Problem Background
One of the lasting consequences of experiencing life trauma is Post Traumatic Stress Disorder (PTSD). This phenomenon can be observed mainly in those exposed to extended periods of traumatic circumstances, including life-threatening events (Sciarrino, N. A., 2022; Steenkamp et al.,2020, p.656). Literature suggests that traumatic experiences can also be catalysts for positive change, i.e., Posttraumatic Growth (PTG) (Henson et al., 2021, p.1). PTG is “positive psychological changes experienced as a result of the struggle with trauma” (Tedeschi et al., 2018, p.3). Research also shows the prevalence of PTG among veterans. The proportion of U.S. veterans with PTSD is 12.9%, higher than the population average (6.8%) (Moore et al., 2021). (Wu et al., 2019, p.5) found that the prevalence of PTG among veterans ranged from 10% to 77.3%.
Purpose of the Study
The purpose of this study is to examine the relationship between PTG, PTSD, and sociodemographic characteristics in the veteran population using data from the NHRVS for 2019-2020. The current study aims to enhance the understanding of PTG and its occurrence in military veterans in the US, shedding light on PTG facilitation in veterans with a DSM-V PTSD diagnosis. Data from the 2019-2020 National Veterans Health and Resilience Survey (NHRVS) will be utilized to answer the research questions. Thus, the research seeks to explore the relationship between PTSD and PTG by examining ethnicity as a factor in the relationship between PTSD and PTG.
Significance/Gap in Knowledge
Traumatic experiences can significantly disrupt the individuals’ flow of life, leading to adverse psychological consequences and mental conditions. Scholarly evidence suggests that encountering negative or hostile events can tremendously increase the likelihood of developing a psychological condition, namely anxiety, depression, and posttraumatic stress disorder (PTSD) (Tedeschi & Calhoun, 2004, p. 2). It has also been demonstrated that the process of Posttraumatic Growth (PTG) can occur after a traumatic experience, promoting rehabilitation and ensuring the restructuring of world beliefs (Tedeschi et al., 2018, p. 6). Specific populations have been proposed to demonstrate traits associated with a higher likelihood of PTG, for example, military veterans and individuals with PTSD (Schubert et al., 2016, p. 470; Mark et al., 2018, p. 904). This specialization plan focuses on PTG research.
Research Questions
- What is the description of prevalence of PTSD in veterans?
- What is the description of prevalence of PTG in general as well as in the five specific domains?
- What is the description of association between PTG and PTSD symptoms in veterans in terms of linear and non-linear relationships?
Hypothesis
The research hypothesis for this study is that the combination of PTSD+PTG effects is connected to better functioning than PTSD-PTG, which is supported by Pietrzak et al. (2015), Tsai et al. (2015), Tsai et al. (2016), and Na et al. (2020). The null hypothesis is no difference between PTSD+PTG and PTSD-PTG conditions.
Objectives
The first goal of this research is to describe the connection between PTG and PTSD in veterans, outlining the factors to be addressed during interventions. After that, the second goal is to characterize the prevalence of PTG in the context of PTSD. The third objective is to define the correlates and predictors of PTG in veterans with PTSD and distinguish the outcome variables of PTG achievement. Finally, the fourth target is to evaluate whether the nature of trauma impacts PTG occurrence.
Thesis
PTG research might be a prominent instrument for improving the psychological welfare of these individuals, introducing a pathway for ensuring positive growth. The emotional health of this population is a significant concern not only for scholars but also for medical professionals, social workers, and government bodies, which helps ensure the availability of psychological aid and PTSD treatment (Dykes, 2016, p. 18). The studies on PTG reveal that therapy can be utilized to promote mental rehabilitation and stability in veterans (Mark et al., 2018; Tsai et al., 2016). Professionals can promote the mental welfare of these community members by implementing PTG-facilitating therapy to effectively deal with traumatic experiences and their consequences.
Literature Review
In order to extensively explore the subject of PTG and its applications, it is necessary to consider its original definition. Posttraumatic Growth is defined as “a result of processes initiated by a significant challenge to a person’s assumptive world” (Tedeschi et al., 2018, p. 6). Tedeschi et al. (2018) explain that PTG is based on the idea of positive change following a traumatic event. This transformation requires the affected person to reshape their perspective on the world. This definition is based on the decades of research that shaped the core ideas of PTG. In the definition of PTG, Tedeschi et al. interpret this concept not only as changes per se but as the changes to the individual’s assumptions about the world initiated after the traumatic experience. Tedeschi et al. (2018) explain that such transformations should result from the challenge to the person’s core beliefs.
Original PTG Definition
An article by Tedeschi and Calhoun (2004) focuses on the concept of PTG and the empirical evidence that supports it. The scholars refer to their original definition of PTG and mention that it is highly significant to clearly comprehend the positive aspects of struggling with trauma to create a valid measure (Tedeschi & Calhoun, 2004, p. 6). The authors describe the theoretical and practical notions behind it, namely traumatic events, growth, and cognitive processing (Tedeschi & Calhoun, 2004). Discussing the process of PTG in detail, the authors cite empirical evidence that demonstrates the importance of achieving PTG for improving the affected individuals’ well-being.
Domains of PTG
Based on the theoretical suggestions introduced by Tedeschi and Calhoun, five primary domains of PTG have been identified. These domains are relating to others, new possibilities, personal strength, spiritual change, and appreciation of life.
Relating to Others
The domain of relating to other people occupies a crucial place in PTG. This area is understood as an increased desire to communicate with others and accept their help. Findings from contemporary studies suggest that veterans who experience PTG are more likely to relate to others, which in turn increases the possibility of successful rehabilitation (Tsai et al., 2015; Pietrzak et al., 2016). Deployment and recurring PTSD symptoms can also affect this domain. It has been hypothesized that extremely severe PTSD symptoms and higher numbers of deployments might prevent PTG (Greenberg et al., 2021, p. 732).
New Experiences
Recognizing and becoming interested in acquiring new possibilities is another domain of PTG. Recognizing new opportunities and directions for life appear to also be affected by deployment and recurring PTSD symptoms (Greenberg et al., 2021, p. 732). Typically, veterans who report PTG demonstrate a propensity towards taking new paths and redefining their priorities, which is consistent with the theoretical suggestion that PTG leads to restructured beliefs. In the long term, such openness to experience can facilitate rehabilitation and promote better well-being.
Personal Strength
A longitudinal study by Tsai et al. (2016) suggests that the domain of personal strength is associated with the reduced severity and incidence of PTSD symptoms at a two-year follow-up. The authors connect this finding with the possibility that the factor of personal strength is related to the use of various coping strategies, which enhances an individual’s likelihood of successfully overcoming trauma (Tsai et al., 2016, p. 271). Similar results are reported by (Tsai et al., 2015, p. 165), who state that personal strength is associated with higher resilience to future traumas.
Spiritual Change
Spiritual change is also noted as an essential growth area, with veterans experiencing changes in their spirituality levels after PTG occurrence (Mark et al., 2018, p. 911). Such transformations usually refer to restructuring religious beliefs and adopting a different perspective on existential and philosophical questions.
Appreciation of Life
Additionally, several authors report that life satisfaction is connected to PTG experiences, with veterans who showed PTG receiving higher life satisfaction scores (Morgan et al., 2017, p. 434; Evans et al., 2018, p. 263; Greenberg et al., 2021, p. 732). Thus, the literature suggests that veterans who showed PTG are more likely to express greater appreciation of life, finding meaning in different aspects of their own lives.
Literature Synthesis
Background
Traumatic experiences frequently facilitate the emergence of various mental health disorders. Previous literature reveals that trauma elevates the possibility of experiencing anxiety, depression, and posttraumatic stress disorder (PTSD) (Tsai et al., 2016). Of special concern are the people with a military background, as their experience is intrinsically connected to violent events (Tsai et al., 2015). Research on Posttraumatic Growth (PTG) suggests that successful rehabilitation is possible through positive psychological growth (Tedeschi et al., 2018). It has also been noted that veterans are especially prone to PTG achievement due to the specificity of their experience (Na et al., 2021). Nevertheless, the connection between PTG facilitation factors in veteran populations remains unclear.
PTG can follow various traumas and differ depending on factors such as demographics, social support, and coping strategies (Kadri et al., 2022, p.2). Mark et al., 2018, p.5) outline ethnicity as a factor. Stigmatized groups and ethnic minorities are more likely to be socioeconomically disadvantaged and subject to additional stressors and negative experiences in their daily lives. On the other hand, this may enable them to develop the skill of growing through hardships (Miliam J., 2006). Alternatively, the greater significance of spirituality among ethnic minorities and stigmatized groups may increase growth (Siegel K et al., 2005).
Studies have shown a relationship between PTG and PTSD, with most considering personality traits as critical mediators (Mattson et al., 2018, p.476). In terms of functioning, research shows that PTG decreases the negative effects of PTSD (Jieling Chen et al., 2015). Some research also suggests that the paradox that PTG presents of the co-occurrence of growth and adversity requires further exploration (Norris et al., 2022). Researchers have expressed the necessity for further research on the relationship between PTSD and PTG (Evans et al., 2018; Stein et al., 2021). Moreover, researchers highlight the importance of more nuanced approaches to modeling the dynamic interplay between PTSD and PTG and the utility of examining coping strategies as potential mediators of this association (Whealin et al., 2020, p.190).
Trauma, PTSD, and PTG in Veterans
Trauma can occur in the lives of various populations. Individuals with military experience have been identified to be one of the most seriously affected populations by traumatic circumstances. Literature suggests that this affliction can be mediated through PTG, with specific factors capable of promoting this process and ensuring successful rehabilitation (Pietrzak et al., 2015, p. 7). A common complication encountered by veterans is connected to symptoms of posttraumatic stress disorder (PTSD), a condition that leads to anxiety, depression, and reduced well-being (Reyes et al., 2019, p. 656). From this perspective, veterans need support that could help mitigate the negative impact of trauma and assist them in achieving better welfare.
The complications connected to maintaining a stable mental condition can become overwhelming for veterans. Previously, research suggested that veterans are especially vulnerable to manifesting symptoms of major depressive disorder and PTSD (Pietrzak et al., 2015, p. 7). Such conditions often lead to the introduction of opioid therapy. Research on specific populations prone to PTG, such as military personnel or people with PTSD, has been conducted, suggesting that individuals with a military background are more likely to show PTG (Tsai et al., 2015; Schubert et al., 2016; Mark et al., 2018). Some scholars linked this phenomenon to the adversity of military experiences, proposing that military experiences provide sufficient ground for PTG occurrence (Mark et al., 2018).
The relationship between PTG and PTSD is essential in understanding the problems military veterans face. A person can have both diagnoses simultaneously, as phenomena stem from the same experience. PTG is an example of the adaptive function of the human psyche that allows people to feel that they have the power to overcome serious problems (Cann et al., 2010). It often leads to positive changes in their lives, which creates a vision of positive development and complete psychological sanity. People who show PTG at times neglect the symptoms of PTSD, which leads to the gradual aggravation of their state. The main issue is that the negative consequences of this neglect are postponed until the period of PTG ends (Cann et al., 2010).
It is possible to talk about the “inverted U shape” that emphasizes the non-linear essence of psychological changes during PTG and contributes to the emotional instability of the person (Pietrzak et al., 2015). The main reason why they feel this inverted U shape exists is because there is non-linearity is psychological changes. The literature states that in the past, several studies have focused on PTG as a beneficial approach for therapeutic interventions aimed at veteran populations (Habib et al., 2018; Mark et al., 2018). PTG is regarded as a process that can result in a better rehabilitation process. Knowledge about the factors connected to the PTG process in veterans is essential for developing an efficient rehabilitation program.
PTG in Veterans
The military personnel are of special interest to scholars focusing on trauma, as the military occupation is connected to a significant level of stress and exposure to trauma. Using the data from the National Health and Resilience in Veteran Study, the research found that 50.1 % of all veterans and 72% of veterans with PTSD reported at least moderate PTG in relation to their traumatic event (Tsai et al., 2015). As such, the article by Mark al., published in 2018, is a comprehensive systematic review of PTG applied to military personnel. Defining PTG as “positive psychological, social, or spiritual growth after a traumatic incident,” the authors clarify the three possible types of growth, “psychological, social, or spiritual ” (Mark et al., 2018, p. 904). The main results are as follows: PTG is more likely to occur in veterans who have an elevated level of social support, spirituality, and rumination; PTG is associated with ethnic minority belonging, with veterans from ethnic minorities being more likely to show PTG; PTG is more likely to occur in active-duty personnel, “who are repeatedly more exposed to conflict and may be better equipped to manage the effects of traumatic ordeals” (Mark et al., 2018, p. 913).
From this perspective, it becomes evident that there are unique factors that increase the likelihood of identifying the likelihood of PTG in individuals with military experiences. Habib et al. (2018) presented a review and qualitative analysis of PTG in military and ex-military personnel, having analyzed nine qualitative studies. The authors adopt the following definition of PTG: “positive, meaningful psychological changes that an individual can experience as a result of coping with traumatic life events” (Habib et al., 2018, p. 617). As the authors aimed to assess the qualitative data on PTG in military personnel, all the included studies used qualitative methods. The authors coded and synthesized a pool of themes that were most frequently discussed by the military personnel who experienced PTG after deployment.
According to the review, there are three main findings: Veterans’ process of PTG originates from deployment-related trauma; Veterans who experienced PTG reflect on six topics: life appreciation, re-evaluating purpose, personal traits improvement, connecting with others, integrating into society, and feeling valuable to society; These outcomes are reported by veterans as the most valuable experiences following the process of PTG and can be used to enhance PTG occurrence (Habib et al., 2018)
Thus, it is concluded that “many (ex-) military personnel experienced growth as a result of trauma experienced on duty, which may allow them to function better and enjoy fulfilling relationships with others” (Habib et al., 2018, p. 623). The authors suggest that PTSD can enhance the occurrence of PTG in veterans, as the emergence of PTSD is connected to significant trauma and, thus, higher levels of growth. Nevertheless, other literature reports mixed findings, and some meta-analyses have identified that the relationship between PTG and PTSD is challenging to define specifically (Mark et al., 2018; Schubert et al., 2016). Therefore, the overall findings on the connection between PTG and PTSD symptoms remain inconclusive.
In the recent literature, several factors have been associated with PTG in Veterans. The number of deployments has been demonstrated to have a crucial connection with PTG occurrence; as such, completing at least two deployments might be related to higher PTG levels (Cline, 2013, p. 77; Greenberg et al., 2021, p. 732). A study by Nordstrand et al. (2019, p. 6) presents a different view, reporting that the number of deployments is not significant. Other potential factors related to PTG include the individuals’ personalities and lower depressive symptomatology (Palmer et al., 2016, p. 299; Mattson et al., 2018, p. e475). Overall, the main factors facilitating PTG are adaptive coping style, moderate trauma, and deliberate rumination. These aspects could be utilized using such instruments as individual therapy, reflection, or group counseling (Schubert et al., 2016, p. 482). Other factors related to PTG have restructured beliefs, the number of deployments, personal traits, and decreased depressive symptoms.
Challenges to Core Beliefs and Rumination
A crucial area of PTG investigation in military personnel is connected to core beliefs and rumination. As originally explained by Tedeschi and Calhoun (1996, p. 455), PTG arises because of overcoming the challenge to personal core beliefs, which must be restructured to achieve proper growth. Rumination, on the other hand, is the focus of the affected individual on their traumatic experiences. Morgan et al. (2017, p. 434) explored the effects of core beliefs, challenges, and rumination in a quantitative study. According to the results, challenges to the core beliefs are significantly connected to both voluntary and non-controlled thoughts about the traumatic events, as well as PTG. The scholars disclose that deliberate rumination, which is conducted by the individual willingly, is positively associated with PTG, and intrusive rumination, which includes non-voluntary negative thoughts, negatively impacts PTG (Morgan et al., 2017, p. 435). A concept similar to rumination, re-experiencing PTSD symptoms, is also mentioned by Greenberg et al. (2021, p. 732), who report identical findings. PTG can be facilitated by intentionally reflecting on the stressful experience, allowing veterans to restructure their beliefs properly.
Large numbers of veterans represent ethnic minorities, which increases the likelihood of encountering minority-related complications. There are significant ethnic distinctions between different veteran populations, with some ethnic groups experiencing unique complications (Coleman et al., 2018). Previous research suggests that separate ethnic communities are more likely to encounter negative financial situations, a non-inclusive environment, and an absence of programs aimed at enhancing their well-being (Coleman et al., 2018). It has also been shown that ethnic minority veterans more frequently occupy disadvantageous social and financial positions, which further increases the risk of unsuccessful rehabilitation (Coleman et al., 2018).
Methodology
The research design for the present study will be quantitative and quasi-experimental. The main method will be the statistical analysis of the data retrieved from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS). The statistical analysis procedures include the computation of the following inferential statistics: descriptive statistics calculations, fitting of linear and quadratic functions, analysis of variance, a multivariable logistic regression analysis, and multivariable analysis of variance (MANOVA). Control for intervening variables will be conducted by including only veterans who experienced at least one potentially traumatic event according to the Life Events Checklist for DSM-5. The conceptual framework is shown in Figure 1 below.
The research question 1 is about PTSD prevalence and anything related to the variable. The research question 2 is about PTG in both general as well as domain-specific contexts. The research question 3 is concerned about linear or non-linear relationships between the two variables.
Considering that PTG is a construct reported by individuals themselves, reporting of PTG became a topic of discussion. Researchers have identified several methodologies, such as questionnaires and surveys, to explore PTG occurrence in veterans and retrieve reliable data about this process. As PTG is not a personality trait but a phenomenon, an experience that can occur, it can be observed or measured. While observation, at times, is utilized, it can prove to be challenging to conduct; researchers typically use interviews and surveys (Schubert et al., 2016, p. 478). Structured and semi-structured interviews have been previously utilized in empirical studies (Schubert et al., 2016, p. 478). Surveys are the most popular, as they allow for a variety of instruments and a quantitative approach (Schubert et al., 2016, p. 478). The most implemented and well-researched measures are scales that assess the process of PTG based on the participant’s reflection on the experience. The key theories of the research design are shown in Table 1 below.
Table 1: Key Theories
Variables
- Variable #1: PTSD prevalence – similar research (Pietrzak et al., 2015)
- Variable #2: PTG prevalence – similar research (Cann et al., 2010)
- Variable #3: Psychosocial and mental functioning – similar research (Weiss & Coll, 2011)
The included variables will be levels of PTG, and mental and psychosocial functioning. Levels of PTSD and PTG will be the independent variables in this study, while psychosocial and mental functioning will be the dependent variables. Ethnicity, partner status, and income will be the control variables; no variables are to be manipulated during the research. Levels of PTG, PTSD, mental and psychosocial functioning, and income will be categorical ordinal variables, with mental and psychosocial functioning also regarded as the outcome variables.
PTG will be assessed using the PTGI-SF subscales, where ordinal values are connected to the five PTG domains. The original article that developed the scale and used in similar context was conducted by Cann et al. (2010): Web.
Similarly, mental and psychosocial functioning will be determined by calculating questionnaire scores, where the highest score refers to better mental functioning and greater psychosocial difficulties, respectively. Ethnicity and partner status will be categorical nominal variables. The variables and related data are presented in Table 2 below.
Table 2: Variables
Sample/Population
The target population is military veterans from the US, while the sample includes military veterans from the US who participated in NHRVS. The sampling methods will be random recruiting and the computation of post-stratification weights. The data collection method to be used is the distribution of the survey materials. In the current study, only those veterans who reported exposure to at least one potentially traumatic event on the Life Events Checklist for DSM-5 were included (n=3,764; 92.5% of the total sample).
Instruments/Materials
Tedeschi and Calhoun (1996) developed and approbated the Posttraumatic Growth Inventory (PTGI), a tool for measuring the process of PTG. The questionnaire included in Appendix A. Tedeschi and Calhoun (1996, p. 455) reported that the final questionnaire had high reliability, meaning that it could be successfully used for identifying PTG in various populations. According to other research, these domains majorly correspond to the individuals’ experiences of PTG, while PTGI is the most frequently used questionnaire in contemporary studies (Schubert et al., 2016, p. 477).
Other Measurements of PTG
Other instruments for assessing PTG were also suggested, resulting in the emergence of a variety of measuring tools that are based on different understandings of PTG. Other authors have introduced measures based on different conceptual ideas, such as the Stress-Related Growth Scale by Park et al. (Schubert et al., 2016, p. 478). Cohen and Murch’s Perceived Benefits Scales (PBS) consider the idea of “perceived benefits,” focusing explicitly on the changes that are regarded as positive by the individuals. Antoni et al. have also suggested the Benefit Finding Scale (BFS) (Schubert et al., 2016, p. 478).
Data Available through NHRVS
Given a large number of veterans and the significant scope of the problem, a national study on the health characteristics of individuals who have military backgrounds has been conducted. The National Health and Resilience in Veterans Study (NHRVS), aimed at ascertaining the well-being of veterans in the USA, has provided researchers with an abundance of data to be analyzed in connection with symptoms experienced by this population (Tsai et al., 2015). NHRVS presents a nationally representative sample of 5309 US veterans. The study was launched in 2011, with the first wave of participant data collected in October-December 2011 and the second wave conducted in September 2013. In total, the survey panel included more than eighty thousand households.
The gathered data included a range of sociodemographic, military, health, and psychosocial characteristics. Veterans reported symptoms of PTSD, depressive and generalized anxiety disorders, problems with physical health, a history of substance abuse, trauma, and suicidal ideation. In addition, such psychosocial variables as a sense of purpose, altruism, and gratitude were included. PTGI questionnaire data is also integrated into NHRVS. The PTGI-SF taken from Cann et al. (2010) is used in this study. PTGI-SF is a 10-item validated instrument that assesses PTGs in five domains. The results are evaluated based on the answers to ten questions, including the following:
- The person changed the priorities they have in life.
- The person started to appreciate their own life more.
- The person managed to accomplish things better.
- The person began to understand their own needs in spirituality better.
- The person developed a bond with others.
- The person found the aims in their own life.
- The person understands better how to cope with difficulties.
- The person’s religious beliefs are enhanced.
- The person understood they have more powers than they used to think.
- The person regains faith in other individuals (Cann et. al., 2010).
It is critical to remember that the short form allows scholars to concentrate on the most general spheres of life where the person might experience sudden positive changes in the process of PTG. The NHRVS dataset can be obtained and used for research on veteran health and well-being. For my dissertation research, I plan to use the NHRVS data to enhance the understanding of PTG and its occurrence in military veterans in the U.S. I am interested in examining factors uniquely associated with PTG in war veterans.
Posttraumatic Growth
Posttraumatic growth was assessed using the Posttraumatic Growth Inventory-Short Form (PTGI-SF; Cann et al., 2010; α=0.92). Total scores range from 0-50, and five subscales, including personal strength, relating to others, new possibilities, spiritual change, and appreciation of life, were assessed (sample item: “Please indicate the degree to which you experienced these changes in your life as a result of [WORST EVENT assessed on the LEC-5]: I know better than I can handle difficulties.”) Endorsement of “moderate,” “great,” or “very great” growth on any of the PTGI-SF items was indicative of PTG.
Given that the distribution of PTGI-SF scores was zero-inflated, non-normal, and positively skewed (Kolmogorov-Smirnov test statistic=0.13, p<0.001), we dichotomized responses based on the moderate or greater endorsement of any item; this approach to operationalizing endorsement of PTG has been used in a meta-analysis on the prevalence of PTG (Wu et al., 2019), as well as a recent study on the prevalence of COVID-19 pandemic-related PTG (Pietrzak et al., 2021).
Procedure
We analyzed data from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative sample of 4,069 U.S. military veterans. The NHRVS sample was drawn from KnowledgePanel®, a survey research panel of more than 50,000 households maintained by the research firm Ipsos. KnowledgePanel® is a probability-based survey panel of a representative sample of U.S. adults that covers approximately 98% of U.S. households. Panel members are recruited through national random samples, originally by telephone and now almost entirely by postal mail. To permit the generalizability of results to the entire U.S. veteran population, Ipsos computed post-stratification weights using the following benchmark distributions of U.S. veterans from the most recent (August 2019) Current Veteran Population Supplemental Survey of the Census Bureau’s American Community Survey: age, gender, race/ethnicity, metropolitan status, education, household income, the branch of service, and years in service.15 An iterative proportional fitting (raking) procedure was used to produce the final post-stratification weights. All participants provided informed consent, and the study was approved by the Human Subjects Subcommittee of the VA Connecticut Healthcare System.
Although previous studies proposed that veterans with PTSD are more likely to experience PTG achievement, these works utilized questionnaires based on the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV). This project, on the other hand, intends to refer to the most recent modification of the manual, DSM-V, released in 2013 (American Psychological Association [APA], 2013). As the current DSM edition introduces a broader definition of PTSD-facilitating experiences, the present study will explore the factors that promote PTG in veterans from a renewed and more extensive perspective. Correlate analysis will be the primary method of analyzing the retrieved data. In addition, the proposed research will consider veterans’ cultural belonging, as, according to Junger (2016), connecting with a certain cultural or ethnic group is a crucial element of positive psychological growth. The study results are expected to be beneficial for promoting wellness and resilience among veterans, improving their capabilities for battling trauma, and maintaining a high quality of life regardless of PTSD symptoms.
Method of Analyzing the Results
The analysis will be done using multiple regression. PTSD symptom levels will be measured using a summary score for the mental health component from the Medical Outcomes Study Short Form 8 health questionnaire and the IPF 7-item self-report short form (Lang et al., 2018). The association between PTG and PTSD will be measured using inferential statistics involving parametric association tests. The statistical tests used for each variable and corresponding research question are shown in Table 3 below.
Table 3: Statistical Tests
The method of analysis is based on a search for a correlation between the designated variables and a statistically significant difference between two samples. The key approaches include fitting linear and quadratic functions, analysis of variance, a multivariable logistic regression analysis, and multivariable analysis of variance (MANOVA). The sources of data are exclusively primary official sources containing statistical data that were collected originally for other studies. Within the context of the study, it is critical to consider the ontology and epistemology elements. Ontology is the reflection of the ontological approach in this study lies in the emphasis on the objects under consideration – veterans, to a greater extent than on external factors of influence. Epistemology is about data being obtained both directly from the sampling questionnaire and from the 2019-2020 NHRVS, which is the primary official source.
The study will have a within-subject design; the utilized instruments were assessed in previous studies. As these instruments showed the necessary alpha Cronbach’s values, it was determined that they had the necessary validity and were measuring the intended constructs, while testing of reliability is not applicable (Ware et al., 2001; Cann et al., 2010; Kleiman et al., 2020). Descriptive statistics can be calculated to summarize the used variables and determine the prevalence of PTG, PTSD, and mental and psychosocial functioning. Multivariable logistic regression is the non-parametric method, while linear and quadratic functions fit, analysis of variance, and MANOVA is parametric. However, in this work, non-parametric tests are mainly used because the nature of the distribution in the samples is not known. The applied methods will be used to find, with a certain level of confidence, the difference between the two designated samples and then find the correlation between the independent and dependent variables.
The study’s validity can be proven by operationalizing the variables and computing the measures’ validities: external, conclusion, construct, and internal. The operationalized concepts are PTG and PTSD, which will be measured by gathering subjective information regarding the veterans’ well-being and physical and mental health. In order to operationalize these definitions into measurable concepts, the various domains of PTG, PTSD, and mental and psychosocial functioning will be assessed. Each variable’s domain will be represented quantitatively, and fitting of linear and quadratic functions, analysis of variance, a multivariable logistic regression analysis, and multivariable analysis of variance (MANOVA) will be the analytical methods.
External validity is determined in this study using a reference distribution of the defining sample from the Supplementary Current Population Survey of Veterans. The calculation of post-stratification weights will achieve this indicator. The study’s reliability is explained by the implementation of the above parametric and non-parametric tests, questionnaires, and sampling procedures, while the design and internal validity of the study are not determined in this case.
Implications and Limitations
The present study will contribute to social work on topics such as trauma coping within clinical social work. Obtaining statistical evidence on the link between PTSD and PTG will contribute to understanding the psychosocial and mental dynamics of individuals who have experienced trauma. Military social work will benefit from further research on PTG and its relationship to PTSD. The key limitations include the control of confounding variables impacting the outcomes of the results.
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