The Role of Functionality in the Latent Structure of Posttraumatic Growth among Survivors of a Flash Flood Disaster Imelu G. Mordeno, Ma. Jenina N. Nalipay & Miriam P. Cue
Psychological Studies ISSN 0033-2968 Psychol Stud DOI 10.1007/s12646-015-0303-0
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Author's personal copy Psychol Stud DOI 10.1007/s12646-015-0303-0
RESEARCH IN PROGRESS
The Role of Functionality in the Latent Structure of Posttraumatic Growth among Survivors of a Flash Flood Disaster Imelu G. Mordeno & Ma. Jenina N. Nalipay & Miriam P. Cue
Received: 13 May 2014 / Accepted: 2 February 2015 # National Academy of Psychology (NAOP) India 2015
Abstract Several studies have examined what model of posttraumatic growth (PTG) best represents its latent structure among Asian population but yielded inconsistent results. Furthermore, there is limited literature assessing the factor structure of PTG in the aftermath of a disaster, and so far, none have looked into the moderating effect of functionality. The present study examined the role of functionality in various areas (work/occupation, domestic chores, relationship with friends, leisure activities, and relationship with family) in the latent structure of PTG among survivors of flash flood disaster (N=912). Findings revealed the 3-factor model as the best-fitting and can be generalized between functional and dysfunctional groups in the areas of work/occupation, domestic chores, and leisure activities, but not with relationships with family and friends. The findings that relationships with family and friends moderate the latent structure of PTG can be vital in
I. G. Mordeno Mindanao State University – Iligan Institute of Technology, Iligan City, Philippines M. J. N. Nalipay (*) Department of Psychology, De La Salle University, Manila, Philippines e-mail:
[email protected] M. J. N. Nalipay e-mail:
[email protected] M. J. N. Nalipay University of Santo Tomas Graduate School Psychotrauma Clinic, Manila, Philippines M. P. Cue Professional Regulatory Board – Psychology, Professional Regulation Commission, Manila, Philippines
integrating interventions that would address the relational issues among survivors. Keywords Posttraumatic growth . Functioning . Latent structure . Flash flood
Filipinos are known for their ability to see the lighter side of distressing events. Such positive response towards a tragic event could be indicative of posttraumatic growth. Posttraumatic growth (PTG) is a significant positive change experienced by individuals as a result from their struggle with a highly challenging and traumatic life situation (Tedeschi and Calhoun 1995; Tedeschi and Calhoun 2004). A number of studies have examined the latent structure of posttraumatic growth (PTG). However, diverse factor structures were found on describing what best represents PTG. Brunet et al. 2010 encouraged more studies to be conducted to ascertain what models would be best fitted considering certain sample characteristics or specific types of traumatic experiences. So far, there are three most popular models in the literature: 5-factor, 3-factor, and 1-factor models. The 5-factor model (Tedeschi and Calhoun 1996), composed of relating to others, new possibilities, personal strength, spiritual change, and appreciation for life, has been validated and supported across diverse samples. This model was confirmed among breast cancer survivors (Brunet et al. 2010), deployed soldiers (Lee et al. 2010), and general population who underwent varying trauma experiences (Linley et al. 2007; Taku et al. 2008). Although with high support from the literature, there were also criticisms on how the five factors were conceptualized. OseiBonsu et al. 2012 cited that two of the factors of the 5-factor model, spiritual change and appreciation for life, has only 2 and 3 items respectively, which may be a source of weakness and instability of these factors (Costello and Osborne 2005).
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Additionally, studies have shown moderate to high correlations among factors of the 5-factor model, which may indicate possible overlapping of constructs (Osei-Bonsu et al. 2012). An alternative model of PTG was proposed by Powell et al. 2003 composed of 3-factors, namely: changes in self/positive life attitude, philosophy of life, and relating to others. The 3factor model was derived using principal-components analysis in a sample of war refugees from former Yoguslavia, and was based on the three broad categories of PTG originally conceptualized by Tedeschi and Calhoun 1995. So far, this model proved to be valid among refugees and displaced people (Powell et al. 2003), Latina immigrants (Weiss and Berger 2006), and in general population with varied trauma experiences (Joseph et al. 2005). Although this model received excellent fit indices, a number of studies found it not to be the best representation of PTG latent structure (Brunet et al. 2010; Taku et al. 2008). Due to inconclusive findings with regard to PTG latent structure, some studies suggested that continued use of total score is the most appropriate (e.g., Osei-Bonsu et al. 2012). The high internal consistency found in several studies (e.g., Jin et al. 2014; Shigemoto and Poyrazli 2013) and high intercorrelation among its components (e.g., Osei-Bonsu et al. 2012; Taku et al. 2008) suggest singularity of dimension in assessing PTG. Unfortunately, this model did not appear superior to other models (Brunet et al. 2010; Linley et al. 2007).
Functionality and Posttraumatic Growth The adaptive significance of PTG and its relationship to functionality has been passionately debated. A number of studies have shown that PTG increases life satisfaction and promotes optimal psychological functioning (Helgeson et al. 2006; Triplett et al. 2012). However, there are also studies that questioned the adaptive function of PTG (Zoellner and Maercker 2006; Filipp 1999). For instance, (Blix et al. 2013) found no supporting data on the assertion that the increase of PTG lowers down psychological distress. In fact, several studies have shown that experiencing higher levels of PTG are associated with higher posttraumatic stress (e.g., Lowe et al. 2013; Solomon and Dekel 2007). The divergent findings on the adaptive function of PTG can be best explained by construing PTG as both a constructive outcome and an illusory process (Maercker and Zoellner, 2004). Constructive outcome pertains to actual, meaningful and adaptive transformation the survivors experience after a trauma event (Tedeschi and Calhoun 2004) while the illusory process refers to unrealistic positive view of life which purpose is to alleviate the negative effect of stressful and lifethreatening events (Taylor et al. 2000). It should be noted that this study lies in the fact that the assessments of PTG and functionality were conducted within
a month after a disaster, and thus, assumes PTG components to be cognitive strategies necessary to decrease the intensity of distress brought about by the event and facilitate future growth. Tedeschi and Calhoun 1995 argue that growth takes time to emerge. Any growth indicators in the immediate aftermath may not be a reflection of change, and instead, can be a manifestation of cognitive strategy the survivors use to reduce distress (Helgeson et al. 2006). Helgeson et al. observed that growth was more likely to be related to a good outcome when a longer time has elapsed since the trauma. We hypothesize that higher PTG is more likely to occur among individuals who are experiencing functional impairment in their daily lives. This notion is based on findings indicating that those who were more impaired psychologically (i.e., higher PTSD scores) tend to have higher PTG scores as they utilize more strategies to alleviate distress and restore some sense of emotional stability (Blix et al. 2013; Jin et al. 2014; Lowe et al. 2013). Current Study This current research was developed for a number of reasons. First, the inconsistent findings on the factor structure that best represents PTG among Asian population (e.g., Ho et al. 2004; Taku et al. 2008) makes it imperative to understand more PTG on its latent level. It would be interesting to know if PTG’s latent structure differ from one culture to the other (e.g., Lamela et al. 2014; Teixeira and Pereira 2013). Second, so far, there is scant literature assessing factor structure of PTG in the immediate aftermath of a disaster. The findings will have a greater implication when developing treatment interventions after a disastrous natural calamity, considering that PTG components are reflections of cognitive efforts in ameliorating the pain. Finally, although there are studies relating daily functioning with PTG (e.g., Blix et al. 2013), the areas of functioning covered in previous studies were quite limited (i.e., work adjustment, social functioning). The limited literature regarding the relationship between PTG and areas of functioning is unfortunate since it is a common assertion in PTG literature that stressrelated growth is intertwined with survivors’ daily life activities. This study looks into the moderating effect of different functional areas (work/occupation, domestic chores, relationship with friends, leisure activities, and relationship with family) on PTG among survivors of a disaster.
Method Participants The researchers coordinated with the community leaders and evacuation camp administrators in identifying the participants of the study. The participants of the study included 912
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survivors who have had direct exposure to the flash flood disaster caused by typhoon Washi, consisting of 37.2 % (n= 339) males and 61.6 % (n=562) females, while 1.2 % (n=11) did not indicate their gender. The mean age of the participants is 36.06 years old (SD=14.71). Purposive sampling technique was employed in the selection of participants. All the participants also satisfied the inclusion criteria that they must have experienced intense emotional reaction (i.e., confused, horrified/fearful, and/or helpless) during the incident and immediately after it. Procedure PTGI (Posttraumatic Growth Inventory; Tedeschi and Calhoun 1996) underwent a forward-backward translation to ensure precise translation and semantic equivalence. An expert translated the English version to Bisaya (local dialect) and another expert back-translated the Bisaya version to the English version. Item-to-item comparison was performed. A team of experts reviewed, discussed and finalized the questionnaire for administration. The test administration sessions were approved by community leaders and evacuation camp administrators. The participants rendered their informed consent verbally prior to the data gathering and after the purpose and procedures of the study have been fully explained to them. They have been made aware that individual assessment results will be discussed with them as a basis for intervention to help them move on with their lives. Openness and honesty of response were emphasized. They were also encouraged to ask questions if there were any items they did not quite understand to ensure accuracy of their responses. Assessment schedules and venue arrangements were worked out with them in consideration of their availability, time preference, and comfort. The camp administrators and community leaders were kept updated of the progress. All data-gathering sessions were conducted within 3 days to 1 month after the incident. Research Instruments Posttraumatic Growth Posttraumatic growth was measured using Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun 1996), a 21-item scale that measures the degree of positive changes experienced by an individual after a traumatic event. Statements are rated using a 6-point Likert scale that ranges from 0 (I did not experience this change as a result of my crisis) to 5 (I experienced this change to a very great degree as a result of my crisis). Possible total scores range from 0 to 105, with the higher scores indicating higher levels of posttraumatic growth. Reliability coefficients for the current data are excellent with Chronbach’s alpha 0.950 and reliability rho of .953.
Functionality A researcher-made instrument was used to measure functionality, with an item probing each area of functionality, namely: work/occupation, domestic chores, relationship with friends, leisure activities, and relationship with family. Participants rated how much symptoms due to the disaster affected their lives on a scale of 1 to 5 (1=not at all; 2=a little bit; 3=a moderate amount; 4=quite a bit; and 5=extremely). Participants who rated a domain from 1 to 3 were considered functional, while those who rated 4 to 5 were regarded as dysfunctional on each of the specific domain. Data Analysis All data analyses were done using EQS version 6.2 (Bentler 2004) and followed Byrne 2006 model evaluation procedures. Missing values that appear to be at random were imputed and replaced using expectation-maximization (EM) method. The study compared three models of PTG to determine the bestfitting model, where all factors were allowed to correlate and no correlated errors were specified. To evaluate and compare model fit, the following fit indices were utilized: S-B chi square (S-Bχ2; Satorra and Bentler 2001), Bayesian information criterion (BIC), nonnormed fit index (NNFI), comparative fit index (CFI), and root-mean-square error of approximation (RMSEA). Due to non-normality of data based on Mardia’s normalized estimate (670.651), robust maximum likelihood estimation method with mean-adjusted Satorra-Bentler chi-square (SBχ2) was used to adjust the fit indices, resulting to robust estimates. Due to the sensitivity of χ2 values to large sample size (Schumacher and Lomax 1996), it was not used as a basis for model rejection. Conventional guidelines were followed in evaluating model fit. An NNFI and CFI value of>.90 was regarded as adequate fit, while>.95 is considered excellent fit. For RMSEA, a value of
