Posttraumatic growth in psychosis: Influence of individual and ecological factors

Introduction: People with psychosis report are more likely to report experiences of adversity. However, some people report positive changes because of adversity. This is called posttraumatic growth (PTG). PTG is defined as the positive psychological changes that an individual experiences because of an emotional struggle with adversity. There has been limited evaluation of what individual and ecological factors facilitate PTG.



Methods: A two-step approach was undertaken. First, a seven-language systematic review examining the predictors and perceived facilitators of PTG following psychosis. Based on a registered protocol, papers were identified through six information sources. Quantitative studies were included if examining correlates, mediators, and temporal relationships. Qualitative studies were included if describing PTG arising from psychosis. Narrative synthesis was conducted to identify facilitators on qualitative studies. Second, we extend systematic review findings through a commentary piece, by applying Bronfenbrenner’s bioecological model to discuss relevant ecological factors to PTG in psychosis.



Results: Thirty-seven papers met the inclusion criteria for the systematic review. Significant correlates and mediators between psychosis symptoms and PTG were identified. Significant mediators included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. No studies explored temporal relationships between psychosis and PTG. Seven facilitators of PTG in psychosis were identified; Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience and Relationships, giving the PROSPER framework. Despite a robust search strategy, findings indicated that most of the research focused on the influence of individual-level factors. Ecological factors for consideration in future research include the effect of personality traits, online communities, mental health services, policy, mass media, and culture.



Conclusion: The PTG in psychosis literature focuses on individual-level facilitators. A greater focus on ecological factors may provide insights into areas in which public mental health and policy can focus to support growth after adversity.