No pain, no gain: cross-lagged analyses of posttraumatic growth and anxiety, depression, posttraumatic stress and prolonged grief symptoms after loss

Figures & data

Table 1. Participant characteristics (N = 412).

Demographic variables
Gender (Valid N (%))
Male	51 (12.4)
Female	360 (87.6)
Age in years (M (SD), range)	49.9 (11.7), 18–83
Educational level (Valid N (%))
Primary school	4 (1.0)
Secondary school	142 (34.5)
Vocational school	106 (25.7)
College/University	160 (38.8)
Loss characteristics
Deceased person is (Valid N (%))
Partner	192 (46.7)
Child	61 (14.8)
Sibling	46 (11.2)
Parent	112 (27.3)
Cause of death is (Valid N (%))
Natural causes (e.g., disease, heart attack)	350 (85.0)
Accident	32 (7.8)
Murder	3 (0.7)
Suicide	27 (6.6)
Death was (Valid N (%))
Expected	157 (38.1)
Unexpected	215 (52.2)
Other (i.e., both or neither)	40 (9.7)
Time since the loss in months (M (SD), range)	20.2 (9.8), 6–48
Anxiety symptoms (M (SD), range)	8.0 (4.1), 0–21
Depressive symptoms (M (SD), range)	7.1 (5.0), 0–21
Prolonged grief symptoms (M (SD), range)	45.2 (23.9), 0–116
Posttraumatic stress symptoms (Valid N = 224) (M (SD), range)	15.4 (9.4), 0–43

Note. No information was collected on ethnicity or race of participants.

Table 2. Zero-order correlations between T1 PTG and symptoms of anxiety, depression, prolonged grief and PTSD.

	Anxiety	Depression	Prolonged grief	Posttraumatic stress
Posttraumatic growth	−.16**	−.28**	−.09	−.14*
Anxiety	–	.72**	.68**	.80**
Depression		–	.72**	.75**
Prolonged grief			–	.87**
Posttraumatic stress				–

Note. PTG = posttraumatic growth. PTSD = posttraumatic stress disorder. **p < .01. *p < .05.

Figure 1. Unstandardized estimated curvilinear relation between PTSD and PTG at T1.

Note: PTG = posttraumatic growth. PTSD = posttraumatic stress disorder. ŷ = 22.941 + 0.461 * x – 0.016 * x².

Table 3. Hierarchical regression analyses testing for curvilinear effects of T1 anxiety, depression, prolonged grief and PTSD symptoms on PTG.

	ΔF	ΔR²	β	95% CI β
Model 1
Step 1 Study	0.96	.00	−.05
Step 2 Anxiety	10.37	.03	.29^†	−.06; .63
Step 3 Anxiety squared	7.10	.02	.46*	−.81; −.12
Model 2
Step 1 Study	0.96	.00	−.04
Step 2 Depression	34.49	.08	.32*	.02; .62
Step 3 Depression squared	17.61	.04	−.63**	−.93; −.33
Model 3
Step 1 Study	1.38	.00	−.07
Step 2 Prolonged grief	3.09	.01	.62**	.30; .96
Step 3 Prolonged grief squared	10.86	.06	−.74**	−1.08; −.42
Model 4
Step 1 Posttraumatic stress	4.23	.02	.39†	−.05; .83
Step 2 Posttraumatic stress squared	6.08	.03	−.55*	−.99; −.11

Note. PTG = posttraumatic growth. PTSD = posttraumatic stress disorder. Final model results are reported only. The covariate “Study” was not included in the models including posttraumatic stress (PTS) levels, because the PTS measure was not used in Study 2. Prolonged grief symptoms only became a significant predictor of PTG after inclusion of squared prolonged grief symptoms in the model; the opposite was true for anxiety, which became an insignificant predictor of PTG after inclusion of squared anxiety symptoms. CI = confidence interval. ^†p < .10. *p < .05. **p < .001.

Figure 2. Cross-lagged model with standardized coefficients for posttraumatic growth and PTSD.

Note: T1 = time point 1; T2 = time point 2; * p < .05. *** p < .001.

Table 4. Standardized results of the cross-lagged models.

Parameters	Models with covariate β (SE)	95% CI	Subgroup exposed to unexpected loss β (SE)	95% CI
Anxiety	(n = 412)		(n = 215)
Autoregressive effects
PTG T2 on PTG T1	.736***	[.685, .787]	.746***	[.677, .815]
Anxiety T2 on Anxiety T1	.777***	[.734, .820]	.785***	[.728, .842]
Cross-lagged effects
PTG T2 on Anxiety T1	.011	[−.063, .085]	.001	[−.101, .103]
Anxiety T2 on PTG T1	−.024	[−.094, .045]	−.048	[−.138, .042]
Correlations
PTG T1 with Anxiety T1	−.154**	[−.250, −.058]	−.194**	[−.326, −.064]
PTG T2 with Anxiety T2	−.079	[−.185, .026]	−.138	[−.285, .009]
Depression	(n = 412)		(n = 215)
Autoregressive effects
PTG T2 on PTG T1	.733***	[.680, .786]	.748***	[.674, .822]
Depression T2 on Depression T1	.824***	[.787, .861]	.844***	[.795, .893]
Cross-lagged effects
PTG T2 on Depression T1	−.002	[−.076, .072]	.006	[−.098, .110]
Depression T2 on PTG T1	.007	[−.058, .072]	−.013	[−.097, .071]
Correlations
PTG T1 with Depression T1	−.274***	[−.364, −.184]	−.341***	[−.460, −.221]
PTG T2 with Depression T2	−.186***	[−.290, −.082]	−.237**	[−.378, −.096]
Prolonged grief (PG)	(n = 412)		(n = 215)
Autoregressive effects
PTG T2 on PTG T1	.735***	[.686, .784]	.746***	[.679, .812]
PG T2 on PG T1	.893***	[.871, .915]	.887***	[.854, .920]
Cross-lagged effects
PTG T2 on PG T1	.007	[−.067, .081]	.000	[−.104, .104]
PG T2 on PTG T1	−.033	[−.082, .016]	−.059	[−.126, .007]
Correlations
PTG T1 with PG T1	−.080	[−.178, −.018]	−.188**	[−.319, −.057]
PTG T2 with PG T2	−.085	[−.191, .021]	−.114	[−.261, .033]
Posttraumatic stress (PTSD)^a	(n = 227)		(n = 134)
Autoregressive effects
PTG T2 on PTG T1	.737***	[.668, .806]	.795***	[.719, .871]
PTS T2 on PTS T1	.838***	[.795, .881]	.829***	[.768, .890]
Cross-lagged effects
PTG T2 on PTS T1	.038	[−.066, .142]	.076	[−.046, .198]
PTS T2 on PTG T1	−.071	[−.151, .009]	−.103	[−.207, .001]
Correlations
PTG T1 with PTS T1	−.132*	[−.261, −.003]	−.230**	[−.393, −.067]
PTG T2 with PTS T2	−.107	[−.250, .036]	−.174	[−.360, .012]

Note. ^aThe covariate “Study” was not included in the models including posttraumatic stress (PTSD) levels, because the PTS measure was not used in Study 2; PTG = posttraumatic growth; CI = confidence interval.; T1 = time point 1; T2 = time point 2; *p < .05. **p < .01. ***p < .001.