Abstract
ObjectivesPost-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems.DesignQualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.SettingEngland.ParticipantsParticipants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British.ResultsComponents of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process.ConclusionsPost-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery.Trial registration number ISRCTN11152837
Highlights
Post-traumatic growth is a relatively new area of research
The aim of this study is to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems
This research was undertaken as part of the National Institute for Health Research (NIHR) Narrative Experiences Online (NEON) study between March and August 2018
Summary
►► This study reports findings from a substantial qualitative investigation of post-traumatic growth in people with psychosis and other severe mental health problems. There is only limited evidence about the frequency and types of post-traumatic growth in people living longterm with psychosis and other severe mental illness experiences.[24] A quantitative study of 121 people with severe mental illness using community mental health rehabilitation centres in Israel found high levels of trauma,[25] and that meaning-making and coping self-efficacy mediated post-traumatic growth experiences.[26] Three small (n=7,27 n=7,28 n=1029) qualitative studies using interpretative phenomenological analysis of semi-structured interviews all identified themes of personal growth. The extent to which (a) the five growth processes identified from event trauma research and (b) the more preliminary early psychosis-specific restorative and constructive identity processes are characterising the same changes is unknown Integration of these two sources of evidence is needed, as is investigation of the experiences of a broader range of people with long-term psychosis, including under-researched groups. The aim of this study is to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems
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