The Curvilinear Association Between Posttraumatic Distress and Posttraumatic Growth Among Pellet Gun Victims: The Moderating Roles of Time Since Trauma and Age

Abstract

Since 2010, the use of pellet guns in Indian-administered Kashmir has led to serious physical and psychological consequences among a growing number of victims. However, no research to date has examined the association between posttraumatic distress and posttraumatic growth (PTG) within this population. Previous research conducted on other types of trauma exposure has yielded inconsistent findings regarding the nature and directionality of this association; namely, whether it is linear or curvilinear. Moreover, this inconsistency may also be due to the effects of other variables, such as time since trauma and age. In the present study, we investigated whether the association between posttraumatic distress and PTG among pellet gun victims is best explained as linear or curvilinear and tested whether this association was moderated by time since trauma and/or age. Using purposive sampling, 120 pellet gun victims were recruited from Indian-administered Kashmir. The results of quadratic hierarchical regression suggested that an inverted U-shaped curvilinear association, sr 2 = 0.07 (medium effect), was a better fit over and above a linear term, sr 2 = 0.06-0.08 (medium effect). The moderation test further revealed that this effect was present across time but became apparent, as an inverted U-shape, 18 to 24 months posttrauma, sr 2 = 0.04 (small effect); age, however, was not found to influence this association. These findings held even after controlling for the effects of confounding variables. The present findings suggest that across time, moderate levels of posttraumatic distress are associated with the highest levels of PTG. The prevalence of mental disorders, particularly posttraumatic stress disorder (PTSD) and depression, is higher in conflict-exposed communities compared to communities with no history of conflict (Priebe et al., 2010). Indian-administered Kashmir is one of the most conflict-affected areas in the world, and a high percentage of its residents have reported exposure to conflict (De Jong et al., 2008). Following a period of unrest in 2010, the use of pellet guns by the central government as a nonlethal defensive weapon against violent protesters has caused several deaths and numerous injuries and, consequently, has resulted in serious physical and mental health issues, including psychological trauma, among victims, (David, 2017). Research has documented that the psychological impacts of trauma exposure can be pathogenic, as in PTSD, with symptoms including intrusion, avoidance, hyperarousal, and negative alterations in cognition and mood (American Psychiatric As-Correspondence concerning this article should be addressed to Imtiyaz Ahmad Dar,

The Hormesis Model for Building Resilience Through Adversity: Attention to Mechanism in Developmental Context

“…Analogous processes are evident in clinical research on posttraumatic growth (PTG), a complex process that emerges over time as individuals find meaning through their trauma. These processes are distinct from hormesis in that psychological strengthening is not necessarily a product of a dose-response or biphasic curve in relation to stress; albeit various PTG studies do show curvilinear effects (Coroiu et al, 2016;Dar & Iqbal, 2020;Kleim & Ehlers, 2009;Shakespeare-Finch & Lurie-Beck, 2014). However, the discussion on the PTG literature is deliberately limited here because this paper seeks to introduce the hormesis model to explain resilience processes in non-clinical populations.…”

The impact of multiple stressful life events on posttraumatic growth in adolescence.

“…There are several directions this study can suggest. First, we suggest examining time since the event, because it has been recently suggested to affect the curvilinear relationship (Dar & Iqbal, 2020). Time since each traumatic event may elucidate why adolescents were more likely to attribute PTG to one event, despite experiencing multiple.…”

Secondary traumatic stress, vicarious posttraumatic growth, and rumination among healthcare professionals: Examining conditional indirect effect of secondary exposure to trauma.

“…Consistent with Dar and Iqbal (2020a, 2020b) professional experience was measured by the number of years participants have been working in their current field, and the time since secondary exposure to armed conflictwas measured in weeks. Participants were simply asked to report how many weeks had passed since they were last exposed to the traumatic details of their patient.…”

“…A large-scale study conducted in all 10 districts of Kashmir revealed a high prevalence of anxiety, depression, and PTSD symptoms among its residents (Housen et al, 2017). Furthermore, the negative consequences of armed conflict in Kashmir are not confined to its direct victims (Dar & Iqbal, 2020b; Housen et al, 2017) but are also reflected in professionals who work with them (Dar & Iqbal, 2020a).…”

“…Tedeschi and Calhoun's (2004) model offers a useful framework for conceptualizing PTG. It states that posttraumatic distress and PTG coexist (Tedeschi et al, 2018) among primary and secondary trauma victims (Dar & Iqbal, 2020a, 2020b). The central concept of the PTG model (Tedeschi et al, 2018; Tedeschi & Calhoun, 2004) is that posttraumatic psychological reactions result from cognitive processing of a traumatic event.…”