An Examination of the Association Between Post-traumatic Growth and Stress Symptomatology in Cardiac Outpatients

  • Kirby Magid
  • Renée El-GabalawyEmail author
  • Anbukarasi Maran
  • Eva R. Serber


This study examined the association between post-traumatic growth (PTG), post-traumatic stress disorder (PTSD), and trauma-related factors in cardiac outpatients. Participants recruited from four cardiology clinics between November 2014 and July 2015 (N = 52, 69.2% men, Mage = 65 years) completed self-assessments of PTG and PTSD along with demographic, cardiac health index, and trauma-related factors. In total, 75% of the sample endorsed their cardiac event as traumatic, while 17.2% reported their cardiac event as their ‘worst trauma’; those endorsing the latter did not significantly differ from those endorsing ‘other traumas’ as their worst. Chi-square analyses indicated that the lifetime traumas of experiencing loss or abandonment, witnessing trauma, and experiencing a natural disaster were significantly related to PTG factors of new possibilities, relating to others, and spirituality. Bivariate correlations on all PTSD symptom clusters and factors of PTG revealed the strongest associations between the PTG factors of spiritual change and appreciation of life. Lifetime PTSD symptoms, duration of negative reactions, and re-experiencing symptoms were found to be significantly associated with higher PTG, and a unique independent effect emerged with avoidance symptoms. Our results suggest that PTG may be associated with particular facets of PTSD symptomatology.


Post-traumatic growth Post-traumatic stress disorder Mental health Cardiac disease Trauma reactions 


Compliance with Ethical Standards

Conflict of interest

Kirby Magid, Renée El-Gabalawy, Anbukarasi Maran, and Eva R. Serber declare that they have no conflict of interest.

Ethical Approval

All procedures were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The study utilized a waiver of informed consent because no protected health information was collected, and data were all restricted to the self-report participant forms.


  1. Affleck, G., Tennen, H., Croog, S., & Levine, S. (1987). Causal attribution, perceived benefits, and morbidity after a heart attack: An 8-year study. Journal of Consulting and Clinical Psychology, 55, 29–35. Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing. Scholar
  3. Barskova, T., & Oesterreich, R. (2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disability and Rehabilitation, 31, 1709–1733. Scholar
  4. Bluvstein, I., Moravchick, L., Sheps, D., Schreiber, S., & Bloch, M. (2013). Posttraumatic growth, posttraumatic stress symptoms and mental health among coronary heart disease survivors. Journal of Clinical Psychology in Medical Settings, 20, 164–172.CrossRefGoogle Scholar
  5. Boscarino, J. A. (2004). Posttraumatic stress disorder and physical illness: Results from clinical and epidemiologic studies. Annals of the New York Academy of Sciences, 1032, 141–153. Scholar
  6. Bowman, M. (1999). Individual differences in posttraumatic distress: Problems with the DSM-IV model. The Canadian Journal of Psychiatry, 44, 21–33. Scholar
  7. Cann, A., Calhoun, L. G., Tedeschi, R., Taku, K., Vishnevsky, T., Triplett, K. N., et al. (2010). A short form of the posttraumatic growth inventory. Anxiety, Stress and Coping, 23, 127–137. Scholar
  8. Carlson, E. B., Smith, S. R., Palmieri, P. A., Dalenberg, C., Ruzek, J. I., Kimerling, R., … Spain, D. A. (2011). Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen. Psychological Assessment, 23, 463–477. Scholar
  9. Cordova, M. J., Cunningham, L. L. C., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20, 176–185. Scholar
  10. Deng, L. X., Khan, A. M., Drajpuch, D., Fuller, S., Ludmir, J., Mascio, C. E., … Kim, Y. Y. (2016). Prevalence and correlates of post-traumatic stress disorder in adults with congenital heart disease. The American Journal of Cardiology, 117, 853–857. Scholar
  11. Edmondson, D. (2014). An enduring somatic threat model of posttraumatic stress disorder due to acute life-threatening medical events. Social and Personality Psychology Compass, 8, 118–134. Scholar
  12. Edmondson, D., & Cohen, B. E. (2013). Posttraumatic stress disorder and cardiovascular disease. Progress in Cardiovascular Diseases, 55, 548–556. Scholar
  13. Edmondson, D., Richardson, S., Falzon, L., Davidson, K. W., Mills, M. A., & Neria, Y. (2012). Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: A meta-analytic review. PLoS ONE, 7, e38915. Scholar
  14. El-Gabalawy, R., Sommer, J., & Mota, N. (2017). Understanding illness-induced PTSD: An epidemiological investigation of prevalence and correlates of a controversial diagnosis. Poster presentation at the 33rd Annual International Society for Traumatic Stress Studies Conference, Chicago, IL.Google Scholar
  15. Evandrou, M. (2005). Health and social care (Chap. 6). In A. Soule, P. Baab, M. Evandrou, S. Balchin, & L. Zealy (Eds.), Focus on older people (focus on series) (pp. 51–66). Basingstoke: Palgrave Macmillian.Google Scholar
  16. Fergus, T. A., & Bardeen, J. R. (2016). Main and interactive effects of mental contamination and tolerance of negative emotions in relation to posttraumatic stress symptoms following sexual trauma. Journal of Psychopathology and Behavioral Assessment, 38, 274–283. Scholar
  17. Field, A. (2009). Discovering statistics using SPSS. Thousand Oaks: Sage.Google Scholar
  18. Gangstad, B., Norman, P., & Barton, J. (2009). Cognitive processing and posttraumatic growth after stroke. Rehabilitation Psychology, 54, 69–75. Scholar
  19. García-Campayo, J., Zamorano, E., Ruiz, M. A., Pérez-Páramo, M., López-Gómez, V., & Rejas, J. (2012). The assessment of generalized anxiety disorder: Psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice. Health and Quality of Life Outcomes, 10, 114. Scholar
  20. Garnefski, N., Kraaij, V., Schroevers, M. J., & Somsen, G. A. (2008). Post-traumatic growth after a myocardial infarction: A matter of personality, psychological health, or cognitive coping? Journal of Clinical Psychology in Medical Settings, 15, 270–277. Scholar
  21. Helgeson, V. S., Reynolds, K. A., & Tomich, P. L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology, 74, 797–816. Scholar
  22. Holtmaat, K., Spek, N., Cuijpers, P., Leemans, C., & Verdonck-de Leeuw, I. (2017). Posttraumatic growth among head and neck cancer survivors with psychological distress. Psycho-Oncology, 26(1), 96–101. Scholar
  23. Huffman, J. C., Smith, F. A., Blais, M. A., Beiser, M. E., Januzzi, J. L., & Fricchione, G. L. (2006). Recognition and treatment of depression and anxiety in patients with acute myocardial infarction. American Journal of Cardiology, 98, 319–324. Scholar
  24. Jansen, L., Hoffmeister, M., Chang-Claude, J., Brenner, H., & Arndt, V. (2011). Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: Prevalence, determinants, and associations with quality of life. British Journal of Cancer, 105, 1158. Scholar
  25. Kang, H. K., Bullman, T. A., & Taylor, J. W. (2006). Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Annals of Epidemiology, 16, 381–386. Scholar
  26. Karagiorgou, O., & Cullen, B. (2016). A comparison of post-traumatic growth after acquired brain injury or myocardial infarction. Journal of Loss and Trauma, 21, 589–600. Scholar
  27. Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to trauamtic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537–547. Scholar
  28. Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics, 50, 613–621. Scholar
  29. Leung, Y. W., Gravely-Witte, S., Macpherson, A., Irvine, J., Stewart, D. E., & Grace, S. L. (2010). Post-traumatic growth among cardiac outpatients: Degree comparison with other chronic illness samples and correlates. Journal of Health Psychology, 15, 1049–1063. Scholar
  30. Liu, H., Petukhova, M. V., Sampson, N. A., Aguilar-Gaxiola, S., Alonso, J., Andrade, L. H., … Kawakami, N. (2017). Association of DSM-IV posttraumatic stress disorder with traumatic experience type and history in the World Health Organization World Mental Health Surveys. JAMA Psychiatry, 74, 270–281. Scholar
  31. Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58, 163–171. Scholar
  32. Lowe, S. R., Manove, E. E., & Rhodes, J. E. (2013). Posttraumatic stress and posttraumatic growth among low-income mothers who survived Hurricane Katrina. Journal of Consulting and Clinical Psychology, 81(5), 877–889. Scholar
  33. McCaslin, S. E., De Zoysa, P., Butler, L. D., Hart, S., Marmar, C. R., Metzler, T. J., & Koopman, C. (2009). The relationship of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms among Sri Lankan University students. Journal of Traumatic Stress, 22, 334–339. Scholar
  34. McClain, C. S., Rosenfeld, B., & Breitbart, W. (2003). Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet, 361, 1603–1607. Scholar
  35. Morgan, J. K., & Desmarais, S. L. (2017). Associations between time since event and posttraumatic growth among military veterans. Military Psychology, 29, 456–463. Scholar
  36. National Park Service, & U.S. Department of the Interior. (n.d.). Charleston’s historic religious and community buildings. Retrieved from
  37. Nenova, M., DuHamel, K., Zemon, V., Rini, C., & Redd, W. H. (2013). Posttraumatic growth, social support and social constraint in hematopoietic stem cell transplant survivors. Psycho-Oncology, 22(1), 195–202. Scholar
  38. Paris, J. (1999). Nature and nurture in psychiatry: A predisposition-stress model of mental disorders. Washington, DC: American Psychiatric Press.Google Scholar
  39. Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. Bmj, 316, 1236–1238. Scholar
  40. Perruccio, A. V., Katz, J. N., & Losina, E. (2012). Health burden in chronic disease: Multimorbidity is associated with self-rated health more than medical comorbidity alone. Journal of Clinical Epidemiology, 65(1), 100–106. Scholar
  41. Posluszny, D. M., Dougall, A. L., Johnson, J. T., Argiris, A., Ferris, R. L., Baum, A., … Dew, M. A. (2015). Posttraumatic stress disorder symptoms in newly diagnosed participants with head and neck cancer and their partners. Head & neck, 37, 1282–1289. Scholar
  42. Remch, M., Laskaris, Z., Flory, J., Mora-McLaughlin, C., & Morabia, A. (2018). Post-traumatic stress disorder and cardiovascular diseases: A cohort study of men and women involved in cleaning the debris of the world trade center complex. Circulation: Cardiovascular Quality and Outcomes, 11, e004572. Scholar
  43. Rosman, L., Ford, J., Whited, A., Cahill, J., Lampert, R., Mosesso, V. … Sears, S. (2016). Compound risk: History of traumatic stress predicts posttraumatic stress disorder symptoms and severity in sudden cardiac arrest survivors. European Journal of Cardiovascular Nursing, 15, 372–379. Scholar
  44. Rothman, K. J. (1990). No adjustments are needed for multiple comparisons. Epidemiology, 1, 43–46. Scholar
  45. Shakespeare-Finch, J., & Armstrong, D. (2010). Trauma type and posttrauma outcomes: Differences between survivors of motor vehicle accidents, sexual assault, and bereavement. Journal of Loss and Trauma, 15, 69–82. Scholar
  46. Shakespeare-Finch, J., & Lurie-Beck, J. (2014). A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder. Journal of Anxiety Disorders. Scholar
  47. Spindler, H., & Pedersen, S. S. (2005). Posttraumatic stress disorder in the wake of heart disease: Prevalence, risk factors, and future research directions. Psychosomatic Medicine, 67, 715–723. Scholar
  48. Spitzer, C., Barnow, S., Völzke, H., John, U., Freyberger, H. J., & Grabe, H. J. (2009). Trauma, posttraumatic stress disorder, and physical illness: Findings from the general population. Psychosomatic Medicine, 71(9), 1012–1017. Scholar
  49. Swickert, R., & Hittner, J. (2009). Social support coping mediates the relationship between gender and posttraumatic growth. Journal of Health Psychology, 14(3), 387–393. Scholar
  50. Tedeschi, R., & Calhoun, L. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18. Scholar
  51. Tedeschi, R., Park, C. L., & Calhoun, L. G. (1998). Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah: Lawrence Erlbaum. Scholar
  52. Tedstone, J. E., & Tarrier, N. (2003). Posttraumatic stress disorder following medical illness and treatment. Clinical Psychology Review, 23, 409–448. Scholar
  53. Thombs, B. D., Bass, E. B., Ford, D. E., Stewart, K. J., Tsilidis, K. K., Patel, U. … Ziegelstein, R. C. (2006). Prevalence of depression in survivors of acute myocardial infarction. Journal of General Internal Medicine, 21, 30–38. Scholar
  54. Tsai, J., El-Gabalawy, R., Sledge, W. H., Southwick, S. M., & Pietrzak, R. H. (2015). Post-traumatic growth among veterans in the USA: Results from the National Health and Resilience in Veterans Study. Psychological Medicine, 45, 165–179. Scholar
  55. Vaccarino, V., Goldberg, J., Rooks, C., Shah, A. J., Veledar, E., Faber, T. L., ... & Bremner, J. D. (2013). Post-traumatic stress disorder and incidence of coronary heart disease: A twin study. Journal of the American College of Cardiology, 62, 970–978. Scholar
  56. Vilchinsky, N., Ginzburg, K., Fait, K., & Foa, E. B. (2017). Cardiac-disease-induced PTSD (CDI-PTSD): A systematic review. Clinical Psychology Review. Scholar
  57. Vishnevsky, T., Cann, A., Calhoun, L. G., Tedeschi, R. G., & Demakis, G. J. (2010). Gender differences in self-reported posttraumatic growth: A meta-analysis. Psychology of Women Quarterly, 34, 110–120. Scholar
  58. Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). National Center for PTSD.
  59. Weston, R., & Gore, P. A. (2006). A brief guide to structural equation modeling. The Counseling Psychologist, 34, 719–751. Scholar
  60. Znoj, H. J. (1999). European and American perspectives on posttraumatic growth: A model of personal growth: Life challenges and transformation following loss and physical handicap. Boston, MA: Annual convention of the American Psychological Association.Google Scholar
  61. Zoellner, T., & Maercker, A. (2006). Posttraumatic growth in clinical psychology: A critical review and introduction of a two component model. Clinical Psychology Review, 26, 626–653. Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of ManitobaWinnipegCanada
  2. 2.Department of Clinical Health Psychology and Department of Anesthesiology, Perioperative and Pain MedicineUniversity of ManitobaWinnipegCanada
  3. 3.Department of MedicineMedical University of South CarolinaCharlestonUSA
  4. 4.Department of Psychiatry/Bio-behavioral MedicineMedical University of South CarolinaCharlestonUSA

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