Direct and Indirect Associations Between Interpersonal Resources and Posttraumatic Growth Through Resilience Among Women Living with HIV in China

  • Xue Yang
  • Qian Wang
  • Xin Wang
  • Phoenix K. H. Mo
  • Zixin Wang
  • Joseph T. F. LauEmail author
  • Linhong Wang
Original Paper


This study aims to test the associations between interpersonal resources and posttraumatic growth (PTG) and their indirect associations through resilience among women living with HIV (WLWH). A cross-sectional study interviewed 546 WLWH from eight clinics of Yunnan and Guangxi provinces in China. PTG, resilience and doctors’ empathy were assessed by the validated scales. Family support, friend support, and partner intimacy were assessed by the self-constructed scales. Significant background factors of PTG included duration of residence in the area, monthly family income, number of years since HIV diagnosis, self-reported presence of AIDS-related symptoms, and current pregnancy. Family social support, partner intimacy, doctors’ empathy, and resilience were positively associated with PTG; friend support was negatively associated with PTG (p < .05). Furthermore, resilience partially mediated the relationships between family support/partner intimacy and PTG, explaining 13.6–14.2% of the variance. Structural equation modeling showed that family support was significantly and indirectly associated with PTG through resilience when controlling for other interpersonal resource indicators. Implications and potential interventions to promote PTG are discussed.


Family/friend support Intimacy with partner Doctors’ empathy Resilience Posttraumatic growth 


Author Contributions

XY and JTFL conceptualized the aims and hypotheses for the study and took primary responsibility for drafting the manuscript. QW as the grant holder contributed to the original study design and questionnaire, research questions, fieldwork coordination, and comments to the manuscript. XW assisted with data analyses and drafting results. PM designed the original study and questionnaire. ZW took primary responsibility for data cleaning. LW provided advice to the project and organizational support.


This work was supported by the Women Health Branch of the Chinese Preventive Medicine Association.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

The manuscript does not contain clinical studies or patient data. The study procedures were carried out in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Ethics Committee of the Chinese University of Hong Kong.


  1. 1.
    World Health Organization. Global AIDS update. 2016. Retrieved from
  2. 2.
    Zhang XY, Huang T, Feng YB, Li M, Chen FF, Li YG, et al. Characteristics of the HIV/AIDS epidemic in women aged 15-49 years from 2005 to 2012 in China. Biomed Environ Sci. 2015;28(10):701–8.PubMedGoogle Scholar
  3. 3.
    Israelski DM, Prentiss DE, Lubega S, Balmas G, Garcia P, Muhammad M, et al. Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS. Aids Care. 2007;19(2):220–5.CrossRefPubMedGoogle Scholar
  4. 4.
    King MB. AIDS, HIV and mental health. Cambridge: Cambridge University Press; 1993.Google Scholar
  5. 5.
    Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.CrossRefPubMedGoogle Scholar
  6. 6.
    Safren SA, Gershuny BS, Hendriksen E. Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties. Aids Patient Care STDs. 2003;17(12):657–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Rzeszutek M, Oniszczenko W, Zebrowska M, Firlag-Burkacka E. HIV infection duration, social support and the level of trauma symptoms in a sample of HIV-positive Polish individuals. Aids Care. 2015;27(3):363–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Rzeszutek M, Oniszczenko W, Firlag-Burkacka E. Temperament traits, coping style and trauma symptoms in HIV + men and women. Aids Care. 2012;24(9):1150–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Cook JA, Burke-Miller JK, Steigman PJ, Schwartz RM, Hessol NA, Milam J. Prevalence, comorbidity, and correlates of psychiatric and substance use disorders and associations with HIV risk behaviors in a multisite cohort of women living with HIV. AIDS Behav. 2018;22:3141–54.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Cook JA, Grey DD, Burke-Miller JK, Cohen MH, Vlahov D, Kapadia F, et al. Illicit drug use, depression and their association with highly active antiretroviral therapy in HIV-positive women. Drug Alcohol Depend. 2007;89(1):74–81.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kennedy CA, Skurnick JH, Foley M, Louria DB. Gender differences in HIV-related psychological distress in heterosexual couples. Aids Care. 1995;7:S33–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Quinn TC, Overbaugh J. HIV/AIDS in women: an expanding epidemic. Science. 2005;308(5728):1582–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Milam JE. Posttraumatic growth among HIV/AIDS patients. J Appl Soc Psychol. 2004;34(11):2353–76.CrossRefGoogle Scholar
  14. 14.
    Milam J. Posttraumatic growth and HIV disease progression. J Consult Clin Psychol. 2006;74(5):817–27.CrossRefPubMedGoogle Scholar
  15. 15.
    Murphy PJ, Hevey D. The relationship between internalised HIV-related stigma and posttraumatic growth. AIDS Behav. 2013;17(5):1809–18.CrossRefPubMedGoogle Scholar
  16. 16.
    Sherr L, Nagra N, Kulubya G, Catalan J, Clucas C, Harding R. HIV infection associated post-traumatic stress disorder and post-traumatic growth—a systematic review. Psychol Health Med. 2011;16(5):612–29.CrossRefPubMedGoogle Scholar
  17. 17.
    Tedeschi RG, Calhoun LG. Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inq. 2004;15(1):1–18.CrossRefGoogle Scholar
  18. 18.
    Yu XN, Lau JTF, Zhang JX, Mak WWS, Choi KC, Lui WWS, et al. Posttraumatic growth and reduced suicidal ideation among adolescents at month 1 after the Sichuan Earthquake. J Affect Disord. 2010;123(1–3):327–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Scrignaro M, Barni S, Magrin ME. The combined contribution of social support and coping strategies in predicting post-traumatic growth: a longitudinal study on cancer patients. Psycho-oncology. 2011;20(8):823–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Yu NX, Chen LH, Ye Z, Li XM, Lin DH. Impacts of making sense of adversity on depression, posttraumatic stress disorder, and posttraumatic growth among a sample of mainly newly diagnosed HIV-positive Chinese young homosexual men: the mediating role of resilience. Aids Care. 2017;29(1):79–85.CrossRefPubMedGoogle Scholar
  21. 21.
    Lau JTF, Wu XB, Wu AMS, Wang ZX, Mo PKH. Relationships between illness perception and post-traumatic growth among newly diagnosed HIV-positive men who have sex with men in China. AIDS Behav. 2018;22(6):1885–98.CrossRefPubMedGoogle Scholar
  22. 22.
    Ye Z, Yu NX, Zhu WL, Chen LH, Lin DH. A randomized controlled trial to enhance coping and posttraumatic growth and decrease posttraumatic stress disorder in HIV-infected men who have sex with men in Beijing, China. Aids Care. 2018;30(6):793–801.CrossRefPubMedGoogle Scholar
  23. 23.
    Siegel K, Schrimshaw EW, Pretter S. Stress-related growth among women living with HIV/AIDS: examination of an explanatory model. J Behav Med. 2005;28(5):403–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Danoff-Burg S, Revenson TA. Benefit-finding among patients with rheumatoid arthritis: positive effects on interpersonal relationships. J Behav Med. 2005;28(1):91–103.CrossRefPubMedGoogle Scholar
  25. 25.
    Littlewood RA, Vanable PA, Carey MP, Blair DC. The association of benefit finding to psychosocial and health behavior adaptation among HIV plus men and women. J Behav Med. 2008;31(2):145–55.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Dong XL, Li GP, Liu CL, Kong LH, Fang YY, Kang XF, et al. The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: a structural equation model analysis. Eur J Oncol Nurs. 2017;29:47–52.CrossRefPubMedGoogle Scholar
  27. 27.
    Calhoun LG, Cann A, Tedeschi RG. The posttraumatic growth model: sociocultural considerations. In: Weiss T, Berger R, editors. Posttraumatic growth and culturally competent practice. Hoboken: Wiley; 2010.Google Scholar
  28. 28.
    Agaibi CE, Wilson JP. Trauma, PTSD, and resilience: a review of the literature. Trauma Violence Abus. 2005;6(3):195–216.CrossRefGoogle Scholar
  29. 29.
    Werner EE, Bierman JM, French FE. The children of Kauai: a longitudinal study from the prenatal period to age ten. Honolulu: University of Hawaii Press; 1971.Google Scholar
  30. 30.
    Bensimon M. Elaboration on the association between trauma, PTSD and posttraumatic growth: the role of trait resilience. Personal Indiv Differ. 2012;52(7):782–7.CrossRefGoogle Scholar
  31. 31.
    Duan WJ, Guo PF, Gan P. Relationships among trait resilience, virtues, post-traumatic stress disorder, and post-traumatic growth. PLoS ONE. 2015;10(5):e0125707.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Tugade MM, Fredrickson BL, Barrett LF. Psychological resilience and positive emotional granularity: examining the benefits of positive emotions on coping and health. J Personal. 2004;72(6):1161–90.CrossRefGoogle Scholar
  33. 33.
    Bonanno GA. Loss, trauma, and human resilience—have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59(1):20–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Bonanno GA. Resilience in the face of potential trauma. Curr Dir Psychol Sci. 2005;14(3):135–8.CrossRefGoogle Scholar
  35. 35.
    Lepore SJ, Revenson TA. Resilience and posttraumatic growth: recovery, resistance, and reconfiguration. Mahwah: Lawrence Erlbaum Associates Publishers; 2006.Google Scholar
  36. 36.
    Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35–40.Google Scholar
  37. 37.
    Westphal M, Bonanno GA. Posttraumatic growth and resilience to trauma: different sides of the same coin or different coins? Appl Psychol-Int Rev. 2007;56(3):417–27.CrossRefGoogle Scholar
  38. 38.
    Hobfoll SE, Hall BJ, Canetti-Nisim D, Galea S, Johnson RJ, Palmieri PA. Refining our understanding of traumatic growth in the face of terrorism: moving from meaning cognitions to doing what is meaningful. Appl Psychol-Int Rev. 2007;56(3):345–66.CrossRefGoogle Scholar
  39. 39.
    Lazarus RS. From psychological stress to the emotions—a history of changing outlooks. Annu Rev Psychol. 1993;44:1–21.CrossRefPubMedGoogle Scholar
  40. 40.
    Mo PKH, Lau JTF, Yu XN, Gu J. The role of social support on resilience, posttraumatic growth, hopelessness, and depression among children of HIV-infected parents in mainland China. Aids Care. 2014;26(12):1526–33.CrossRefPubMedGoogle Scholar
  41. 41.
    Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82.CrossRefPubMedGoogle Scholar
  42. 42.
    Kilmer RP, Gil-Rivas V, Tedeschi RG, Cann A, Calhoun LG, Buchanan T, et al. Use of the revised posttraumatic growth inventory for children. J Trauma Stress. 2009;22(3):248–53.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Li JH, Mo PKH, Wu AMS, Lau JTF. Roles of self-stigma, social support, and positive and negative affects as determinants of depressive symptoms among HIV infected men who have sex with men in China. AIDS Behav. 2017;21(1):261–73.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Rzeszutek M, Oniszczenko W, Firlag-Burkacka E. Social support, stress coping strategies, resilience and posttraumatic growth in a Polish sample of HIV-infected individuals: results of a 1 year longitudinal study. J Behav Med. 2017;40(6):942–54.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Yu YJ, Peng L, Chen L, Long L, He W, Li M, et al. Resilience and social support promote posttraumatic growth of women with infertility: the mediating role of positive coping. Psychiatry Res. 2014;215(2):401–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Garrido-Hernansaiz H, Murphy PJ, Alonso-Tapia J. Predictors of resilience and posttraumatic growth among people living with HIV: a longitudinal study. AIDS Behav. 2017;21(11):3260–70.CrossRefPubMedGoogle Scholar
  47. 47.
    Stewart DE, Yuen T. A systematic review of resilience in the physically ill. Psychosomatics. 2011;52(3):199–209.CrossRefPubMedGoogle Scholar
  48. 48.
    Swickert R, Hittner J. Social support coping mediates the relationship between gender and posttraumatic growth. J Health Psychol. 2009;14(3):387–93.CrossRefPubMedGoogle Scholar
  49. 49.
    Vogt DS, Rizvi SL, Shipherd JC, Resick PA. Longitudinal investigation of reciprocal relationship between stress reactions and hardiness. Personal Soc Psychol B. 2008;34(1):61–73.CrossRefGoogle Scholar
  50. 50.
    Cadell S, Regehr C, Hemsworth D. Factors contributing to posttraumatic growth: a proposed structural equation model. Am J Orthopsychiatr. 2003;73(3):281–9.CrossRefGoogle Scholar
  51. 51.
    Demi A, Bakeman R, Moneyham L, Sowell R, Seals B. Effects of resources and stressors on burden and depression of family members who provide care to an HIV-infected woman. J Fam Psychol. 1997;11(1):35–48.CrossRefGoogle Scholar
  52. 52.
    Jankowski S, VidekaSherman L, LaquidaraDickinson K. Social support networks of confidants to people with AIDS. Soc Work. 1996;41(2):206–13.CrossRefPubMedGoogle Scholar
  53. 53.
    Dirik G, Karanci AN. Variables related to posttraumatic growth in Turkish rheumatoid arthritis patients. J Clin Psychol Med Settings. 2008;15(3):193–203.CrossRefPubMedGoogle Scholar
  54. 54.
    Karanci AN, Erkam A. Variables related to stress-related growth among Turkish breast cancer patients. Stress Health. 2007;23(5):315–22.CrossRefGoogle Scholar
  55. 55.
    Nenova M, DuHamel K, Zemon V, Rini C, Redd WH. Posttraumatic growth, social support, and social constraint in hematopoietic stem cell transplant survivors. Psycho-oncology. 2013;22(1):195–202.CrossRefPubMedGoogle Scholar
  56. 56.
    Kamen C, Vorasarun C, Canning T, Kienitz E, Weiss C, Flores S, et al. The impact of stigma and social support on development of post-traumatic growth among persons living with HIV. J Clin Psychol Med Settings. 2016;23(2):126–34.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Rzeszutek M. Social support and posttraumatic growth in a longitudinal study of people living with HIV: the mediating role of positive affect. Eur J Psychotraumatol. 2017;8(1):1412225.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Rzeszutek M. A longitudinal analysis of posttraumatic growth and affective well-being among people living with HIV: the moderating role of received and provided social support. PLoS ONE. 2018;13(8):e0201641.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Zeligman M, Barden SM, Hagedorn WB. Posttraumatic growth and HIV: a study on associations of stigma and social support. J Couns Dev. 2016;94(2):141–9.CrossRefGoogle Scholar
  60. 60.
    Cieslak R, Benight C, Schmidt N, Luszczynska A, Curtin E, Clark RA, et al. Predicting posttraumatic growth among Hurricane Katrina survivors living with HIV: the role of self-efficacy, social support, and PTSD symptoms. Anxiety Stress Coping. 2009;22(4):449–63.CrossRefPubMedGoogle Scholar
  61. 61.
    Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27(3):237–51.CrossRefPubMedGoogle Scholar
  62. 62.
    Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Fam Med. 2009;41(7):494–501.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Yang X, Mak WWS. The differential moderating roles of self-compassion and mindfulness in self-stigma and well-being among people living with mental illness or HIV. Mindfulness. 2017;8(3):595–602.CrossRefGoogle Scholar
  64. 64.
    Tedeschi RG, Tedeschi RG, Park CL, Calhoun LG. Posttraumatic growth: conceptual issues. In: Tedeschi RG, Tedeschi RG, Park CL, Calhoun LG, editors. Posttraumatic Growth: Positive Changes in the Aftermath of Crises. Mahwah: Erlbaum; 1998.Google Scholar
  65. 65.
    Li J, Mao Y, Tang H, Han J, Xu J, Wu Z. Analysis of factors associated with antiretroviral therapy initiation and its timeliness among HIV sero-discordant couples in high HIV prevalence regions, China. Chin J Prev Med. 2015;49(7):625–31.Google Scholar
  66. 66.
    Mercer SW, Maxwell M, Heaney D, Watt GCM. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705.CrossRefPubMedGoogle Scholar
  67. 67.
    Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GCM. Relevance and practical use of the consultation and relational empathy (CARE) measure in general practice. Fam Pract. 2005;22(3):328–34.CrossRefPubMedGoogle Scholar
  68. 68.
    Fung CSC, Hua A, Tam L, Mercer SW. Reliability and validity of the Chinese version of the CARE Measure in a primary care setting in Hong Kong. Fam Pract. 2009;26(5):398–406.CrossRefPubMedGoogle Scholar
  69. 69.
    Gu J, Lau JTF, Wang Z, Wu AMS, Tan X. Perceived empathy of service providers mediates the association between perceived discrimination and behavioral intention to take up HIV antibody testing again among men who have sex with men. PLoS ONE. 2015;10(2):e0117376.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Yu XN, Zhang JX. Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) with Chinese people. Soc Behav Personal. 2007;35(1):19–30.CrossRefGoogle Scholar
  71. 71.
    Lau JT, Yeung NC, Yu X, Zhang J, Mak WW, Lui WW, et al. Psychometric properties of the Chinese version of the revised Posttraumatic Growth Inventory for children (PTGI-CR). Asia Pac J Public Health. 2015;27(2):NP1310–20.CrossRefPubMedGoogle Scholar
  72. 72.
    Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002;7(4):422–45.CrossRefPubMedGoogle Scholar
  73. 73.
    Hayes AF. PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling. 2012.
  74. 74.
    Yum JO. The impact of confucianism on interpersonal relationships and communication patterns in East-Asia. Commun Monogr. 1988;55(4):374–88.CrossRefGoogle Scholar
  75. 75.
    Chang EC, Yang HF, Yu T. Perceived interpersonal sources of life satisfaction in Chinese and American students: cultural or gender differences? J Posit Psychol. 2017;12(4):414–24.CrossRefGoogle Scholar
  76. 76.
    Diener E, Lucas RE, Scollon CN. Beyond the hedonic treadmill—revising the adaptation theory of well-being. Am Psychol. 2006;61(4):305–14.CrossRefPubMedGoogle Scholar
  77. 77.
    Cordova MJ, Cunningham LLC, Carlson CR, Andrykowski MA. Posttraumatic growth following breast cancer: a controlled comparison study. Health Psychol. 2001;20(3):176–85.CrossRefPubMedGoogle Scholar
  78. 78.
    Park CL, Cohen LH, Murch RL. Assessment and prediction of stress-related growth. J Personal. 1996;64(1):71–105.CrossRefGoogle Scholar
  79. 79.
    Updegraff JA, Taylor SE, Kemeny ME, Wyatt GE. Positive and negative effects of HIV infection in women with low socioeconomic resources. Personal Soc Psychol Bull. 2002;28(3):382–94.CrossRefGoogle Scholar
  80. 80.
    Kirshenbaum SB, Hirky AE, Correale J, Goldstein RB, Johnson MO, Rotheram-Borus MJ, et al. “Throwing the dice”: pregnancy decision-making among HIV-positive women in four US cities. Perspect Sex Reprod Health. 2004;36(3):106–13.CrossRefPubMedGoogle Scholar
  81. 81.
    Ter Kuile FO, Parise ME, Verhoeff FH, Udhayakumar V, Newman RD, Van Eijk AM, et al. The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-Saharan Africa. Am J Trop Med Hyg. 2004;71(2):41–54.CrossRefPubMedGoogle Scholar
  82. 82.
    Takada S, Weiser SD, Kumbakumba E, Muzoora C, Martin JN, Hunt PW, et al. The dynamic relationship between social support and HIV-related stigma in rural Uganda. Ann Behav Med. 2014;48(1):26–37.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Rhodes T, Cusick L. Love and intimacy in relationship risk management: HIV positive people and their sexual partners. Sociol Health Illn. 2000;22(1):1–26.CrossRefGoogle Scholar
  84. 84.
    Li L, Lee SJ, Thammawijaya P, Jiraphongsa C, Rotheram-Borus MJ. Stigma, social support, and depression among people living with HIV in Thailand. Aids Care. 2009;21(8):1007–13.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Mrug S, Elliott MN, Davies S, Tortolero SR, Cuccaro P, Schuster MA. Early puberty, negative peer influence, and problem behaviors in adolescent girls. Pediatrics. 2014;133(1):7–14.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Gardner M, Steinberg L. Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Dev Psychol. 2005;41(4):625–35.CrossRefPubMedGoogle Scholar
  87. 87.
    Westling E, Andrews JA, Hampson SE, Peterson M. Pubertal timing and substance use: the effects of gender, parental monitoring and deviant peers. J Adolesc Health. 2008;42(6):555–63.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Maman S, Mbwambo JK, Hogan NM, Weiss E, Kilonzo GP, Sweat MD. High rates and positive outcomes of HIV-serostatus disclosure to sexual partners: reasons for cautious optimism from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. AIDS Behav. 2003;7(4):373–82.CrossRefPubMedGoogle Scholar
  89. 89.
    Gielen AC, Fogarty L, O’Campo P, Anderson J, Keller J, Faden R. Women living with HIV: disclosure, violence, and social support. J Urban Health. 2000;77(3):480–91.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Reis C, Heisler M, Amowitz LL, Moreland RS, Mafeni JO, Anyamele C, et al. Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med. 2005;2(8):743–52.CrossRefGoogle Scholar
  91. 91.
    Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychol Health Med. 2006;11(3):353–63.CrossRefPubMedGoogle Scholar
  92. 92.
    Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC Med Educ. 2014;14:219.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Reynolds WJ. The measurement and development of empathy in nursing. Abingdon: Routledge; 2017.CrossRefGoogle Scholar
  94. 94.
    Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34(2):90–4.CrossRefPubMedGoogle Scholar
  95. 95.
    Kramer D, Ber R, Moore M. Increasing empathy among medical-students. Med Educ. 1989;23(2):168–73.CrossRefPubMedGoogle Scholar
  96. 96.
    Prati G, Pietrantoni L. Optimism, social support and coping strategies as factors contributing to posttraumatic growth: a meta-analysis. Psychol Health. 2009;24:44.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of MedicineThe Chinese University of Hong KongSha TinChina
  2. 2.The Chinese University of Hong Kong Shenzhen Research InstituteShenzhenChina
  3. 3.Maternal Health DepartmentNational Center for Women and Children’s Health, China CDCBeijingChina
  4. 4.Women Health Branch of the Chinese Preventive Medicine AssociationBeijingChina

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