International Society for Traumatic Stress Studies

What determines posttraumatic stress and growth following various traumatic events? A study in a Turkish community sample

Posted 28 January 2017 in JOTS Highlights by Ervin Gül, PhD & A. Nuray Karanci, PhD

Experiencing traumatic life events, such as natural disasters, accidents, life-threatening illnesses, torture, sexual and/or physical violence, unexpected death of loved ones, terrorist attacks, and many more, are unfortunately quite prevalent in the lifetime of adults. Every experience seems to be a different story, the story being shaped by the individuals’ history, characteristics and how they cope with the event and the meaning they give to the event. Thus, the psychological consequences of these events may be dissimilar for everyone. Negative consequences such as post-traumatic stress, depression, grief, substance abuse are among the consequences of experiencing such events. However, there is also the possibility that individuals exposed to trauma show resilience or they exhibit positive transformations in the process of coping with adversity. This positive transformation can be conceptualized as a growth process, named as post-traumatic growth or adversarial growth. Which factors pave way to these negative or positive outcomes? Which personality characteristics, event types, ways of coping strategies, rumination styles are responsible for these outcomes? What roles do perceived social support have following traumatic events? Are these variables culture-specific or more global? Do individuals experience post-traumatic stress symptoms (PTS) and post-traumatic growth (PTG) simultaneously? Do the previous research findings hold when the sample is a Turkish community group, a sample from a predominantly muslim, collectivistic culture as different from Western samples based on university populations or survivors of specific traumas?

In this study we aimed to understand the factors related to PTS and PTG as a consequence of experiencing various traumatic life events. Thus we explored to what degree personality traits, type of traumatic event, coping strategies, event-related ruminations, perceived social support relate to PTS and PTG. Our results were striking by demonstrating fair consistency with previous findings from Western samples.

Overall the findings from the current study indicated that PTS and PTG are associated with relatively different variables, with the exception of younger age, longer symptom-duration and deliberate-rumination, which were common to both of the outcomes. Being female and having low levels of income were associated with higher PTS severity. Personality traits appeared important for both outcomes, however different traits were prominent for the two outcomes. The findings showed that experiencing greater impairment of functioning relates to higher PTS. The current study also showed that different group of event-types had an impact on divergent outcomes.

The present study indicated that deliberate-rumination was a common factor for both symptom severity and PTG, whereas intrusive-rumination was only significantly associated with symptom severity. Thus, it seems that deliberately thinking about the traumatic event does not only increase PTS but it also facilitates PTG. Coping with the adversity also mattered: Fatalistic coping related to PTS, whereas problem-solving coping related to PTG. The results showed the contributory role of perceived social-support only for promoting PTG. In this study, although there was a low positive correlation between PTS and PTG, the regression analysis showed no significant effect of PTS on PTG.

The present study was particularly valuable by examining the worldwide discussed associates of two outcomes (i.e., PTS and PTG) following TEs in a relatively large community sample from a predominantly Muslim and collectivistic culture, thus, having potential to support/challenge the findings from western samples.

The study has some limitations regarding data gathering via face-to-face, one-time administration which may have inhibited the rates of disclosure of some type of events (e.g., assault/violence) and the post-event processing period may be underreported due to limited rapport with the participants. Secondly, the retrospective nature of data gathering and the cross-sectional design prohibited strict causal interpretations.

In mental health services, fostering deliberate-ruminative processes, improving active coping mechanisms, and providing awareness of available (if any) social support would be facilitators of growth. Another implication is that the symptoms of PTS should not just be seen as factors to be eliminated, but rather as an expression of the struggle which may initiate growth.

Discussion Question

  1. What do you think about the role of fatalistic coping strategies regarding cultural factors being related to higher levels of posttraumatic stress symptoms severity?
  2. What do you think about the different effects of two types of rumination labeled as intrusive and deliberate?

Reference Article 

Gul, E. and Karanci, A. N. (2017), What Determines Posttraumatic Stress and Growth Following Various Traumatic Events? A Study in a Turkish Community Sample. JOURNAL OF TRAUMATIC STRESS. doi:10.1002/jts.22161

Author Biographies

Ervin Gul, PhD completed her doctoral degree in Clinical Psychology Program at the Psychology Department of the Middle East Technical University, Ankara, Turkey. She involved and worked on many Trauma-Focused Projects around Turkey (Ankara, Erzincan, Kocaeli, Izmir) and on international projects (University College London, UK) related to resilience and preparedness to disasters. She worked as an Assistant Professor in Gediz University, Izmir, Turkey. She has been conducting psychotherapy sessions since 2009 under supervision and in private practice.

A. Nuray Karanci, PhD is a lecturer in the Psychology Department of the Middle East Technical University, Ankara, Turkey since 1980 and a practicing clinical psychologist. She got her M.S in Clinical Psychology from Liverpool University, U.K and her  PhD from Hull University U.K.  She has been extensively involved in research on psychological consequences of disasters, schizophrenia, anxiety disorders and other psychiatric problems and the implementation of psychosocial support programs in the aftermath of various disasters.