Post-Traumatic Growth and Stress Disorder Among Veterans

Words: 1814

Health & Medicine

6th Oct, 2023

The Problem Identification

The general purpose of the present research paper is to investigate the relationships between PTG, PTSD, and sociodemographic characteristics in the veteran populations according to the data provided by the 2019-2020 National Health and Resilience in Veterans Study (NHRVS). In addition, the study aims to examine the possible impacts of PTSD+PTG and PTSD-PTG conditions on the health and well-being outcomes of the United States veterans. The addressed problem is the impact of Post-Traumatic Growth (PTG) on the development of mental disorders, such as Post-Traumatic Stress Disorder (PTSD), in military veterans.

Considering that PTSD often negatively affects the mental and social functioning of the veteran populations, while PTG is believed to improve such functioning, it is essential to identify the primary relationships between PTSD and PTG. The literature gap to be attended is the lack of recent data regarding the connection between PTG and PTSD, as well as the absence of research on the relationships between PTG and sociodemographic data. The main theory utilized in the study will be the theory of Posttraumatic Growth.

The purpose statement can be divided into three parts: the health and mental disorders of the veterans; mental disorders development; and PTSG learning. Table 1 represents the main theories describing these parts.

The health and mental disorders of the veterans	A: Military-to-civilian transition B: Theory of suicide	A: Cooper et al., 2017 B: Pfeiffer et al., 2014	A: It explores why an enduring attachment to the military exists for Veterans and to develop an understanding of how ‘‘looking back’’ on life events experienced in the military may cause difficulty for some in transition. B: All military veterans have acquired the capability to die by suicide through military training, meaning this component of the interpersonal-psychological theory of suicide is present in all service members and veterans at all times.
Mental disorders development	A: Attachment Theory B: Network Theory	A: Belitsky & Jacobs, 1986 B: Borsboom, 2017	A: According to attachment theory, interactions with inconsistent, unreliable, or insensitive attachment figures interfere with the development of a secure, stable mental foundation; reduce resilience in coping with stressful life events; and predispose a person to break down psychologically in times of crisis 3. B: Network theory claims that mental disorders arise from a set of components (e.g., thoughts, emotions, behaviors, somatic experiences, and other relevant biological, psychological, or social factors) and the causal relationships among these components.
PTSG learning	A: Posttraumatic Growth Theory B: Emotional Processing C: Cognitive Model	A: Tedeschi & Calhoun, 2004 B: Foa & Rothbaum, 1998 C: Ehlers & Clark, 2000	A: A theory that explains this kind of transformation following trauma. B: The fear structures of trauma survivors with PTSD include two basic dysfunctional cognitions that underlie the development and maintenance of PTSD. C: It suggests a person will develop PTSD if the person processes a traumatic event in a way that leads to a feeling of a present and severe threat.

The Research Questions

The current study will include five research questions, with questions 1 and 2 being descriptive and questions 3, 4, and 5 being causal, demonstrated in Table 2.

Table 2: The relationship between research questions and variables

Research Question	Variable	Statistical Test
RQ1. How and at what rate does PTG spread?	Level of PTG	Cronbach Alpha
RQ2. Which ethnic groups and countries are most affected by PTG?	Level of PTG	Cronbach Alpha
RQ3. What is the link between PTG and PTSD? Is the combination of these syndromes effective, or does it have a worsening effect?	Level of PTG Level of PTSG	t-test
RQ4. How does the severity of trauma affect a person’s mental and physical health? Is there a relationship between severity and the consequences of the syndrome?	Mental functioning	t-test
RQ5. Can increased attention to one’s health affect the development of PTG among veterans?	Level of PTG	Cronbach Alpha

The Research 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.

The Study Variables

The included variables will be levels of PTG, mental and psychosocial functioning, and such sociodemographic data as ethnicity, partner status, and income. Levels of PTSD and PTG will be the independent variables in this study, while psychosocial and mental functioning will be dependent variables. Ethnicity, partner status, and income will be the control variables; no variables are to be manipulated during 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. 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. All these data are presented in Table 1. The relationship between research questions and variables is shown in Table 2.

Table 1: Descriptions and operational definitions for included variables

Variable	Research Question and/or Hypothesis	Operational Definition & Citation
Variable 1: Level of PTG	How and at what rate does PTG spread? Which ethnic groups and countries are most affected by PTG? What is the link between PTG and PTSD? Can increased attention to one’s health affect the development of PTG among veterans? H0: The combination of PTSD+PTG effects is not connected to better functioning in comparison with PTSD-PTG.	PTG is defined as “a result of processes initiated by a significant challenge to a person’s assumptive world” (Tedeschi et al., 2018, p. 6). The Posttraumatic Growth Inventory Short-Form (PTGI-SF), all questions (Cann et al., 2010).
Variable 2: Mental functioning	How does the severity of trauma affect a person’s mental and physical health? Is there a relationship between severity and the consequences of the syndrome?	Deviations of mental function are described in eight different planes: from physical functioning, its limitations, bodily pain and the ratio of energy and fatigue, to social functioning and its role limitations against the background of emotional problems (SF-8 Health Survey; Ware et al., 2001).
Variable 3: Psychosocial functioning/PTSD	Which sociodemographic, trauma, health, and psychosocial factors are related to PTG? What is the link between PTG and PTSD? H0: The combination of PTSD+PTG effects is not connected to better functioning in comparison with PTSD-PTG.	PTSD-related functional impairment, such as lower interest in social activities, feelings of detachment, and overall perceptions of functional difficulties. Brief Inventory of Psychosocial Functioning (B-IPF; Kleiman et al., 2020).
Control variables 1, 2, and 3: ethnicity, partner status, and income	How is each of the control variables related to the levels of PTG, PTSD, and mental and psychosocial functioning?	Benchmark distributions of U.S. veterans provided by the Current Veteran Population Supplemental Survey (U.S. Census Bureau, n.d.)

The Research Design and Methods

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). Analysis of variance and MANOVA will be the tests of comparison in the study. 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.

Validity and Reliability of the Instrument

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).

The Major Strategy for Sampling

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. The data presented will be on the ordinal level since it can be categorized and ranked while the intervals cannot be inferred.

The Use of Descriptive Statistics

Descriptive statistics can be calculated to summarize the used variables and determine the prevalence of PTG, PTSD, and mental and psychosocial functioning.

Parametric and Non-Parametric Methods of the Study

The multivariable logistic regression is the non-parametric method, while linear and quadratic functions fit, analysis of variance, and MANOVA are parametric. However, in this work, non-parametric tests are mainly used, due to the fact that the nature of the distribution in the samples is not known. In fact, 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.

Validity of the Study

Study’s validity can be proven by operationalizing the variables and computing the measures’ validities: external, conclusion, construct, and internal.

The Operationalization of the Study Variables

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. To operationalize these definitions into measurable concepts, the various domains of PTG, PTSD, and mental and psychosocial functioning will be assessed. Additionally, it will be established how each of the concepts is to be represented in respondents’ answers regarding their behavior and well-being. 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.

Ontology: 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: data will be obtained both directly from the sampling questionnaire and from the 2019-2020 NHRVS, which is the primary official source.
Methodology: search for a correlation between the designated variables and a statistically significant difference between two samples.
Methods: fitting of linear and quadratic functions, analysis of variance, a multivariable logistic regression analysis, and multivariable analysis of variance (MANOVA).
Types of sources: exclusively primary official sources containing statistical data that were collected originally for other studies.

References

Belitsky, R., & Jacobs, S. (1986). Bereavement, attachment theory, and mental disorders. Psychiatric Annals, 16(5), 276-280.

Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5-13.

Cann, A., Calhoun, L. G., Tedeschi, R. G., Taku, K., Vishnevsky, T., Triplett, K. N., & Danhauer, S. C. (2010). A short form of the Posttraumatic Growth Inventory. Anxiety, Stress, & Coping, 23(2), 127-137.

Cooper, L., Caddick, N., Godier, L., Cooper, A., Fossey, M., & Engward, H. (2017). A model of military to civilian transition: Bourdieu in action. Journal of Military, Veteran and Family Health, 3(2), 53-60.

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.

Foa, E.B., & Rothbaum, B.O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford.

Kleiman, S. E., Bovin, M. J., Black, S. K., Rodriguez, P., Brown, L. G., Brown, M. E., & Marx, B. P. (2020). Psychometric properties of a brief measure of posttraumatic stress disorder–related impairment: The Brief Inventory of Psychosocial Functioning. Psychological services, 17(2).

Na, P. J., Tsai, J., Southwick, S. M., & Pietrzak, R. H. (2021). Factors associated with post-traumatic growth in response to the COVID-19 pandemic: Results from a national sample of U.S. military veterans. Social Science & Medicine (1982). Web.

Pfeiffer, P. N., Brandfon, S., Garcia, E., Duffy, S., Ganoczy, D., Kim, H. M., & Valenstein, M. (2014). Predictors of suicidal ideation among depressed veterans and the interpersonal theory of suicide. Journal of Affective Disorders, 152, 277-281.

Pietrzak, R. H., Tsai, J., Armour, C., Mota, N., Harpaz-Rotem, I., & Southwick, S. M. (2015). Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: Results from the National Health and Resilience in Veterans Study. Journal of Affective Disorders, 174, 522–526. Web.

Tedeschi, R. G., & Calhoun, L. (2004). Posttraumatic growth: A new perspective on psychotraumatology. Psychiatric Times, 21(4), 58-60.

Tedeschi, R. G., Shakespeare-Finch, J., Taku, K., & Calhoun, L. G. (2018). Posttraumatic growth: Theory, research, and applications. Routledge.

Tsai, J., El-Gabalawy, R., Sledge, W. H., Southwick, S. M., & Pietrzak, R. H. (2015). Post-traumatic growth among veterans in the USA: Results from the National Health and Resilience in Veterans Study. Psychological Medicine, 45(1), 165–179. Web.

Tsai, J., Sippel, L. M., Mota, N., Southwick, S. M., & Pietrzak, R. H. (2016). Longitudinal course of posttraumatic growth among US military veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 33(1), 9–18. Web.

U.S. Census Bureau. (n.d.). Current Population Survey (CPS). Web.

Ware, J. E., Kosinski, M., Dewey, J. E., & Grandek, B. (2001). How to score and interpret single-item health status measures: A manual for users of the SF-8 Health Survey. QualityMetric.