Sex-Trafficked Survivors: The Relation Between Posttraumatic Growth and Quality of Life

Pediatric cancer can be considered an event potentially leading to posttraumatic stress symptoms (PTSS) as well as posttraumatic growth (PTG). While clinically significant levels of PTSS are rare in childhood cancer survivors, PTG is common in this population. However, the relationship of PTG to overall adaptation and quality of life (QOL) in pediatric cancer patients is not clear. Therefore, our study aims to analyse the relationships of PTSS and PTG with QOL in childhood cancer survivors. In this study, 172 childhood cancer survivors completed measures of quality of life (Minneapolis-Manchester Quality of Life Scale; child and adolescent version), posttraumatic stress (UCLA PTSD Reaction Index for DMS-IV) and posttraumatic growth (Benefit Finding Scale for Children). Correlation analyses were carried out separately for the child (up to 13 years, N = 47) and adolescent (more than 13 years, N = 125) groups and each QOL dimension. In the adolescent group, the relationship of PTSS and PTG with QOL was further verified by regression analyses while controlling for age, gender, and time off treatment. In children, negative relationships between PTSS and QOL were found, but the relationships between QOL and PTG were not significant. In adolescents, significant relationships were found for all dimensions of QOL and PTSS and also for several dimensions of QOL and PTG. The relationships between PTSS and QOL dimensions were negative in both groups, and the relationships between PTG and QOL in the adolescent group were weakly positive. In adolescents, regression analyses controlling for age, gender and time off treatment were performed and confirmed a negative relationship of PTSS with all QOL dimensions except for social functioning. For PTG, regression analyses revealed a significant positive relationship with QOL dimensions of social functioning, outlook on life and intimate relations. While the relationship between PTSS and QOL is negative for almost all QOL dimensions in children and adolescents, the nature of the relationship between PTG and QOL appears to be more complex and changing over time. PTG in children may reflect different processes with different outcomes than PTG in adolescents.

Purpose: Socioeconomic disparities in psychosocial adjustment to breast cancer has garnered little attention. Those who are medically underserved with little to no access to quality health care are more likely to be diagnosed with late-stage cancer, have more complications, and face psychosocial and cultural factors that impact their quality of life. Socioeconomic status (SES) is a multidimensional construct that is typically comprised of income, education, and occupation. Recent research suggests that these indicators impact cancer health in independent manners. Moreover, increasing evidence supports the health protective features of having meaning in life. A recurrent theme is resilience – the ability to regain or maintain well-being in the face of adversity. The perceived benefits one reports (e.g. better relationship quality, greater sense of self-efficacy, etc.) after experiencing a stressful life event is known as post-traumatic growth (PTG). This study examines the relationships between SES indicators (e.g. education, household income), quality of life (QOL), and the role of PTG as an underlying mechanism in the impact of SES in psychosocial adjustment to breast cancer among Chinese American breast cancer survivors (CABCS). Methods: 136 CABCS completed a baseline questionnaire from a larger, intervention study. Results: Education and household income were all positively related to overall quality of life. Education was positively related to functional QOL and additional breast cancer concerns. Annual household income was positively related to all QOL domains. Regression analyses revealed an association between household income with PTG and PTG with overall QOL. Bootstrapping analyses supported a full mediation as the indirect effect of household income on overall QOL through PTG was statistically significant. Further examining QOL subscales, PTG was associated with better social QOL and household income showed a significant indirect effect on social QOL through PTG suggesting PTG fully mediates the effect of household income on social QOL. PTG was associated with better emotional QOL and less breast cancer concerns. However, the total effect of household income on emotional QOL was non-significant. The total effect of PTG on breast cancer was marginally significant (p = .06). Analyses for education failed to reveal any significant direct or indirect effect on overall QOL and its subscales through PTG. Conclusion: These findings suggest that SES indicators such as household income and educational attainment are differentially related to QOL domains among CABCS. Household income is linked to better social and emotional QOL through reported PTG suggesting that findings benefits within adversity including reported meaning may enhance well-being. This underscores the differential role of socioeconomic indicators when assessing health outcomes and the importance of implementing psychosocial interventions that facilitate PTG in improving QOL among immigrant cancer survivors. Citation Format: Carol Wang, Qian Lu. Socioeconomic status and quality of life among Chinese American breast cancer survivors: The role of post-traumatic growth [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A060.

Positive psychology mediates the relationship between symptom frequency and quality of life among colorectal cancer survivors during acute cancer survivorship.

To evaluate the impact of disclosure/nondisclosure of cancer diagnosis on patients' posttraumatic stress symptoms (PTSS), posttraumatic growth (PTG), and quality of life (QOL). Patients with primary hepatocellular carcinoma (HCC) who were admitted for potentially curative treatments in a teaching hospital were recruited. Patients were interviewed at admission regarding their QOL and their attitude towards disclosure of diagnosis. They were interviewed again for QOL, PTSS, and PTG at discharge and at 1month after discharge. There were 300 patients recruited, 88.3% of whom preferred disclosure of cancer diagnosis. In fact, 162 patients (54.0%) received disclosure of their cancer diagnosis before discharge (disclosed group). However, for the 138 patients whose diagnoses were concealed by their families (uninformed group), 116 patients (84.1%) had learned of their diagnosis of HCC independently within 1month after discharge. Comparing the scores at 1month after discharge with scores at discharge showed that the PTSS score significantly declined for patients in the disclosed group and the PTG score significantly decreased for the uninformed patients at 1month after discharge (p < 0.001 for both comparisons). Additionally, compared with the uninformed group, patients in the disclosed group had lower scores for PTSS (p < 0.001), higher scores for PTG (p < 0.001), better emotional functioning (p < 0.001), and better global QOL (p = 0.006) at 1month after discharge. Our findings indicate that concealing the diagnosis of cancer from patients is unlikely to succeed. Additionally, disclosure of diagnosis is beneficial for HCC patients in reducing PTSS and improving PTG and QOL.

BackgroundPsychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.MethodsFifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.ResultsAll patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins.A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.ConclusionsMulti-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.

Objective To explore the effect of social support and coping style on posttraumatic growth of ostomy patients. Methods A total of 237 patients with ostomy from Affiliated Hospital of Qingdao University were investigated using General questionnaire, Perceived Social Support Scale, Medical Coping Modes Questionnaire and Posttraumatic Growth Inventory by cross-sectional survey method from September 2017 to March 2018. The path of social support and coping style on post-traumatic growth was established by correlation analysis and structural equation model. Results The total score of posttraumatic growth in patients with ostomy was (66.76±12.20) points, which was at the upper-middle level. Correlation analysis showed that posttraumatic growth was positively correlated with comprehension of social support (r=0.551, P <0.01), positively correlated with face style (r=0.580, P < 0.01), negatively correlated with avoidance style and resignation style (r=-0.334, P < 0.01; r=-0.449, P < 0.01). Structural equation model showed social support had directly positive effect on posttraumatic growth, path coefficient were 0.44. Face style, avoidance style, and resignation style had a partial mediating effect between social support and posttraumatic growth, and mediation effects account for 20.01%, 5.21%, 9.25% of the total effect, respectively. Conclusions The posttraumatic growth level of patients with ostomy needs to be improved. Medical staff should strengthen social support for patients and guide patients to adopt the positive coping styles, reduce the avoidance and resignation coping styles, and promote patients to get more posttraumatic growth, furthermore, improve their social adaptability and quality of life. Key words: Ostomy; Posttraumatic growth; Social support; Coping style, path analysis

Background and objective People with psychosis report experiences of highly traumatic events. Positive change or post-traumatic growth (PTG) can occur as a result of traumatic experiences. Yet there is limited attention on PTG in psychosis, possibly due to the negative impact of psychotic symptoms on functioning and quality of life. The aim of this review was to identify significant correlates and mediators of PTG in psychosis, and to develop a conceptual framework synthesising facilitators of PTG in psychosis.MethodTen electronic databases were searched in seven languages, and five journals and grey literature were searched in English. Quantitative studies were eligible if examining correlates, mediators, or the temporal relationship between PTG and one or more variables. Qualitative studies were eligible if describing PTG arising from experiences of psychosis. Findings from quantitative papers were grouped by analysis method, with significant correlates, mediators, and temporal relationships descriptively reported upon. Narrative synthesis was conducted on findings in qualitative papers.ResultsThirty-seven papers were included. Significant correlates and mediators of PTG were identified. Mediators of PTG in psychosis included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. No studies describing the temporal relationship between PTG and psychosis were identified. The narrative synthesis identified seven facilitators of PTG in psychosis: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, and Relationships, giving the acronym PROSPER.Conclusions Individuals with psychosis can be supported to grow from traumatic experiences. Clinicians can support PTG through the provision of trauma-informed care that supports positively valued identity changes. For researchers, the findings provide an evidence-based theoretical framework for conceptualising PTG, which can be validated through longitudinal cohort studies and underpin the development of new clinical interventions.

This longitudinal study characterized psychological adjustment in a sample of lung cancer patients by examining the occurrence of posttraumatic stress and growth and their relationships with mental and physical health quality of life and survival over time. Two waves of consecutive cohort samples, totaling 115 participants diagnosed with lung cancer, were identified from outpatient oncology clinics. Of these, 93 consented and completed the first of three assessments, and 57 completed the study. Prevalence of posttraumatic stress symptoms (PTSD Checklist) and posttraumatic growth (Posttraumatic Growth Inventory) were assessed and used to predict physical and mental health components of quality of life (Short Form 36) and survival. Patients reported both negative and positive psychological sequelae, with prevalence of estimated PTSD ranging from 5-16% at each assessment as determined by symptom and cut-off methods. Posttraumatic stress and growth were positively related, but were differentially associated with outcomes. More posttraumatic stress predicted lower mental health quality of life, whereas more posttraumatic growth predicted better physical health quality of life and longer survival. These relationships persisted after accounting for disease variables and attrition due to death or illness. These findings highlight the importance of using longitudinal designs to identify relationships between stress and resilience factors in predicting outcomes.

Background: Diagnosing with low-grade gliomas (LGGs) can be a very shocking and stressful experience, a traumatic event potentially leading to the development of posttraumatic stress symptoms (PTSS), and posttraumatic growth (PTG). Understanding how patients cognitively and behaviorally response to their diagnosing is also important to postoperative treatment. Thus, the current study explored the association between PTG and quality of life (QoL) of Chinese patients with LGGs. The moderation effects of coping strategies and PTSS on the relationship between PTG and QoL have been examined as well.Methods: Posttraumatic stress symptoms, Posttraumatic growth, coping strategies, and QoL were measured by using self-report surveys. Three hundred and thirty patients completed surveys approximately 1 month after surgery. We used three multiple regression models and added interaction terms in these models to test the moderation effects of PTSS and coping strategies on the relationship between PTG and QoL.Results: The results of hierarchical multiple regression suggested that PTG significantly predicted QoL, both PTSS and coping strategies moderated the association between PTG and QoL. Specifically, the association between PTG and QoL for patients who have non-significant PTSS is stronger than those who have significant PTSS. Furthermore, as the score of Avoidant Coping increases, the association between PTG and QoL becomes weaker.Conclusion: Posttraumatic growth may help to improve the QoL of LGGs patients, but PTSS and Avoidant Coping impeded the positive effect of PTG on QoL.

Trauma can also lead to positive outcomes such as posttraumatic growth. Therefore a lot of studies about posttraumatic growth in correlation exist with different trauma types. Severe illness like cancer is one reason for possible positive psychological change. This study aims to assess posttraumatic growth and health related quality of life in patients with a primary oral squamous cell carcinoma. Thirty patients have been treated at the Clinic for Oral, Jaw and Face Surgery at University of Göttingen between 2011 and 2012 and were enrolled in this study. Routinely the University of Washington Quality of Life (UW-QOL). Questionnaire was handed out to them pre-operatively and in intervals of post-operative recalls. For assessing the posttraumatic growth the PTGI (Posttraumatic Growth Inventory) Questionnaire designed by Tedeschi and Calhoun was used. The design of this study is a retrospective analysis of the existing data. Repeated- measures- ANOVA was used to test the significance of changes in PTG from 30 to 360 days. Followed by paired test of each moment of time. The Analysis of possible influences like gender, age, civil status or religion, was realized with t-test for independent samples. Furthermore there was a statistical evaluation of the pre- and post-op Quality of Life (QOL), as well as the description of different influence quantities. From n=30 50% dropped out of the cohort due to a lack of compliance. Fifteen patients filled out the questionnaires frequently and entirely. Two of these patients died one year after surgery. The global analysis showed that there is significant chance in posttraumatic growth in dependency of the time (p<0,001). The presentation of the results describes an anticlimax. There is a decrease in PTR from 30 days to 360 post-op. Survivors reported higher scores right after the diagnosis which degreases over the time after the diagnosis. The global analysis of each subscale showed that four of the five subscales have a statistic relevant chance from 30 to 360 days (p<0,05). The results of the paired analysis was mixed. Only for one subscale (“Personal Relationships”) was a significant trend for every moment of time (p<0,05). Only gender showed a significant relation to one of the subscale “New Possibilities (p=0,02). Patients at the age of 60 and younger estimated there new possibilities to be better, than patients over 60 years. There was also a significant outcome for religious patients and “Personal Relationships” (p=0,04). Health related quality of life also showed significant relation to time. Chronical sequence reported poorer quality post-operatively. Physical function: “Chewing” presented the largest increase from pre-operatively to time after surgery (p=0,005). The global analysis showed also significant results for “Swallow” (p=0,045), “Speech” (p=0,030) and “Taste” (p=0,032). Social-emotional function: “Shoulder” was tested with a significant result of p=0,004. No significant relation between age, religion and family status was shown. There is a slight tendency of women reporting better quality of life in the aftermath of surgery (p=0,05). The development of quality of life was tested in connection to different oral reconstructions. Therefore the cohort was classified in different cancer stages. Because of the reduced sample size results are not being tested for significance. Free flap versus local reconstruction showed that free flap reconstruction was associated with poorer quality of life. When testing the correlation between posttraumatic growth and quality of life, the results did not support the presumption that higher posttraumatic growth correlates with poorer quality of life. There is a negative correlation, showing a decreasing PTR when having poorer quality of life. The analysis has a small sample size. Patients with oral-cell-carcinoma suffer a high mortality rate and often suffer low quality of life, thus it makes studies hard to conduct. Findings indicate the existance of posttraumatic growth after the diagnosis. There should be further studies to investigate how treatment is projecting on quality of life and how the psychological well being can be positively influenced.

Objective To identify the posttraumatic growth (PTG) level of cancer patients and to examine the effects of rumination on posttraumatic growth of cancer patients. Methods A total of 312 cancer patients were recruited by convenience sampling. A cross-sectional study was conducted in cancer patient by means of questionnaires that included demographic scale, Event Related Rumination Inventory and the Posttraumatic Growth Inventory (PTGI). Results A total score of event-related rumination in cancer patients was 25.13±11.11, and the total score of posttraumatic growth was 67.21±14.66. The PTG was positively correlated to event-related rumination in cancer patients (r=0.384, P < 0.01). Multiple stepwise regressions indicated that the variables of deliberate of rumination, gender, age, degree of psychological distress, intrusive rumination and education level were main predictors of PTG. Among those deliberate of rumination positively predicts PTG, while intrusive rumination negatively predicts PTG. The level of PTG in female gender cancer patients were higher than male patients, younger age and high education level, less psychological distress patients related to higher PTG. Conclusions Cancer patients reported a lower level of rumination and PTG. Clinical healthcare providers should inspire and promote cancer patients' deliberate rumination, decrease their intrusive rumination, pay attention to male, more psychological distress, older age and lower education level patients, in order to facilitate patients' PTG and then improve their quality of life. Key words: Neoplasms; Rumination; Posttraumatic growth

Background:As research on quality of life of colorectal cancer (CRC) survivors has mainly focused on downsides of cancer survivorship, the aim of this study is to investigate benefit finding (BF) and post-traumatic growth (PTG) in long-term CRC survivors.Methods:Benefit finding, PTG, and quality of life were assessed 5 years after diagnosis in a population-based cohort of 483 CRC patients using the benefit finding scale, the post-traumatic growth inventory, and the EORTC QLQ-C30. Prevalence of BF and PTG, determinants of moderate-to-high BF and PTG, and the association between BF, PTG, and quality of life were investigated.Results:Moderate to high levels of BF and PTG were experienced by 64% and 46% of the survivors, respectively. Survivors with the highest level of education and with higher depression scores reported less BF and PTG. The PTG increased with increasing stage and self-reported burden of diagnosis. Quality of life only correlated weakly with PTG (Pearson's r=0.1180, P=0.0112) and not with BF (r=0.0537, P=0.2456).Conclusion:Many long-term CRC survivors experience BF and PTG. As these constructs were not strongly correlated with quality of life, focusing solely on quality of life after cancer misses an important aspect of survivorship.

Posttraumatic growth (PTG) refers to positive psychological changes resulting from individuals' inner struggles with traumatic events such as life-threatening illness. Although palliative care patients are confronted with their own mortality, little is known about their PTG experience. This study investigates whether PTG is an empirically relevant concept for palliative patients by assessing the prevalence and areas of growth, and examining associations with psychological distress and quality of life. Participants were recruited in Switzerland. Using validated questionnaires, we assessed PTG (Posttraumatic Growth Inventory, PTGI), psychological distress (Hospital Anxiety and Depression Scale), and quality of life (McGill-Quality of Life Questionnaire - Revised). We performed descriptive analyses, Spearman correlations, and linear regressions. Fifty-five patients completed the PTGI, 44% of whom experienced no/low growth, 47% moderate growth, and 9% high/very high growth. Participants experienced the greatest positive changes in terms of appreciating life and relating to others. We found significant negative bivariate correlations between PTG and psychological distress (r = -0.33) and between PTG and depression (r = -0.47). Linear regressions showed that PTG is associated with depression (β = -0.468; p = 0.000), but not with anxiety or quality of life (adjusted R2 = 0.219). Over half of our patients experienced moderate to very high growth, indicating that PTG is an empirically relevant psychological process in palliative care. PTG is associated with lower levels of depression, possibly as those experiencing growth are more able to process past traumas and build a more positive outlook on one's life and self. By contrast, the relative independence of anxiety and PTG points to the likely coexistence of positive and negative psychological responses to trauma. The lack of association between PTG and quality of life points to the uniqueness of the PTG concept in capturing how people access deeper meaning and greater appreciation of life along the path toward posttraumatic self-reconstruction.

Quality of life (QoL) is an important patient outcome in oncology. Many breast cancer survivors report difficulties with QoL. Adverse childhood events (ACEs) and posttraumatic growth (PTG) may influence QoL in breast cancer survivors after diagnosis. The aim of this study was to determine the association of QoL with ACEs and PTG among breast cancer survivors 2 years after diagnosis. This was a cross-sectional study, conducted on 93 Chinese breast cancer survivors diagnosed at least 2 years prior to the study. Measures included a self-reported demographic questionnaire, the Adverse Childhood Experiences questionnaires, the Posttraumatic Growth Inventory, and the Functional Assessment of Cancer Therapy-Breast Cancer QoL questionnaire. Among the 93 participants, more than one-third (34.4%) experienced childhood adversity. We found a negative relationship between ACEs and QoL and a positive relationship between PTG and QoL. The findings suggest that childhood adversity and PTG are important predictors of QoL among breast cancer survivors at least 2 years after diagnosis. Women who had experienced ACEs had poorer health-related QoL than did those who did not. Individuals who experienced PTG following a cancer diagnosis also reported better QoL than did those who did not. A better understanding of how ACE and PTG contribute to breast cancer survivors' QoL will help in tailoring and therefore enhancing the efficacy of interventions aimed at improving QoL.

This study examined variables associated with post-traumatic growth (PTG) in stroke carers and compared predictions of two models of PTG within this population: the model of Schaefer and Moos was compared to that of Tedeschi and Calhoun (1992, Personal coping: Theory, research, and application. Westport, CT: Praeger, 149; 1998, Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah, NJ: Lawrence Erlbaum, 99; 2004, Psychol. Inq., 15, 1, respectively). A cross-sectional survey design was employed. Carers of stroke survivors (N = 71) completed questionnaires measuring PTG, coping style, social support, survivor functioning, age, and carer quality of life. Correlation, multiple regression, and mediation analyses were used to test hypotheses. All carers completing the PTG measure (N = 70) reported growth, but average scores differed from cancer carers (Chambers et al., 2012, Eur. J. Cancer Care, 21, 213; Thombre et al., 2010, J. Psychosocial Oncol., 28, 173). PTG was positively correlated with deliberate and intrusive rumination, avoidance coping, social support, and quality of life. Regression analysis showed that factors identified by Tedeschi and Calhoun (deliberate rumination, intrusive rumination, social support, acceptance coping, survivor functioning) accounted for 49% of variance in PTG, whereas those identified by Schaefer and Moos (active coping, avoidance coping, social support, survivor functioning, and age) accounted for only 21%. Rumination, especially deliberate rumination, explained most variance in PTG and mediated the effect of social support on PTG. The findings add to the limited body of evidence suggesting that stroke carers experience growth. Deliberate rumination and social support are important in explaining growth, and the findings support the model proposed by Tedeschi and Calhoun over that of Schaefer and Moos. What is already known on this subject? Literature on caring for stroke survivors focuses on negative outcomes (Ilse, Feys, de Wit, Putman, & de Weerdt, 2008) to the exclusion of positive outcomes such as post-traumatic growth (PTG; Calhoun & Tedeschi, 1999). Studies of a variety of health conditions have demonstrated that PTG occurs in patients and carers after illness events and is associated with well-being (Gangstad, Norman, & Barton, 2006; Helgeson, Reynolds, & Tomich, 2006; Kim, Schulz, & Carver, 2007). Exploratory studies and studies of benefit finding have shown that PTG occurs in stroke carers (Bacon, Milne, Sheikh, & Freeston, 2009; Buschenfeld, Morris, & Lockwood, 2009; Haley et al., 2009; Thompson, 1991), but there are no studies using standard instruments to assess PTG in this population. Moreover, current theories posit different explanations for PTG (Schaefer & Moos, 1992, 1998; Tedeschi & Calhoun, 2004), and there is a need for empirical tests (Park, 2010). What does this study add? This study extends knowledge by measuring PTG with a standard instrument in a sample of UK stroke carers and investigating associated variables. The study also compared the predictive power of the models of PTG proposed by Tedeschi and Calhoun (2004) and Schaefer and Moos (1992, 1998). PTG was found in UK stroke carers, but levels differed from cancer carers in other countries. Factors associated with PTG were identified; Tedeschi and Calhoun's model best predicted PTG. Deliberate rumination had a direct effect on PTG and also mediated the effect of social support. Deliberate rumination is a possible target for therapeutic interventions to enhance PTG.