Summary
measures
13 Describe the methods of handling
data and combining results of
studies, if done, including measures
of consistency (e.g., I2) for each
meta-analysis.
N/A
Synthesis of
results
14 Describe the methods of handling
data and combining results of
studies, if done, including measures
of consistency (e.g., I2
) for each meta-analysis.
N/A
Risk of bias
across studies
15 Specify any assessment of risk of
bias that may affect the cumulative
evidence (e.g., publication bias,
selective reporting within studies).
6-7 and Figure 1
Additional
analyses
16 Describe methods of additional
analyses (e.g., sensitivity or
subgroup analyses, meta-regression),
if done, indicating which were pre-
specified.
N/A
RESULTS
Study selection 17 Give numbers of studies screened,
assessed for eligibility, and
included in the review, with reasons
for exclusions at each stage, ideally
with a flow diagram.
6-10, Figure 1
45
Study
characteristics
18 For each study, present
characteristics for which data were
extracted (e.g., study size, PICOS,
follow-up period) and provide the
citations.
6-10, Figure 1
Risk of bias
within studies
19 Present data on risk of bias of each
study and, if available, any
outcome level assessment (see item
12).
N/A
Results of
individual
studies
20 For all outcomes considered
(benefits or harms), present, for each
study: (a) simple summary data for
each intervention group (b) effect
estimates and confidence intervals,
ideally with a forest plot.
Tables 1-5
Synthesis of
results
21 Present results of each meta-analysis
done, including confidence intervals
and measures of consistency
N/A
Risk of bias
across studies
22 Present results of any assessment of
risk of bias across studies (see Item
15).
N/A
Additional
analysis
23 Give results of additional analyses, if
done (e.g., sensitivity or
subgroup analyses, meta-regression
[see Item 16]).
N/A
DISCUSSION
Summary of
evidence
24 Summarize the main findings
including the strength of evidence
for each main outcome; consider
their relevance to key groups (e.g.,
healthcare providers, users, and
policy makers).
11-14
Limitations 25 Discuss limitations at study and
outcome level (e.g., risk of bias), and
at review-level (e.g., incomplete
retrieval of identified research,
reporting bias).
14-15
Conclusions 26 Provide a general interpretation of
the results in the context of
otherevidence, and implications for
future research.
15
FUNDING
Funding 27 Describe sources of funding for the
systematic review and othersupport
(e.g., supply of data); role of funders
for the systematic
review.
N/A
46
... The LEC-5 doesn't provide a composite or overall score. Thus far, the LEC-5 has been translated into two languages: Polish (Rzeszutek et al., 2021;Rzeszutek & Gruszczyńska, 2018) and (Bae et al., 2011) Korean language. The LEC-5 scale has also been culturally adapted in the Brazilian context (Lima et al., 2016). ...
... Only a few tools, like the Stressful Life Events Screening Questionnaire (Kubany et al., 2000), emerged as prominent options, and the Traumatic Life Events Questionnaire, have undergone comprehensive testing to ensure their psychometric soundness (Elhai et al., 2009). The Life Events Checklist was newly added and contributed to the list following the development of its psychometric properties, which established strong convergent and construct validity and sufficient test-retest reliability or internal consistency of the LEC-5 scale (Rzeszutek et al., 2021;Rzeszutek & Gruszczyńska, 2018). ...
... This study further compared the results with previous research, approving the theoretical seven-factor model based on the WMH SASH study, which comprised classifications including war, accidents, bodily harm, network trauma, sexual assault, extreme suffering, and witnessing a traumatic event (Kwobah et al., 2022). Moreover, Rzeszutek et al. (2018) developed a four-factor structure of the LEC that aligns with the DSM-5 criteria for PTSD, explaining 56% of the total variance (Rzeszutek & Gruszczyńska, 2018). The present study endeavors to translate and adapt an Urdu version of LEC-5 for the Pakistani school student population, explore its factor structure, and establish psychometrics for the Pakistani population. ...
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Background: Trauma exposure is a widespread phenomenon worldwide that often results in enduring mental and physical health disorders, such as posttraumatic stress disorder (PTSD). However, there are significant gaps in our knowledge of trauma exposure in the Pakistani context and in the validity of standardized tools for measuring potentially life-threatening trauma exposure. This study aimed to establish the psychometric properties of a translated and adapted version of the Life Events Checklist (LEC-5) among Pakistani school students, commonly utilized to assess traumatic events associated with psychopathology. Method: This study utilized a cross-sectional research design and purposive sampling to examine the psychometric properties of the translated and adapted version of the LEC-5 scale in the Pakistani population. The back-translation technique was used for translation and adaptation. Results: The results of the exploratory factor analysis identified a four-factor model associated with and supportive of the DSM-5 criteria for symptoms of trauma exposure. This scale highlights the LEC-5's test-retest reliability and cross-cultural validity to examine trauma exposure symptoms in Pakistani school students. It can serve as a valuable and highly effective instrument for examining trauma exposure symptoms in both clinical practice and research in the Pakistani population. Conclusions: This present study highlights the significance of the Urdu-translated LEC-5 as a reliable and valid tool for examining trauma exposure symptoms in Pakistani school students and its valuable contribution to both educational and clinical applications. Its results support the use of the LEC-5 in helping to develop a deeper insight into trauma experiences in schoolchildren, highlighting its importance for informed intervention development and promoting research endeavors.
... Therefore, the decrease of negative affect and the increase of positive affect may facilitate resilience (Fredrickson, 2001). After experiencing trauma, positive affect may help an individual to build enduring personal resources in the form of integrated views of the self and the world, develop long-term plans and goals, experience personal growth in adversity (Affleck & Tennen, 1996;Fredrickson, 2001;Rzeszutek & Gruszczynska, 2018), and relieve PTSD in adolescents . In contrast, negative affect may be associated with more PTSD (Badour et al., 2017;Dornbach-Bender et al., 2020;Simons et al., 2021) and less PTG (Boyraz et al., 2010;Rzeszutek, 2017). ...
... However, inconsistent with our hypothesis, the direct association between optimism at T1 and PTG at T3 was non-significant. In previous meta-analyses, the nature of this link was inconclusive (Bostock et al., 2009;Casellas-Grau et al., 2017;Rzeszutek & Gruszczynska, 2018). This may be explained by the necessity of cognitive-affective process in forming PTG (Tedeschi & Calhoun, 2004), together with the variability of behaviors that optimists show across situations (Mischel & Shoda, 1995;Scheier et al., 1986). ...
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This study investigated the mediating roles of positive adversity beliefs and affect in the relationships between optimism, posttraumatic stress disorder (PTSD), and posttraumatic growth (PTG) among adolescents. We conducted three assessment waves 8.5 (T1), 9.5 (T2), and 10 (T3) years after the Wenchuan earthquake. Overall, 449 earthquake survivors (Mage = 13.44, SD = 1.31 years) completed questionnaires regarding optimism (T1), PTSD (T3), PTG (T3), positive adversity beliefs (T2), positive affect (T2), and negative affect (T2). After controlling for adolescents’ gender, age, trauma exposure, school performance, and their parents’ working status, optimism was directly associated with PTSD and indirectly associated with PTSD via positive adversity beliefs, negative affect, and “positive adversity beliefs-negative affect”. Optimism was indirectly associated with PTG via positive adversity beliefs, positive affect, negative affect, “positive adversity beliefs-positive affect”, and “positive adversity beliefs-negative affect”. These findings suggested that PTSD and PTG were influenced by different mechanisms: positive affect fostered PTG and negative affect accelerated both PTSD and PTG. Therefore, posttraumatic psychological services should focus on helping adolescents cultivate optimism and positive beliefs and develop emotion regulation skills.
... As this study was conducted in 2020, during the pandemic, and benefit finding was assessed during the coping process, this study defined benefit finding as a coping strategy. Unlike post-traumatic growth, which arises from major crises resulting in transformational changes beyond a return to baseline or adaptation to trauma/stressors, benefit finding can be adopted in less stressful contexts (Rzeszutek & Gruszczyńska, 2018;Tedeschi & Calhoun, 2004). Therefore, the term "benefit finding" is used because we focus on the common positive changes experienced by the general population during the early stages of the COVID-19 pandemic. ...
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Background and objectives: During large-scale stressful events such as pandemics, situational uncertainty and daily routine disruptions increase anxiety prevalence, underscoring the need for research on approaches to promote effective coping. This study focused on the psychological function of benefit finding in the context of the COVID-19 pandemic. Design and methods: Both Study 1a (a cross-sectional survey of 567 Chinese adults) and Study 1b (a two-wave longitudinal survey of 406 Chinese adults) examined the relationship between benefit finding and anxiety, with hope as the mediator. Study 2 used an interventional design to examine the efficacy of daily benefit-finding writing among 129 Chinese college students. Results: In Studies 1a and 1b, benefit finding was positively associated with anxiety, which was mediated by hope. Study 2 showed that daily writing tasks significantly promoted benefit finding. Hope mediated the relationship between benefit finding and anxiety at both the within- and between-person levels. Conclusions: Benefit finding can foster hope and relieve anxiety. Daily benefit-finding activities, which can be conducted online, can help improve mental health during pandemics.
... Reports from Warsaw-based research found a strong link between social support and lower levels of suicide and improved psychological wellbeing and health among HIV/AIDS patients (Rzeszutek & Gruszczyńska, 2018). In Namibia, Gentz et al. (2017) agree with Rzeszutek (2017)'s findings that more social support levels (especially from prenatal caregivers) have been found to be a protective measure against mental health disorders among adolescents living with HIV/AIDS. ...
Thesis
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The study explores experiences of disclosure, stigma, sexuality and social support to treatment adherence for HIV positive adolescents In Chiredzi district. Qualitative study methodology was adopted. 22 adolescents aged 13 and 19 were recruited to participate in this study while attending social support or when they come to collect their medication. Individual in depth interviews were carried out asking adolescents about their personal romantic lives, experiences and difficulties they must face while living with HIV and AIDS. Findings revealed that adolescents living with HIV (ALWH) are confronted with stigma and discrimination while simultaneously grappling with emotional issues such as dealing with disclosure. Consequent to this challenges, adolescents (particularly males) adopt several coping mechanisms to deal with difficulties and these include (but not limited) to non-disclosure of their seropositive status to their sexual partners thereby risking reinfection and exposing their partners to HIV. Social support was minimal. Non disclosure of seropositive status contributed to poor adherence to or default HIV medication. Further findings attest to the fact that adolescents refrain from disclosing their HIV status because they want to fit in with their peers and romantic partners. Presumably this justifies why while there has been a decline in the number of new infections among all ages, there has been a significant escalation in HIV infection among the adolescent population, amid a high incidence of virological failure. Evidently, statistics will maintain an upward trajectory if proper measures are not implemented. The study concludes that a life - cycle approach to HIV prevention and management is crucial in responding to adolescent HIV/AIDS challenges because risks of HIV infection, the challenges of assessing services and the solutions to these challenges change at different stages of someone's life. The scenario justifies the adoption and implementation of the principle of biomedical holistic approach in order to find suitable education programmes for the community, health workers and adolescents.
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Through the course of the last few decades researchers have observed that Adverse Childhood Experiences (ACE) can act as a breeding ground for transformative positive changes to develop in the face of adversity. This process of enhanced growth is systematically studied as ‘Post Traumatic Growth’ (PTG). Though there is an existing association between ACE and PTG, yet there is a paucity of studies that explores the mediating variables in this relationship. The current study aims to explore the role of self-compassion (SC) and psychological flexibility (PF) between ACE and PTG among Indian young adults. The study was conducted on 298 Indian participants who were in the age bracket of 18–25 years. The study variables were assessed using self-administered rating scales. Participants were screened for ACE using Adverse Childhood Experiences (ACEs) Questionnaire. Additionally, Self-Compassion Scale (SCS-SF), Acceptance and Action Questionnaire-II (AAQ-II), Posttraumatic Growth Inventory- Short Form were other tools used. The results have indicated that both Psychological Flexibility and Self-Compassion mediate the relationship of ACE with PTG. The current findings have emphasized on the role of Psychological Flexibility and Self-Compassion in moving towards Post Traumatic Growth. These findings reassert that Psychological Flexibility and Self-Compassion are foundational to Acceptance Commitment Therapy and highly useful especially while working with trauma affected populations.
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Drawing on Catherine Malabou’s notion of plasticity, this article argues for a conception of resilience as plastic. Resilience has proven an important concept in health care, describing how we manage life-changing illnesses. Yet, resilience is not without its critics, who suggest it neglects a political, social, or personal dimension in illness. In this article, I propose that a concept of plastic resilience can address these criticisms. On this account, success should not be based on a return to function, but rather on how actively we are involved in the formation of a new self after illness. I address some approaches that can benefit from “plastic resilience,” namely, art therapy, expert companionship, and shared decision-making. In each case, I underline how we should help patients thematize and engage with their new selves, while also being constantly vigilant for how these changes might impact our current assumptions around their preferences for treatment.
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Background In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV—1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. Objective To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. Methods The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. Results Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. Conclusions By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. Trial Registration ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714 International Registered Report Identifier (IRRID) PRR1-10.2196/47151
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This longitudinal study investigated the predictors of HIV-related resilience (HR) and posttraumatic growth (PTG) among Spanish-speaking HIV-positive people. Perceived past resilience, internalised stigma and coping strategies were hypothesised as possible predictors. Data were collected at two time points from 119 HIV-positive people. Path analyses with latent variables revealed that half of HR eight months after diagnosis was predicted by rumination, emotional expression, positive thinking, internalised stigma, and perceived past resilience. The latter three, along with isolation, self-blame, thinking avoidance, and help seeking predicted some PTG dimensions eight months after diagnosis. The results highlight the importance of internalised stigma associated with HIV infection and of the differential use of coping strategies, and point to the need for clinicians and policy makers to implement stigma reduction and appropriate coping strategies interventions.
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This study investigated the level of posttraumatic growth (PTG) and its association with the level of social support, stress coping strategies and resilience among a people living with HIV (PLWH) in a one year longitudinal study. We also controlled for age, HIV infection duration and the presence of posttraumatic stress symptoms (PTSS). From the 290 participants, initially eligible for the study, 110 patients were recruited for the first assessment and 73 patients participated in a follow-up assessment. Participants filled out following psychometric tools: the Posttraumatic Growth Inventory (PTGI), the Berlin Social Support Scales (BSSS), the Mini-COPE Inventory, the Resiliency Assessment Scale (SPP-25) and the PTSD-F questionnaire. Received support and resilience were positively, whereas return to religion as coping strategy was negatively related to the PTG. Clinicians and researchers needs to focus on potentially positive consequences of HIV infection, i.e. PTG, and factors that might promote it among PLWH.
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Empirical studies (n = 39) that documented positive change following trauma and adversity (e.g., posttraumatic growth, stress‐related growth, perceived benefit, thriving; collectively described as adversarial growth) were reviewed. The review indicated that cognitive appraisal variables (threat, harm, and controllability), problem‐focused, acceptance and positive reinterpretation coping, optimism, religion, cognitive processing, and positive affect were consistently associated with adversarial growth. The review revealed inconsistent associations between adversarial growth, sociodemographic variables (gender, age, education, and income), and psychological distress variables (e.g., depression, anxiety, posttraumatic stress disorder). However, the evidence showed that people who reported and maintained adversarial growth over time were less distressed subsequently. Methodological limitations and recommended future directions in adversarial growth research are discussed, and the implications of adversarial growth for clinical practice are briefly considered.
Article
Objective: To describe major findings on posttraumatic growth (PTG) in cancer, by analyzing its various definitions, assessment tools, and examining its main psychological and clinical correlates. Methods A search in relevant databases (PsycINFO, Pubmed, ProQuest, Scopus and Web of Science) was performed using descriptors related to the positive reactions in cancer. Articles were screened by title, abstract and full-text. Results: Seventy-two met the inclusion criteria. Most articles (46%) focused on breast cancer, used the Post-traumatic Growth Inventory (76%), and had a cross-sectional design (68%). PTG resulted inversely associated with depressive and anxious symptoms, and directly related to hope, optimism, spirituality and meaning. Illness-related variables have been poorly investigated compared to psychological ones. Articles found no relationship between cancer site, cancer surgery, cancer recurrence and PTG. Some correlations emerged with the elapsed time since diagnosis, type of oncological treatment received and cancer stage. Only few Studies differentiated illness-related life threatening stressors from other forms of trauma, and the potentially different mechanisms connected with PTG outcome in cancer patients. Conclusions: The evaluation of PTG in cancer patients is worthy, since it may promote a better adaption to the illness. However, many investigations do not explicitly refer to the medical nature of the trauma, and they may have not completely captured the full spectrum of positive reactions in cancer patients. Future research should better investigate issues such as health attitudes; the risks of future recurrences; and the type, quality, and efficacy of medical treatments received and their influence on PTG in cancer patients.
Article
This brief report aimed to study the relationships among anxiety, depression, resilience, and posttraumatic growth in newly diagnosed people living with HIV, and to examine the role that peri-diagnosis-perceived stress might play in their later development. Data were collected at two time points from 119 HIV-positive people. Analyses of variance, correlation analyses, and structural equations modeling were performed. Results revealed that heterosexual participants felt more anxiety than homosexual participants. Significant strong correlations between the three posttraumatic growth dimensions were found, and significant strong correlations also existed between anxiety and depression (positive) and resilience and anxiety (negative). There was a moderate negative correlation between resilience and depression, and the latter also had a weak correlation with the posttraumatic growth dimension of positive changes in the self. Posttraumatic growth did not show any other significant correlations. Perceived stress significantly predicted resilience (negatively) and anxiety and depression (positively). It did not predict posttraumatic growth. Since resilience which seems to be incompatible with anxiety and depression, efforts should be made to promote it. In this sense, minimizing perceived stress around the time of diagnosis would be of importance. Likewise, posttraumatic growth could also be encouraged. Health care providers can play an important role in reducing levels of stress, and also in identifying anxiety and depression and promoting resilience and posttraumatic growth.