Development and Evaluation of the Posttraumatic Growth Status Inventory

doi:10.4236/psych.2013.411120

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Psychology

2013. Vol.4, No.11, 831-844

Published Online November 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.411120

Open Access 831

Development and Evaluation of the Posttraumatic Growth

Status Inventory

Tatjana Alexander1, Rainer Oesterreich2

1Department of Rehabilitation Psychology, Albrecht-Ludwigs-University of Freiburg, Freiburg, Germany

2Department of Quantitative Methods, University of Technology, Berlin, Germany

Email: tatjanabarsk@gmx.de

Received August 11th, 2013; revised September 12th, 2013; accepted October 13th, 2013

Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any

medium, provided the original work is properly cited.

Posttraumatic growth reflects beneficial psychological processes in persons with traumatic experiences.

Existing measures of growth were criticized due to their retrospective self-report format that may cause

biases in capturing the growth processes in individuals with several specific kinds of trauma, such as phy-

sical or psychological disabilities of close family members, bereavement and some others kinds of trau-

matic experience. In this case, the feelings of guilt may prevent the persons from being aware of the fa-

vorable personal changes. The objective of this study was to develop and to evaluate an alternative meas-

uring instrument that uses a status quo response format instead of retrospective items and covers addi-

tional areas of growth-related changes. The samples comprised 440 adult persons with traumatic expe-

rience, including 181 parents of children with mental and/or physical disabilities. Exploratory and confir-

matory factor analyses revealed a 7-factors solution, corresponding to the following subscales: Relation-

ships to Others, New Possibilities, Personal Strength, Appreciation of Life, Spiritual Changes, Generativ-

ity, and Openness. Results showed good reliability and concurrent validity. The PGSI is recommended

particularly for use in longitudinal studies as well as in samples of persons whose trauma relates to a se-

vere psychological or physical disability in their families.

Keywords: Posttraumatic Growth; Coping; Resources; Inventory

Introduction

In the past decade, the possibilities of multifaceted positive

psychological outcomes, as a consequence of a traumatic life

experience, such as an onset of severe health problems in a

person her/himself or in a close family member, bereavement or

experience of violence, became more and more the objective of

theoretical and empirical research work. The approaches to de-

scribe the underlying psychological changes led to creating

scientifically-founded concepts like posttraumatic growth (PTG,

Calhoun, & Tedeschi, 1999; Tedeschi & Calhoun, 2004), ad-

versarial growth (Linley & Joseph, 2004), thriving (O’Leary &

Ickovics, 1995), benefit finding (Affleck & Tennen, 1996), and

stress-related growth (Park, 1996). From these terms, describ-

ing comparable processes in the aftermath of a traumatic event,

the term “posttraumatic growth” seems to be the most establi-

shed. The concept ‘posttraumatic growth’ serves as an expres-

sion for processes of changing life orientations and priorities as

well as the achievement of a new level of feelings and self-

awareness. These processes are initiated by the attempts to

adapt to highly challenging life circumstances that can produce

high levels of psychological distress. The person’s struggle with

the new reality in the aftermath of trauma is essential in influ-

encing the degree and the individual profile of posttraumatic

growth. Eventually, the processes of growth involve a move-

ment beyond pre-trauma levels of adaptation, they represent ra-

ther ongoing development as a static outcome (Tedeschi & Cal-

houn, 2004). Persons often characterize the corresponding chang-

es as valuable enrichment in their lives. The following domains

of perceived personal growth processes were discussed in em-

pirical literature: changes in self like feelings of being strong

and more self-assured, a new sense of increased closeness in re-

lationships with others, open-mindedness, religiosity/spirituali-

ty changes, as well as alterations in philosophy of life including

increased life appreciation and the attempt to live each day to

the fullest (Schaefer & Moos, 1992; Calhoun & Tedeschi, 1999;

Tedeschi & Calhoun, 2004; Danoff-Burg & Revenson, 2005).

In order to capture growth processes, studies use the Post-

traumatic Growth Inventory (PTGI, Tedeschi, & Calhoun, 1996),

the Benefit Finding Scale (BFS, Antoni et al., 2001; Tomich &

Helgenson, 2004), or the Stress-Related Growth Scale devel-

oped by Park and collaborators (SRGS, Park, Cohen, & Murch,

1996). These measures differ in regard to the following aspects

which will be addressed in turn: a) the target population, for

whom the particular measure was designed, b) priority at the

focal point in the assessment procedure, c) the degree to which

a measure allows for the differentiation between various growth

domains, (d) and general connotation of the items.

a) The first discrepancy concerns the target population. Where-

as the PTGI and the SRGS were developed for and are com-

monly applied in populations with different kinds of traumatic

experience, the BFS was originally designed specially for using

with individuals whose trauma relates to severe medical condi-

tions, primarily actual or past cancer. Recently, this measure

T. ALEXANDER, R. OESTERREICH

was also used to capture beneficial psychological changes in fa-

mily caregivers (Kim, Schulz, & Carver, 2007).

b) When regarding the content, the growth measures differ

slightly in the focal point in the assessment procedure. All three

measuring instruments represent the growth facets relationships

to the others, and personal strength, respectively.

However, the Benefit Finding Scale only contains a great

number of items capturing family relationships growth and ac-

ceptance. In contrast, the PTGI as well as the SRGS, but not the

BF measures religious/spiritual changes. Furthermore, the PTGI

includes items that relate to “life appreciation” and “new possi-

bilities” growth domains, which are not covered sufficiently by

the SRGS and the BFS. At last, the SRGS is a single measure

which comprises several items capturing self-understanding and

affect-regulation as additional growth aspects.

c) The degree to which each of the measures allows for the

differentiation between various growth domains depends on the

dissimilarity in items content and on the underlying factorial

structure of the questionnaires, which may serves as a founda-

tion for composition of separate subscales. For the PTGI, the

stability of a five-factor structure was proved in empirical stud-

ies (Tedeschi & Calhoun, 1996; Maercker & Langner, 2001;

Taku et al., 2008).

Less unambiguous were the results of factor analyses on the

BFS and the SRGS items. Various investigations revealed dif-

ferent factorial solutions [Antoni et al., 2001 (BFS, 1 factor);

Weaver et al., 2008 (BFS, multiple factor models); Kim, Schulz,

& Carver, 2007 (BFS, 6 factors); Park, Cohen, & Murch, 1996

(SRGS, 1 factor); Armeli, Gunthert, & Cohen, 2001 (SRGS, 8

factors); Maercker & Langner, 2001 (SRGS, 1 factor)]. As a

consequence, no established subscales were created; the total

scores only had been commonly used in studies as a global

growth assessment.

d) The fourth difference concerns the general connotations of

each of the separate items. The BFS inquires about things “The

disease taught me to do or to feel”, suggesting a somewhat pas-

sive role for the affected persons, whereas the PTGI and the

SRGS ask for changes, which “one has experienced as a result

of traumatic events”, seeing respondents as more “active” sub-

jects.

On the whole, existing measures of growth proved to be very

useful in the research on positive adaptation and beneficial

psychological processes in the aftermath of significant trau-

matic events. Nevertheless, they were also criticized in the li-

terature due to several limitations. The main criticism arises out

of the retrospective self-report format: All currently available

measures ask for subjective experiences of trauma related

changes; they do not capture the “status quo” of growth proc-

esses. The retrospective measurement of changes implies, that

people can correctly compare their actually attributes with their

pre-trauma characteristics. However, the recollection of how

they were prior to the time of traumatic life event may be dis-

torted due to cognitive biases. For example, McFarland and

Alvaro (2000) observed that traumatic event victims tended to

derogate their pre-event characteristics. Another study address-

ed the issue, whether current methods of measuring PTG (i.e.,

linked questions to stressful event) generally create a positive

bias which may undermine the data validity (Smith & Cook,

2004). In order to examine positive biases in self-reported growth,

Smith and Cook compared reports of growth from two groups

of individuals. In the first group, participants completed the

Posttraumatic Growth Inventory in relation to a specific stress-

ful event. In the second group, PTGI questions were not linked

to specific events. Instead, participants were instructed to gen-

erally think about the past 4 years, and indicate the degree to

which specific, personal changes occurred. In the “unlinked

group” only, individuals exposed to traumatic events reported

greater growth in Personal Strength and Relationships to Others

than participants who did not experience a traumatic event

within last four years. The authors conclude that current meas-

urements may actually underestimate PTG to a small but sig-

nificant degree. Linking questions about PTG to specific stress-

sors could influence participants to be cautious about attributing

their growth experiences to a stressful event.

Furthermore, due to a retrospective item format, current growth

scales are less appropriate in measuring the beneficial growth

processes in individuals whose traumatic experience is related

to several specific conditions like a physical disease or a psy-

chological disorder in their families. In this case, the feelings of

guilt may prevent the persons from being aware of the favor-

able personal changes (Peters & Jackson, 2009; Johnson, O’Reil-

ly, & Vostanis, 2006; Alexander & Wilz, 2010). Qualitative re-

search demonstrates several concrete examples of such intra-

psychic ambivalence. For instance, a mother of a child with se-

vere health-related problems reported barriers to acknowledge

positive changes: “The harm of my child cannot be profitable

for me in any way” (Schirmer & Alexander, 2013).

Another criticism of the currently available growth scales is

that they do not cover all potentially relevant growth domains

(e.g., Park & Lechner, 2006). Thus, according to findings from

qualitative research, positive changes often occur in areas like

more attentiveness for one’s own needs and feelings (Mohr et

al., 1999), self-care (e.g., Siegel & Schrimshaw, 2000; Paken-

ham, 2007; Affleck et al., 1987), open-mindedness and the way

one treats others, particularly the pleasure in supporting others

and in sharing one’s own knowledge and helpful life experience

(Cadell & Sullivan, 2006; Danoff-Burg & Revenson, 2005; Up-

degraff et al., 2002). The last mentioned intrapersonal changes

often occur in relation to several specific kinds of trauma, in-

cluding experience concerned to severe physical or psycholo-

gical health conditions in the family (e.g. Alexander & Wilz,

2010; Barskova & Oesterreich, 2009). None of the existing

growth measures includes subscales which address the corres-

ponding growth areas.

In regard to these criticisms, the goal of the study was to de-

velop and to evaluate a Status Quo Measure of Posttraumatic

Growth that should overcome several problems of the existing

questionnaires. Firstly, the item format of a newly developed

inventory should allow to avoid or to reduce cognitive biases

during information recall up to a substantial degree. In order to

sidestep potential response distortions caused through interfered

feelings of guilt or shame (which arise particularly often in peo-

ple whose traumatic experience relates to a misery of their close

relatives, such as a physical disease or a severe psychological

disorder), the items should inquire what a respondent currently

senses, feels, thinks and/or does, without building an explicit

connection to a definite critical life event. Secondly, a new

measure of growth was supposed to differentiate between sepa-

rate growth domains, including growth areas highlighted in cur-

rent empirical literature on beneficial growth processes in rela-

tives of chronically disabled persons. On the whole, the new

measuring instrument (the Posttraumatic Growth Status Inven-

tory, PGSI) should facilitate a multidimensional construct-ade-

quate capturing of complex intra-personal growth-related proc-

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T. ALEXANDER, R. OESTERREICH

esses in individuals with different kinds of traumatic experi-

ence.

In order to estimate the concurrent validity of the PGSI, we

aimed for capturing the correlations between the PGSI sub-

scales and the psychological health indicators as well as corre-

sponding correlations between the PGSI and several measures

of coping behavior. As demonstrated in empirical investigations,

posttraumatic growth has been found to be positively linked to

several criteria of psychological health and to the adaptive cop-

ing strategies, in case a sufficiently long period of time has

passed since the initial traumatic event (Siegel & Schrimshaw,

2007; Ho, Chan, & Ho, 2004; Lechner et al., 2006; Mc Millen

& Cook, 2003; Morris, Shakespeare-Finch, & Scott, 2007; Sch-

midt et al., 2012; Kountrouli, Anagnostopoulos, & Potamia-

nos, 2012). Further studies showed significant negative rela-

tionships between the posttraumatic growth and maladaptive,

dysfunctional coping, like substance abuse and behavioral dis-

engagement (Urcuyo et al., 2005; Milam, 2004; Loiselle et al.,

2011).

In view of the results from these studies, we resolved to use

the mental health- and coping-related variables as appropriate

criteria in testing the concurrent validity of the PGSI in the final

stage of the study. We expected negative associations of the

PGSI with depression, anxiety, physical complaints and mal-

adaptive coping strategies. In contrast to this, we hypothesized,

that the correlations between the PGSI and different adaptive

coping strategies, such as active coping, seeking for social sup-

port and regenerative coping would be positive.

Method

Participants and Procedure

The general purpose of this study was to develop a measur-

ing instrument of posttraumatic growth that, due to its status

quo item format (as well as capacity to capture additional growth

areas), may be particularly appropriate for using with individu-

als who experienced several specific kinds of trauma, such as a

physical disease or a psychological disorder in a close family

member. In addition to this, the questionnaire should be, overall,

applicable in studies focusing on beneficial psychological pro-

cesses in the aftermath of different kinds of serious traumatic

experience. Consequently, in the stage of item selection and the

initial psychometric screening, we decided to select participants

with a broad array of significant psychological traumas. In the

second stage, the psychometric properties and the factorial

structure of the newly developed inventory were repeatedly

tested, especially in samples of individuals with disease-related

traumata.

In accordance with this procedure, the data collected from

sample one were used to complete the item selection, to iden-

tify the factorial structure underlying the newly developed Post-

traumatic Growth Status Inventory and to screen psychometric

properties of the separate PGSI subscales. The first sample con-

sisted of 118 university students and 96 employed adults with

different kinds of significant traumatic experience. Several ad-

vertisements at the university and an advertisement at a local

newspaper provided information about the project. Due to the

fact that the whole questionnaire packet was somewhat long

and required ca. sixty minutes to fill-out all measures, the parti-

cipants could pick up the questionnaire at the university and

complete it at home. In an attempt to reduce the missing data

and to foster the motivation, all participants received ten Euros

and a brief anonymous feedback concerning their individual

test scores in comparison with the norm values of the used mea-

suring instruments (when available) and the mean values from

the whole sample.

Sample two was recruited in order to test the stability of the

initial factorial solution that was identified in sample one, and

to provide empirical evidence concerning the validity and the

reliability of the newly developed Posttraumatic Growth Status

Inventory. As mentioned above, an important aim of the study

was to develop a measure of posttraumatic growth that should

be suitable to capture growth processes in individuals whose

trauma relates to their close relatives’ highly stressful experi-

ence, such as a mental or a physical disability in their families.

Consequently, the second sample should include individuals

with this kind of trauma. To recruit the eligible participants, we

contacted professionally moderated self-help groups for parents

of children with different kinds of disabilities as well as several

doctors’ offices. One hundred eighty-one parents of children

with mental or physical disabilities and 45 adult persons whose

trauma related to their own severe medical conditions gave

their consent to participate in the study and completed the ques-

tionnaires. The corresponding return rate resulted in 92%. To

foster commitment, similar to sample one, the participants re-

ceived anonymous detailed feedback regarding their individual

test scores in comparison with the mean values from their ref-

erence group as well as the information about the main results

of the whole study, after completion of the investigation.

Measures

Demographics and Information about Traumatic Events

All participants responded to several questions concerning

demographic information. As preview research demonstrated

the role of emotional support as an important predictor on post-

traumatic growth and, generally, positive psychological adjust-

ment (Barskova & Oesterreich, 2009; Taylor & Stanton, 2007),

the respondents were also asked to which extent they have the

possibility to talk with a supportive person about their problems

in a confidential way, if necessary. In addition, participants of

sample one (mixed sample of university students and employed

adults with different kinds of traumatic experience) were asked

to provide information about the traumatic life event they had

experienced within the past five years, including the nature of

the event and the time elapsed since the event. Participants of

the sample two (whose trauma was related to either their own

severe medical condition or to their child mental or physical di-

sability) were asked about the time elapsed since the diagnosis

and the extent to which the awareness of the diagnosis was up-

setting for them, with scores ranging from 0 (hardly upsetting)

to 3 (completely upsetting).

Coping

To assess what coping strategies participants preferred in

dealing with stressful events in their lives, we used the Brief

COPE questionnaire (Carver, 1997). The Brief COPE includes

14 subscales: active coping, planning, positive reframing, ac-

ceptance, use of humor, turning to religion, using emotional

support, using instrumental support, self-distraction, denial, vent-

ing, substance use, behavioral disengagement, and self-blame.

Response options ranged from 0 (I don’t do this at all) to 3 (I

do this a lot). Previous research has demonstrated the internal

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T. ALEXANDER, R. OESTERREICH

reliability and convergent validity of the Brief COPE subscales

(Carver, 1997; Muller & Spitz, 2003). Several subscales of the

questionnaire may be classified as adaptive, functional coping

behavior (e.g., active coping, planning, and using emotional

support), the others capture rather maladaptive, dysfunctional

co-ping (e.g., substance use, behavior disengagement, and self-

blame).

In order to estimate the degree to which participants use re-

generative coping that is not captured by the Brief COPE, we

composed a short scale consisting of 4 items (e.g., “I learn spe-

cific relaxation techniques”). The internal consistency of this

additional short scale was acceptable (Cronbach’s alpha of .71

in sample one and Cronbach’s alpha of .73 in sample two).

Health Indicators

The Impact of Event Scale-Revised (IES-R; Weiss & Mar-

mar, 1997) was applied to capture the degree of the posttrauma-

tic stress disorder symptoms (PTSD) in the aftermath of trau-

matic events. The IES-R is a 22-item scale assessing intrusive

thoughts, avoidance, and hyperarousal symptoms consistent

with PTSD. Participants were asked to focus on the time im-

mediately after their traumatic experience and then indicate

how much they were distressed or bothered during this time by

each “difficulty” listed. Items were rated for frequency of oc-

currence on a 5-point scale ranging from 0 (“not at all”) to 4

(“extremely”). The convergent validity of the IES-R was ex-

amined in previous studies by assessing the correlations be-

tween the IES-R and the PTSD checklist and could be classified

as “high” (Creamer, Bell, & Failla, 2003).

Somatization, depression and anxiety subscales from the

Brief Symptom Inventory (BSI, Derogatis, 1993) were used to

assess recent mental health status. The somatization subscale

captures psychological distress resulting from the perception of

body dysfunction (e.g., cardiovascular, gastrointestinal, and re-

spiratory). The depression subscale addresses symptoms of cli-

nical depressive syndrome, such as withdrawal of interest in life

activities, dysphoric affect, and loss of energy. Typical anxiety

symptoms measured with the anxiety subscale are nervousness,

restlessness, and tension. Previous studies have revealed satis-

factory internal reliability of above .70 and the good convergent

validity for the separate BSI subscales (Derogatis & Melisara-

tos, 1983; Derogatis, 1993). Concordant to the results from the

previous research, the internal reliabilities of the BSI subscales

reached in our study (in the sample two) adequate values

of .84, .86, and .83 for anxiety, depression, and somatization

subscales, respectively.

To receive additional information concerning participants’

somatic complaints, we applied the Freiburg Complaint List

(the FBL-R, Batra, Slifkin, & Fahrenberg, 1995). The FBL-R is

a self-report standardized questionnaire that lists different gen-

eral as well as specific physical complaints including tiredness,

pain, sensory, cardiovascular, and gastrointestinal symptoms.

The respondents were asked how often they experience each of

the different somatic complaints mentioned in the questionnaire.

The total score of the FBL-R was used in our study as an indi-

cator of the self-reported physical well-being. Prior research

provided empirical evidence for the concurrent validity of the

Freiburg Complaint List. In a representative sample of adults,

highly significant correlations were found between FBL-R

scores and indicators of illness, health concern, and utilization

of health services (Fahrenberg, 1995).

Posttraumatic Gr owth

Participants of sample one responded to the initially 48 items

which should constitute the newly developed Posttraumatic

Growth Status Inventory. Some of the items were adapted from

existing scales, and others were generated from the relevant

empirical and theoretical literature and from the interviews with

individuals facing various traumatic events (for authors’ quail-

tative research and literature review see Barskova & Oester-

reich, 2009; Schirmer & Alexander, 2013).

A substantial part of the persons (n = 45) who were inter-

viewed in the stage of the item generation, were individuals

with a traumatic experience related to severe physical condi-

tions or psychological disabilities of their close relative (a child

or a spouse living in the same home). Each item from the initial

item pool was rated using a 7-point Likert scale, ranging from 1

(does not apply) to 7 (completely applies). Items addressed the

following nine potential growth domains: appreciation for life

(e.g., “Every day is special to me”), relationships to others (e.g.,

“I know I can depend on others in difficult times”), new possi-

bilities (e.g., “I know from experience that difficult and fearful

events can bring about various unexpected possibilities”), per-

sonal strength (e.g., “I can handle difficulties well”), spirituality

(e.g., “I have a pronounced religious or spiritual faith”), open-

ness (e.g., “I enjoy listening to others opinions even when they

contradict what my convictions are”), treating others (e.g., “I

enjoy sharing my experiences to help others to find a solution

to their problems”), sustainability (e.g. “Sometimes, I reflect

how my life would be after the next five years”), and world

view (e.g., “I am interested in other cultures”). In the second

sample, respondents completed the final form of the newly

developed PGSI that contained 36 items.

Participants of both samples also completed the Posttrau-

matic Growth Inventory (PTGI, Tedeschi, & Calhoun, 1996).

The PTGI is a 21-item questionnaire that measures the degree

of the positive changes experienced in the aftermath of a trau-

matic event. The PTGI contains five subscales. The internal

consistency for the total score and separate subscales of the

PTGI has been reported as satisfactory (Cronbach’s Alpha co-

efficient for the total score = .90; Relating to others = .85; Per-

sonal Strength = .72; New Possibilities = .84; Spiritual Change

= .85; and Appreciation of Life = .67). Further, women were

found to receive higher scores than men (Tedeschi & Calhoun,

1996).

Data Analyses

Data analyses procedure included seven major stages. First,

the exploratory factor analysis (EFA) was conducted among the

data of sample one. All 48 items from the original pool were

entered into the exploratory factor analysis. The purpose of this

phase was to specify a statistically and meaningfully viable mo-

del of the factor structure underlying the newly developed ques-

tionnaire and to identify items with inappropriate item parame-

ters that should be eliminated. At stage two, in light of the re-

sults of the exploratory factor analysis, item selection took place,

followed by the labeling of the factors and specification of sub-

scales’ composition in phase 3. During stage four, we comple-

ted a brief preliminary assessment of the PGSI subscales inter-

nal consistency and estimated their correlations with correspon-

ding subscales of the retrospective posttraumatic growth meas-

ure from Tedeschi and Calhoun (1996) as measures for crite-

rion validity. After this, the correlations between the PGSI sub-

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T. ALEXANDER, R. OESTERREICH

scales and post-event symptoms of posttraumatic stress disorder,

such as avoidance, intrusions and hyperarousal, were calculated.

In terms of concurrent validity, we expected that the PGSI sub-

scales would be positively associated with symptoms of post-

traumatic stress disorder experienced immediately in the after-

math of a traumatic event.

At stage 5, using the data of the sample two, we conducted

the Confirmatory Factor Analysis (CFA) upon the remaining

thirty-six items to examine the construct validity and the stabil-

ity of the factorial solution. Further, we tested the criterion and

concurred validity as well as the Cronbach’s Alpha reliability

of the finally 36-item version of the Posttraumatic Growth Sta-

tus Inventory (stage 6 and stage 7) in sample two. Similarly to

the procedure in sample one, the criterion validity was esti-

mated by analyzing the correlations between the newly devel-

oped PGSI subscales and the “classical” measure of posttrau-

matic growth from Tedeschi and Calhoun (1996). The concur-

rent validity was assessed in this final stage by calculating the

correlations between the PGSI subscales and psychological

health indicators as well as corresponding correlations between

the PGSI and several measures of coping behavior. As it is

recommended in the guidelines on estimating the validity of the

measures comprising of the multiple subscales (APA, 1999;

Crocker & Algina, 1986), we used several kinds of potentially

associated variables in order to provide a possible differentiated

picture of concurrent validity for each separate subscale. By

reason that the validity estimation procedure of this kind bears a

predominantly descriptive character, we refrained from the ap-

plication of the alpha error corrections, as it is common in the

initial testing of the psychometric properties of the newly de-

veloped measuring instruments with a multi-factorial structure

(APA, 1999; Crocker & Algina, 1986).

Confirmatory Factor Analysis

An import part of this study was the application of the con-

firmatory factor analysis (CFA) in sample 2 to examine con-

struct validity and stability of the factorial solution of the PGSI.

In contrast to the EFA, the aim of which is simply to identify

the factor structure underlying the set of variables, the goal of

the CFA is to test a hypothesized factor structure or statistical

model and to assess its fit to the data.

The estimation of model fit was based on multiple criteria

that reflected statistical and practical considerations. The re-

ported goodness-of-fit statistics include chi-square value, the

normed chi-square (chi square/df), as well as the Goodness of

Fit Index (GFI) and the Root Mean Square Error of Approxi-

mation (RMSEA). The statistically significant chi square indi-

cates that a significant proportion of variance in the data re-

mains unexplained by the model; however a statistically sig-

nificant chi-square can often be produced as an artifact of sam-

ple size and small variations in the data (Hu & Bentler, 1995).

The normed chi-square (chi square/df) should fall within the

levels of 1.0 to 3.0 for acceptable fit (Carmines & McIver,

1981). The RMSEA expresses the lack of fit due to reliability

and also model (mis)specification. RMSEA should be smaller

than .08 for acceptable fit, values ranging from .08 to .10 indi-

cate mediocre fit, and those greater than .10 indicate poor fit

(Byrne, 2001; MacCallum, Browne, & Sugawara, 1996). The

GFI is the Goodness of Fit Index. The GFI can be classified as

absolute index of fit because it basically compares the hypothe-

sized model (i.e., factorial structure) with no model at all. The

GFI varies from 0 to 1, but theoretically can yield meaningless

negative values. By convention, GFI should by equal to or

greater than .90 to accept the model (Jöreskog & Sörbom, 1984;

Loehlin, 2004). By this criterion the present model is accepted.

Results

Step 1: Item Selection and Preliminary Assessment of

Validity and Reliability of the Newly Developed

Subscales Based on the Data from the Sample One

The Descriptive Characteristics of Sample One

As reported above, sample one consisted of 118 undergradu-

ate students who experienced a highly stressful event during the

past five years as well as 96 employed adults who also stated

that they were traumatized by a personally significant event

within the same 5-years period of time. The average age in this

sample was 32 years; sixty-five percent of the respondents were

women (n = 140) and thirty-five percent were men (n = 74).

The events the study participants had experienced were catego-

rized as follows: a) bereavement (25%); b) serious disease of

close relatives (19%); c) severe enduring interpersonal conflicts

with one significant person (14%); d) completely change of the

familiar surroundings (12%); e) personal illness or accident

(6%); f) grave work-related or academic problems (6%); g) so-

cial abuse (by a group of people) (4%); h) a victim of violence

(4%); i) injury-producing accidents in immediate family (3%); j)

pregnancy-related problems (2%); k) witness of violence (1%);

l) bankruptcy (1%); m) tsunami (.5%); n) other (2.5%). On the

average, participants’ most stressful event occurred 35.78 months

(SD = 21.05), i.e., approximately three years prior to data col-

lection.

Item Selection Based on Results of the Exploratory Factor

Analysis

All 48 items from the original pool were entered into an ex-

ploratory factor analysis using principal components extraction

and oblique rotation. The oblique rotation was chosen by reason

that, corresponding with previous research (Tedeschi & Cal-

houn, 1996; Maercker & Langner, 2001), the different domains

of posttraumatic growth were expected to be correlated. The

factor solution was determined by the number of factors gener-

ated with eigenvalues greater than 1, as well as by theoretical

considerations. Because the factor solutions for students and

non-students were virtually identical, data from the sub-samples

of participated students and employed adults with traumatic

experience were combined. Eight factors had an eigenvalue

greater than one. Examination of the pattern of factor loadings

revealed 8 items that had factor loadings less than .30. These

items were dropped. The remaining forty items were subjected

to another exploratory factor analysis. Results of this second

factor analysis were principally the same as the original facto-

rial solution. Each item loaded highest on its respective factor

and had relatively low loadings (<.30) on all other factors. Cor-

responding to the content of the items which constituted the

separate factors, the factors were labeled as following: relation-

ships to others, personal strength, new possibilities, spiritual-

ity/religiosity, openness, generativity, appreciation for life, and

sustainability. Eight subscales with the similar labels as those

of the separate factors were composed based on the results from

the factor analysis.

As a next analysis step, the Pearson inter-correlations be-

tween the separate subscales were calculated. Somewhat sur-

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T. ALEXANDER, R. OESTERREICH

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836

prisingly, the sustainability subscale showed very low correla-

tions with other subscales of the questionnaire, a part of which

was even non-significant negative, indicating that sustainability

does not constitute a facet of posttraumatic growth. Conse-

quently, the four items of this subscale were also eliminated.

For the remaining seven inventory subscales (Table 1), positive

statistically significant inter-correlations were demonstrated

(Table 2).

Preliminary Assessment of the Psychometric Properties of

the PGSI

The thirty-six items of the resulting Posttraumatic Growth

Status Inventory (PGSI) are listed in Table 1, along with the

scale names. Response options of the items are “does not ap-

ply”, “hardly applies”, “somewhat applies”, “partially applies”,

“applies”, “more applies”, and “completely applies”. The short

definitions of the seven subscales are as follows. The relation-

ships to others subscale refers to warm, trustfully relationships

to other people, the generativity subscale reflects pleasure in

supporting others and in sharing one’s own knowledge and

helpful life experience, the appreciation of life area links to

active lifestyle and the attempt to live each day to the fullest,

and the openness area relies to open-mindedness, philosophic

or scientific interests. Finally, three further subscales capture

sense of personal strength, appreciation for religious/spiritual

things, and recognition of new possibilities for one’s life, re-

spectively. Cronbach’s alpha coefficients of the total PGSI

score and its separate subscales exceeded in sample one the

recommended criterion of .70 for acceptable instrument internal

reliability (Nunnaly & Bernstein, 1994).

The Cronbach’s alpha of the total PGSI score reached a value

of .92, indicating a high degree of internal reliability. The

known-groups validity of the PGSI was estimated via dichoto-

mizing the variable “IES values” by a median split and compar-

ing the PGSI subscales means of persons whose reported IES

values in the first weeks after a critical event were high with

those of persons with low IES values. In accordance to the ex-

pectations, the PGSI values of individuals with a high level of

PTSD symptoms following a stressful event were higher than

the posttraumatic growth scores of persons who did not suffer

from pronounced stress disorder symptoms, with the exception

of the subscale “personal strength”. T-tests for independent

Table 1.

The composition of the PGSI subscales.

Subscale Items

Area: Relationships to Others

r1. I make no secret about my feelings. (1)

r2. I accept the fact that I need others. (6)

r3. I have sympathy for others. (13)

r4. I invest a lot in my relationships. (17)

r5. I know I can depend on others in difficult times. (24)

r6. I know a lot about how good people can be. (29)

Area: Generativity

g1. I enjoy teaching someone something new. (2)

g2. I enjoy sharing my experiences to help others to find a solution to their problems. (8)

g3. I can identify with others feelings. (11)

g4. Occasionally I help others with conflict of interests to arrive at a satisfactory solution. (25)

g5. If I have the chance, I help others by offering ways for improvement and positive criticism. (33)

Area: Personal Strengths

p1. I am inclined to change the things that need to be changed. (3)

p2. I can handle difficulties well. (5)

p3. I have a strong sense of self-confidence. (9)

p4. I am strong enough to master unseen and unusual problems. (22)

Area: Appreciation of Life

a1. Every day is special to me. (4)

a2. Life is interesting and colorful for me. (12)

a3. I have more distinct ideas about what is important in life now than a couple of years ago. (19)

a4. I do a lot with my life. (35)

Area: Spirituality/Religiosity

s1. I have an appreciation for religious things. (15)

s2. I have an appreciation for spiritual things. (18)

s3. I have thought a lot about religions and religious topics. (26)

s4. I have a pronounced religious or spiritual faith. (32)

Area: New Possibilities

n1. My lifestyle is changing and developing. (7)

n2. I have gained new interests for sometime now. (10)

n3. Sometimes I accomplish something that others find important and extraordinary. (14)

n4. I know from experience that difficult and fearful events can bring about various unexpected possibilities. (27)

n5. I have been walking on a different path in my life for sometime now. (30)

n6. New opportunities are available to me that I did not even notice a couple of years ago. (36)

Area: Openness

o1. I enjoy discussing topics which concern the development of society. (16)

o2. I have a feeling of unity with nature. (20)

o3. I enjoy listening to others opinions even when they contradict what my convictions are. (21)

o4. I have thought a lot about the meaning of life. (23)

o5. I enjoy reading philosophic or scientific literature. (28)

o6. I have understanding for people whose lifestyles are completely different than mine. (31)

o7. I am interested in other cultures. (34)

Note: The numbers in brackets correspond to the item numbers in the final version of the whole inventory.

T. ALEXANDER, R. OESTERREICH

Table 2.

Intercorrelations between the PGSI subscales in sample one (N = 214).

Relationships to Others Generativity Personal Strength Spirituality/ReligiosityOpenness Appreciation of Life

Generativity .578**

Personal Strength .346** .373**

Spirituality/Religiosity .278** .192** .107*

Openness .490** .444** .316** .462**

Appreciation of Life .626** .429** .603** .268** .486**

New Possibilities .396** .367** .398** .337** .497** .646**

Note: *p < .05; **p < .01.

samples showed that these differences were significant for the

PGSI total score (t = 1.90; p < .05) as well as the following

subscales: relationships to others (t = 1.75; p < .05), generativ-

ity (t = 1.93; p < .05), openness (t = 3.01; p < .01), and new

possibilities (t = 1.74; p < .05). Table 3 contains more detailed

information concerning the size of bivariate correlations be-

tween three main kinds of PTSD symptoms (intrusions, avoid-

ance and hyperarousal) and different PGSI subscales. The total

score of PGSI was significant positively related to intrusion and

hyperarousal symptoms, experienced during the first weeks af-

ter a traumatic event, however, neither PGSI total score nor any

of the PGSI subscales were statistically significant associated

with avoidance symptoms.

Further, Pearson correlations between the PGSI subscales and

the corresponding subscales from the retrospective growth mea-

suring instrument of Tedeschi and Calhoun (1996) were com-

puted as estimates of criterion validity. For generativity and

openness PGSI areas, the total score of the PTGI measure from

Tedeschi and Calhoun was used as criterion value. All correla-

tion coefficients were highly statistically significant, they rang-

ed from r = .35 (for generativity subscale) to r = .78 (for religi-

osity/spirituality subscale), indicating sufficient criterion valid-

ity. The results are summarized in Table 4.

Step 2: Estimating Stability of the Factorial Solution

and Assessing the Psychometric Properties of the

PGSI Based on the Data from Sample Two

Descriptive Characteristics of Sample Two

A second sample of individuals with traumatic experience

was recruited with the aim to evaluate the psychometric proper-

ties of the newly developed Posttraumatic Growth Status Inven-

tory in groups of individuals whose trauma related to enduring

stress conditions. This sample consisted of two subgroups. The

first subgroup included 110 parents of children with serious

mental disabilities (Down syndrome; n = 56, autism or Asper-

ger syndrome; n = 54) as well as 71 parents of visually handi-

capped children. Thirty-four percent of all children had other

comorbid physical disabilities, such as congenital heart defects,

epilepsy, cerebral palsy, sensory problems, and others. The se-

cond subgroup of sample two included n = 45 individuals whose

traumatic experience was related to their own severe medical

condition.

The parents were on the average forty-one years old, the ma-

jority was well-educated (13.58 years of formal education, on

the average) and 142 (78%) were married. Seventy-five percent

were mothers and twenty-five percent were fathers. Seven years

passed on the average since the child’s diagnosis. The mean age

of the children was ten years.

The individuals with a disease-related trauma (n = 45) were

on the average thirty-nine years, with the mean of formal edu-

cation of 13.72 years. Seventy-nine percent were men. Simi-

larly to the sub-sample of parents, the diagnosis dated back ap-

proximately 7 years. The most frequently documented illnesses

in this subgroup were HIV, cardiac diseases and cancer.

In the entire sample, the majority of participants (78%) char-

acterized the first awareness of the diagnosis as a “definitely

upsetting” event. The explorative analyses of relationships be-

tween the PGSI and respondents’ demographic characteristics

yielded a weak statistically significant correlation between PGSI

total score and gender (r = .16), indicating that women’s values

were slightly higher than those of the men. Table 5 demon-

strates the means for PGSI subscales depending on the kind of

the traumatic event.

Confirmatory Factor Analysis and Estimation of Reliability

In order to estimate the stability of the factorial solution gain-

ed based on the exploratory factor analysis upon the data from

sample one, we conducted the confirmatory factor analysis (CFA)

in the second mixed sample of individuals with traumatic ex-

perience using maximum likelihood method. On the whole, the

initial seven-factorial model demonstrated a reasonably good fit

to the data: the RMSEA = .078; chi square = 1385 (df = 584; p

= .00); chi square /df = 2.37; GFI = .965. Figure 1 shows the

results the CFA including the factor loadings of the separate

items and the subscales composition.

Cronbach’s alpha coefficients are displayed in Table 5. In-

ternal consistency reliabilities were sufficiently high and, simi-

larly to the analogous estimations in sample one, the recom-

mended criterion of .70 for acceptable instrument internal reli-

ability (Nunnaly & Bernstein, 1994) was exceeded for all PGSI

subscales. The Cronbach’s alpha reliability of the total PGSI

score was with .93 very high.

Analysis of Criterion Validity, Correlations between PGSI

and Indicators of Mental Health

In order to examine the criterion validity of the PGSI-sub-

scales, we calculated the correlations with corresponding sub-

scales of the “classical” measure of trauma-related changes from

Tedeschi and Calhoon (1996). The external validity criterion for

the generativity and openness domains was the total score of the

Tedeschi and Calhoon’s questionnaire. The results (Table 4) pro-

vide good support for criterion validity (r = .32 for life apprecia-

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T. ALEXANDER, R. OESTERREICH

Table 3.

Correlations between PGSI subscales and PTSD symptoms in sample one (N = 214).

Relationships

to Others Generativity Personal

Strength

Spirituality/

Religiosity Openness Appreciation

of Life New Possibilities PGSI Total

IES Intrusions .12* .13* −.08 .08 .25** .01 .10 .14*

IES Avoidance .06 .09 −.04 .02 .04 .08 .07 .07

IES Hyperarousal .07 .05 −.20** .23** .22** −.03 .10 .11*

IES Total .11* .11* −.15* .14* .22** .03 .12* .14*

Note: In sample one (N = 214) Cronbach’s alpha coefficients of the three IES subscales reached values of .80, .72, and .80, of the IES total the value of .85. *p < .05; **p

< .01.

Table 4.

Criterion validities of the PGSI subscales in sample one (N = 214) and sample two (N = 226).

Relationships

to Others Generativity Personal

Strength

Spirituality/

Religiosity Openness Appreciation

of Life

New

Possibilities PGSI Total

Sample One .58** .35** .47** .78** .41** .60** .66** .67**

Sample Two .63** .37** .40** .74** .40** .32** .58** .59**

Note: The coefficients represent Pearson correlations between PGSI subscales and corresponding subscales of PTGI from Tedeschi and Calhoun (1996). For generativity

and openness subscales, the correlations with the total score of the PTGI were calculated.

Table 5.

The means and standard deviations for PGSI subscales and PGSI total in both sub-samples of sample two, and Cronbach’s alpha reliabilities of the

PGSI subscales.

Relationships

to Others M (SD) Generativity

M (SD) Personal

Strength M (SD)

Spirituality/

Religiosity M (SD)

Openness M

(SD) Appreciation

of Life M (SD) New Possibilities

M (SD) PGSI Total

M (SD)

Parents 28.58 (5.84) 26.56 (4.44) 20.29 (4.07) 15.89 (7.01) 33.67 (6.70)19.42 (4.32) 27.02 (6.55) 171.42 (28.51)

Disease Related

Trauma 28.29 (6.61) 25.30 (5.58) 18.68 (4.80) 14.43 (6.73) 35.10 (7.82)19.39 (4.64) 27.07 (7.63) 168.28 (32.64)

Total Sample

Female

Male

28.92 (6.09)

27.21 (6.11)

26.89 (4.36)

24.73 (5.47)

20.23 (4.15)

19.13 (4.71)

15.83 (7.09)

14.88 (6.79)

33.79 (6.72)

33.43 (7.69)

19.64 (4.46)

18.58 (4.33)

27.80 (6.63)

24.97 (6.64)

173.10 (28.93)

162.93 (31.79)

Cronbach’s Alpha .79 .81 .83 .91 .75 .78 .80 .93

Note: “Parents”: Parents of children with mental or physical disabilities (n = 181). “Disease related trauma”: Individuals with a severe medical condition (n = 45). Cron-

bach’s alpha coefficients represent the reliabilities of the PGSI subscales in the whole sample two (N = 226).

tion subscale to r = .74 for religiosity/spirituality subscale).

To test whether the PGSI-subscales are substantially associ-

ated with depression, anxiety and somatization symptoms, we

analyzed the Pearson correlations of the PGSI-subscales with

the BSI and the FBL. The results are illustrated in Table 6. The

PGSI areas were almost without any exemption statistically sig-

nificant inversely associated with BSI anxiety subscale (r =

−.15 to r = −.38). Additionally, all PGSI domains with exemp-

tion of the religiosity/spirituality domain were statistically sig-

nificant inversely related to BSI depression symptoms (r = −.20

to r = −.53). Further, all PGSI areas with exemption of the “new

possibilities” subscale showed statistically significant negative

correlations with BSI somatization scale (r = −.16 to r = −.30)

as well as with psychosomatic symptoms measured with the FBL

(r = −.12 to r = −.30). On the whole, these results indicated that

a higher level of posttraumatic growth was related to a low le-

vel of anxiety, depression and somatization symptomatology.

Analysis of Relationships between the PGSI and F r equency

of Using Different Adaptive and Maladaptive Coping

Strategies

In order to test concurrent validity, Pearson correlations be-

tween PGSI subscales and different coping strategies were cal-

culated. As discussed in the literature on stress and coping, one

and the same coping strategy may be more or less adaptive, de-

pending on the special kind of the major stressful event and on

the individual life situation (Meichenbaum, 1985; Antonow-

sky, 1987; Connor-Smith & Flachsbart, 2007). Taking into con-

sideration this knowledge from previous research with a long

tradition, we decided to accomplish two separate analyses on

the relationships between PGSI growth domains and coping stra-

tegies, because of the very different nature of traumatic events

in both subgroups (parents of children with mental and/or phy-

sical disabilities and individuals whose trauma related to their

own severe medical conditions). The results from the correspon-

ding analyses are presented in Table 7.

Correlations between PGSI and Coping Strategies in the

Parents Sub-Sample

In the sub-sample of 181 parents of children with mental and/

or physical disabilities, the data analyses yielded the following

empirical results. Both, the relationships to others and genera-

tivity PGSI subscales were positively associated to several po-

entially adaptive coping strategies, including active coping, t

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T. ALEXANDER, R. OESTERREICH

Figure 1.

Confirmatory factor analysis, factorial structure of the PGSI.

Table 6.

Correlations between PGSI subscales and mental health indicators in sample two (N = 226).

Relationships

to Others Generativity Personal

Strength

Spirituality/

Religiosity Openness Appreciation

of Life

New

Possibilities PGSI Total

BSI Anxiety −.33** −.27** −.35** −.15* −.20** −.38** −.15* −.33**

BSI Depression −.37** −.32** −.46** −.08 −.20** −.53** −.27** −.40**

BSI Somatization −.30** −.24** −.24** −.17** −.16** −.29** −.11 −.27**

FBL Psychosomatic

Complaints −.29** −.18** −.30** −.12* −.19** −.33** −.10 −.27**

Note: In the sample two (N = 226), Cronbach’s alpha coefficients of the three BSI subscales reached the values of.84, .86, and .87, of the FBL the value of .92. *p < .05; **p

< .01.

Planning, positive reframing, turning to religion, as well as us-

ing emotional and instrumental support.

On the other side, there were statistically significant negative

correlations of these PGSI areas with two kinds of dysfunc-

tional coping behavior; substance use and behavioral disenga-

gement. The personal strength subscale showed similar cor-

relations with adaptive and dysfunctional coping strategies.

Beyond this, the personal strength area was significant nega-

tively associated with self-blame (r = −.29) and positively asso-

ciated with acceptance that ranks among potentially adaptive

coping behavior (r = .14). The religiosity/spirituality subscale

was not associated with active coping and planning. However,

data analyses offered positive associations between religios-

ty/spirituality PGSI area and other adaptive coping strategies i

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T. ALEXANDER, R. OESTERREICH

Table 7.

Correlations between PGSI subscales and frequency of using different coping strategies, in both subgroups of sample two (parents of children

with disabilities, n = 181, and persons with a severe medical condition, n = 45).

Relationships

to Others Generativity Personal

Strength

Spirituality/

Religiosity Openness Appreciation

of Life

New

Possibilities PGSI Total

Active Coping .25** [.29*] .20** [.12] .33** [.40**] .11 [−.21] .23** [.10] .39** [.35*] .33** [.40*] .34** [.26*]

Planning .15* [.09] .23** [.33*] .17* [.23] .01 [.10] .29** [.04] .15* [.21] .21** [.04] .23** [.18]

Positive Reframing .34** [.39**] .36** [.39**] .50** [.53**] .12 [.28**] .40** [.42**] .51** [.55**] .51** [.42**] .52** [.56**]

Acceptance −.03 [.02] −.08 [.14] .14* [.07] .05 [.24] .16* [.10] .07 [.02] .10 [−.09] .09 [.09]

Humour −.01 [.00] .08 [.25] .06 [.16] .07 [.38*] .16* [.45**] .07 [.03] .09 [.14] .10 [.32*]

Religion .16* [.01] .13* [−.19] −.01 [−.29*].77

** [.63**] .35** [.03] .15* [.11] .21** [.23] .39** [.14]

Using Emotional

Support .53** [.40**] .35** [.07] .14* [.18] .22** [−.08] .37** [.15] .24** [.28*] .37** [.40**] .44** [.27*]

Using Instrumental

Support .55** [.34*] .44** [−.03] .23** [.12] .18* [−.23] .38** [.05] .22** [.15] .26** [.30*] .44** [.14]

Denial −.09 [.12] −.00 [−.30*] −.13 [−.38**].08 [−.06] −.05 [−.09] −.20** [−30*] −.10 [−.05] −.08 [−.21]

Self-Distraction −.06 [.00] −.06 [.05] −.10 [.13] −.12 [.02] −.05 [.17] −.21** [.13] −.11 [.09] −.14* [.11]

Venting .17* [.00] −.05 [.00] −.08 [−.11] .16* [.03] .04 [.12] .13 [−.11] .22** [.03] .13* [.01]

Substance Use −.14* [−.10] −.21** [−.17] −.20** [−.29*]−.05 [.10] −.08 [.23] −.15* [−.27*] −.05 [−.07] −.15* [−.07]

Behavioural

Disengagement −.21** [−34*] −.15* [−.36*] −.23** [−.28*].01 [−.09] −.08 [−.31*]−.23** [−.44**] −.11 [−.35*] −.17* [−.41*]

Self-Blame −.04 [−.20] −.01 [−.15] −.29** [−.35*].04 [−.07] .07 [−.06] −.27** [−32*] −.07 [−.05] −.08 [−.20]

Regenerative

Coping .17* [.37**] .08 [.39**] .16* [.27*] .09 [.08] .27** [.53**] .27** [.37**] .29** [.24] .26** [.43**]

Availability of

a Confident .44** [.40**] .30** [.12] .23** [.32*] .19** [.06] .27** [.07] .37** [.37**] .27** [.41**] .40** [.31*]

Note: The coefficients without any brackets represent the Pearson correlations in the sub-sample of parents. The coefficients in square brackets represent the corre-

sponding Pearson correlations in the sub-sample of persons with a disease-related trauma. *p < .05, **p < .01.

(r = .22 for using emotional support and r = .18 for using instru-

mental support). The correlations between this PGSI subscale

and maladaptive coping strategies were not significant.

The openness PGSI domain was positive statistically signifi-

cant related to eight adaptive coping strategies (active coping,

planning, positive reframing, acceptance, turning to religion,

using emotional and instrumental support, and humour) and it

was not related to any kind of dysfunctional coping behavior.

The appreciation of life and the new possibilities PGSI sub-

scales showed positive associations with six adaptive coping

strategies (active coping, planning, positive reframing, turning

to religion, using emotional and instrumental support). In addi-

tion, for the appreciation of life area, but not for the new possi-

bilities PGSI area, the negative statistically significant correla-

tions with four maladaptive coping strategies (denial, substance

use, behavioral disengagement, and self-blame) were demon-

strated. Five of seven growth subscales (relationships to others,

personal strength, openness, life appreciation, and new possi-

bilities) as well as the PGSI total score were positively corre-

lated with regenerative coping (r = 16 to r = .29). Finally, the

PGSI total score was positive, statistically significant associ-

ated to six potentially adaptive coping strategies (active coping,

planning, positive reframing, turning to religion, using emo-

tional and instrumental support) and it was significant nega-

tively correlated with two kinds of dysfunctional coping (sub-

stance use and behavioral disengagement).

Correlations between PGSI and Coping Strategies in the

Sub-Sample of Persons with Their Own Disease-Related

Trauma

Following correlation patterns between PGSI areas and dif-

ferent kinds of coping behavior were demonstrated in the sub-

sample of 45 persons with a severe medical condition (Table 7).

The relationships to others and the new possibilities PGSI sub-

scales were positively associated to the four different potenti-

ally adaptive coping strategies (active coping, positive refram-

ing, using emotional and instrumental support). They were also

negatively related to behavioral disengagement (r = −.34 and r

= −.35); the correlations with other potentially maladaptive co-

ping strategies were not significant. The personal strength and

the appreciation of life PGSI areas were positively correlated

with active coping and positive reframing, both of these sub-

scales were also negative, statistically significant related to three

potentially dysfunctional coping strategies (substance use, be-

havioral disengagement, and self-blame). The generativity and

the openness PGSI domains showed positive, statistically signi-

ficant correlations with positive reframing. Beyond this, the ge-

nerativity subscale was positively associated with planning (r

= .33), and the openness domain with coping through humorous

handing of stressful life situations (r = .45). Both generativity

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T. ALEXANDER, R. OESTERREICH

and openness subscales were negatively related to behavioral

disengagement (r = −.36 and r = −.31). The religiosity/spiritu-

ality subscale was positively correlated with three adaptive co-

ping strategies (positive reframing, humour, and turning to reli-

gion). However, similarly to findings from the parents sub-sam-

ple, it was not associated with any dysfunctional coping strate-

gies. For five PGSI areas (with exemption of religiosity/spiri-

tuality and new possibilities subscales, respectively), positive

statistically significant correlations with regenerative coping

were demonstrated (r = .27 to r = .53).

Are There Systematic Differences in Pattern of Correlations

between P G SI and Vari ous Coping Strategies across both

Groups: Parents of Children with Mental and/or Physical

Disabilities vs. Individuals with a Disease-Related Trauma?

Data analyses revealed several similarities in patterns of cor-

relations between both subgroups constituting the second sam-

ple: parents of children with mental and/or physical disabilities

vs. individuals with their own disease-related trauma. Thus, the

personal strength and life appreciation subscales were most con-

sistently negative correlated with maladaptive coping strategies

in both groups. Alike, the “relationships to other” PGSI sub-

scale showed consistent positive associations with adaptive co-

ping behavior in parents as well as in the outpatients group.

Interestingly, statistical analyses offered also several differ-

ences in pattern of correlations between both subgroups. Where-

as functional coping strategies “planning”, as well as “coping

through active seeking emotional and instrumental support”

were consistently positive correlated with PGSI factors in the

parents sample, they were not statistically significant associated

to the most of PGSI factors in the sample of persons with their

own disease-related trauma. By contrast, coping through humo-

rous handling of burdensome life situations was more frequent-

ly linked to PGSI subscales for the outpatients sample than for

the sample of parents. Additionally, denial and behavioral dis-

engagement as maladaptive coping strategies were definitely

more strongly related to PGSI subscales in the outpatients

group than in parents of children with disabilities.

Regarding differences in the relative impact of the separate

PGSI domains, the generativity and openness subscales yielded

a stable pattern of positive, statistically significant correlations

with several kinds of adaptive coping behavior in parents’ sam-

ple, but not in the sample of individuals whose traumatic ex-

perience was related to their own severe medical condition.

Discussion

The aims of the study described in this paper were to develop

and to evaluate a measuring instrument that allows for captur-

ing the current status in processes of growth in the aftermath of

traumatic experience. Unlike contemporary available retrospec-

tive growth questionnaires (the PTGI, the SRGS and the BSI),

the new measure was designed to estimate the actual profile of

different growth related aspects. Accordingly, when completing

the PGSI, respondents do not need to remember their crucial

experience and to recall how they were prior to the stressful

event; they should simply describe their actual behavior, think-

ing and feeling. This kind of item format was chosen in order to

avoid distortion through potential cognitive biases, documented

in previous investigations (McFarland & Alvaro, 2000; Smith

& Cook, 2004). Additionally, taking into account findings from

recent empirical literature on posttraumatic growth (Cadell &

Sullivan, 2006; Danoff-Burg & Revenson, 2005; Updegraff et

al., 2002; Pakenham, 2007), the initial item pool contained

items asking for self-awareness, world view and the way of

treating others, beside the items focused on already well-known

growth areas (such as relationships to others, personal strength,

and appreciation of life) as they are addressed in the currently

most established retrospective measure of PTG from Tedeschi

and Calhoun (1996). The findings provide evidence of sound

reliability, as well as good convergent and concurrent validity

of the Posttraumatic Growth Status Inventory subscales. The

results of the confirmatory factor analysis yielded support for

stability of the initial factorial solution. Interestingly, five ex-

tracted factors, e.g. personal strength and appreciation of life,

correspond to the growth facets which were identified in factor

analyses upon growth related items in other studies (e.g., Te-

deschi & Calhoun, 1996). This attests to the soundness and satis-

fying validity of the construct ‘posttraumatic growth’. The PGSI

contains seven subscales and permits the capturing of personal

changes in the following growth domains: relationships to oth-

ers, spirituality/religiosity, appreciation of life, generativity,

openness, personal strength, and new possibilities. In compari-

son to the “classical” retrospective posttraumatic growth meas-

ure from Tedeschi and Calhoun (1996), the PGSI assesses growth

associated processes in two additional areas, generativity and

openness. The 7-stage item response format permits a precise

differentiation between various degrees in the distinct growth

related characteristics.

Comparison of mean PGSI scores showed significant differ-

ences between participants who suffered from less or more

symptoms of posttraumatic stress disorder in the first time after

a traumatic event. Thereby, the known-groups validity of the

newly developed questionnaire could be demonstrated. Further,

the acceptability of the PGSI is demonstrated by minimal miss-

ing data (2.7% in sample one and 2.4% in sample two). On the

whole, the study provides empirical evidence for good psycho-

metric properties and practicability of the newly developed

growth status inventory.

A particular strength of the PGSI is its applicability in sam-

ples of individuals whose trauma evolved from the confronta-

tion with suffering of others, for example, parents of children

with psychological and physical disabilities, persons who wit-

nessed violence, and, generally, care-givers and close relatives

of people with life-threatening illnesses. As shown in other stu-

dies, (e.g., Alexander & Wilz, 2010), feelings of guilt may ac-

count for barriers to acknowledge beneficial trauma-related

changes in these populations. In the stage of the item generation,

those participants of our study, whose traumatic experience re-

lated to their family members (child’s, spouse’s, or parent’s) se-

vere health conditions or disabilities, reported in individual se-

mi-structured interviews about the comparable difficulties to re-

flect on possible beneficial trauma-related change due to moral

considerations. A measuring instrument, like the PGSI, that fo-

cuses solely on current experience, without any connection to

past live events, can help to sidestep the corresponding barriers

and to attenuate the tendency to distortions due to social desir-

ability. This reduction of corresponding distortions may partial-

ly explain the fact, that the internal consistencies of the PGSI

subscales were higher in our study than the internal consisten-

cies of comparable subscales of the retrospective-oriented PTGI

questionnaire (e.g., in sample two, .83 vs. .73 for the subscale

“personal strength” and .78 vs. .72 for the subscale “life appre-

ciation”). Altogether, the results of our study imply that the

Open Access 841

T. ALEXANDER, R. OESTERREICH

validity of individual reports on growth related processes could

be increased by the means of using item format which focuses

on the actual experience and not on perceived inner changes.

Additionally, the newly developed measure may be very use-

ful for capturing positive personal changes in samples of indi-

viduals whose trauma relates in a particular degree to experi-

ence of stigmatization, like potentially stigmatizing diseases

(e.g., mental disorders, HIV) as well as social or sexual abuse.

As documented in empirical literature, the proceeding of the

stigma-associated feelings of “spoiled identity” (Goffman, 1986)

often lead to inducing the re-examination of old values and pri-

orities and to efforts of creating a new definition of self iden-

tity. The active establishment of an alternative identity as a po-

sitive adjustment instead of a resignation requires openness to a

new experience and enhanced tolerance towards other ways of

life and other ways of communication. Since the PGSI contains

a separate openness subscale which addresses this special com-

ponent of positive individual psychological changes, this inven-

tory may be more appropriate in capturing the corresponding

processes than the conventional posttraumatic growth and be-

nefit finding measuring instruments. Although a part of our stu-

dy’s participants were individuals who experienced traumas

with such stigmatization potential, further research is required

to provide additional evidence concerning the applicability of

the PGSI in these specific populations.

Another area of application for the PGSI may be longitudinal

studies designed to investigate different stages in processes of

posttraumatic growth in persons with enduring stress conditions

subsequent to an acute traumatic event, such as a case of severe

disability-related health problems in a person her/himself or in

a close family member. Two groups of persons with analogous

kinds of traumatic experience were participants of our study:

parents of children with psychological and physical disabilities

as well as individuals whose trauma related to their own severe

medical conditions. In both samples, good psychometric prop-

erties of the PGSI were demonstrated. Additionally, the data

analyses offered the ability of the PGSI to differentiate between

individuals with dissimilar kinds of traumatic experience. The

pattern of correlations between the separate PGSI subscales and

various potentially adaptive and maladaptive coping strategies

were partially different in parents and outpatients samples.

Thus, “coping though active seeking instrumental or emotional

support” and “planning” were more consequently related to the

separate growth domains in the parents sample than in the sam-

ple of individuals with an illness-related trauma. It may point to

important differences in potential adaptive significance of cop-

ing behavior. For parents caring for children with mental dis-

abilities, positive personal changes in terms of growth may

involve acquirement of such essential skills as mobilization of

their social networks for help in caring the child and for infor-

mational support. The efforts to mobilize the social environ-

ment would be inevitably related to the necessity to overcome

feelings of shame due to the ‘particular kind’ of the child’s

disability and to accept the new after-child-diagnosis life situa-

tion. To undergo this experience could require personal strength

and individual development in terms of personal growth. Atten-

tion-grabbing is also another systematic dissimilarity, and pre-

cisely in use of denial as a coping strategy that was more con-

sistently negatively linked to PTG areas in the outpatients’ sam-

ple than in the parents’ sample. What may imply denial for

persons raising children with autism or Down syndrome? It

could basically imply the recognizing the feeling that “my child

is o.k.”. In fact, this kind of perception neither necessarily leads

to dysfunctional behavior, nor it should be an indication of re-

sistance to the processes of trauma-related growth. Conversely,

if persons with a severe disease respond with denial to their

diagnosis or to their physical symptoms, it may be frequently

linked to a lack of compliance with medical treatment as well

as to the insistence on several old maladaptive unhealthy habits

as a phenomenon that is opposite to personal changes in terms

of stress-related growth.

Limitations and Considerations

Despite generally promising study results, several limitations

should also be kept in consideration concerning the findings re-

ported above.

First, a mixed sample of undergraduate students and adults

with significant traumatic experience were used at the stage of

item selection. It might stand to reason to query whether the

students can be representative for the population of traumatized

individuals. However, it is not unusual, to use the students sam-

ples at the initial phase in the development of psychological

measuring instruments (Stanton et al, 2000; Tedeschi & Cal-

houn, 1996). Furthermore, students are comparable to the gen-

eral population pertaining to experience with trauma (Vrana &

Lauterbach, 1994).

Second, a cross-sectional study design was used to evaluate

the psychometric properties of the PGSI. A cross-sectional in-

vestigation does not permit any unambiguous conclusions in

terms of causality. Consequently, the direction of relationships

between separate PGSI areas and indicators of mental health,

such as anxiety, depression and psychosomatic symptoms as

well as between PGSI and different coping strategies remained

unclear. Future longitudinal studies with repeated measure-

ments are warranted to test corresponding causation hypotheses.

Additional longitudinal studies may also be necessary to pro-

vide more information about the alterability of the PGSI values

across various periods of time.

A further limitation relates to the issue of the potential un-

ambiguousness of the construct “posttraumatic growth” in terms,

as it could be captured by the newly developed questionnaire.

How can we be sure that the PGSI items assess the posttrau-

matic growth processes as a result of an individual’s traumatic

experience, given the fact that the participants are asked to

describe their behavior, thinking and feelings, without the ex-

plicit reference to the traumatic event? Indeed, it is a general

difficulty with the operationalisation of complex psychological

constructs that we can seldom be fully confident of definite

sources/triggers for the multifaceted psychological processes,

like intrapersonal growth. A number of common cognitive bi-

ases, such as illusory correlation, subjective validation, social

desirability bias, or backfire effect (Tversky & Kahnemann,

1974; Fiedler, 1991; Danton & Ortegren, 2011; Sanna, Schwarz,

& Stocker, 2002), may contribute to misattribution, if the re-

spondents were explicitly asked about perceived causes of their

inner changes. The PGSI refrains from asking about subjective

attribution of reported inner growth processes to a concrete se-

vere traumatic experience. However, there is other, implicit evi-

dence of potential relationships. Firstly, the PGSI focuses on

seven areas, which are well-documented in empirical and theo-

retical literature as domains of posttraumatic growth. Accord-

ingly, high statistically significant correlations between the se-

parate PGSI subscales and the corresponding PTGI growth

Open Access

842

T. ALEXANDER, R. OESTERREICH

areas were demonstrated in our data analyses. Secondly, the

PGSI is designed to be applied in studies with individuals who

experienced verifiable psychological traumas, like a physical or

mental disability in their close relatives, their own severe me-

dical conditions or other kinds of trauma. Thirdly, the compa-

rison of the PGSI scores from different measuring times, as

well as from the interventional and the control groups, should

provide additional evidence about links between trauma-related

experiences and corresponding changes in the processes of in-

tra-psychical growth.

Due to a specific item format focusing on current state, the

PGSI offers the potential to capture slight positive as well as in-

verse-directed alterations in processes of posttraumatic growth

with a higher precision than the alternative existing “retrospec-

tive” growth scales. However, this particular feature of the

newly developed inventory should be examined in more detail

in further investigations.

To summarize, the study provides empirical evidence for good

psychometric properties and practicability of the newly devel-

oped Posttraumatic Growth Status Inventory. The PGSI is re-

commended particularly for use in longitudinal studies as well

as in samples of persons whose trauma relates to a severe psy-

chological or physical disability in their families.

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