2013. Vol.4, No.11, 831-844
Published Online November 2013 in SciRes (
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
Received August 11th, 2013; revised September 12th, 2013; accepted October 13th, 2013
Copyright © 2013 Tatjana Alexander, Rainer Oesterreich. This is an open access article distributed under the
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
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
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-
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-
Open Access
esses in individuals with different kinds of traumatic experi-
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.,
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.
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
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.
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).
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
Open Access 833
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-
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,
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-
Open Access
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.
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-
Item Selection Based on Results of the Exploratory Factor
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-
Open Access 835
Open Access
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.
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
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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Table 3.
Correlations between PGSI subscales and PTSD symptoms in sample one (N = 214).
to Others Generativity Personal
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).
to Others Generativity Personal
Religiosity Openness Appreciation
of Life
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.
to Others M (SD) Generativity
M (SD) Personal
Strength M (SD)
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
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
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
Open Access
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).
to Others Generativity Personal
Religiosity Openness Appreciation
of Life
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
Open Access 839
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).
to Others Generativity Personal
Religiosity Openness Appreciation
of Life
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]
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]
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
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
Open Access
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.
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
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
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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