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      Post-traumatic growth in mental health recovery: qualitative study of narratives

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          Abstract

          Objectives

          Post-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.

          Design

          Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.

          Setting

          England.

          Participants

          Participants 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.

          Results

          Components 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.

          Conclusions

          Post-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

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          Most cited references49

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          Psychiatric comorbidities and schizophrenia.

          Peter Buckley, Brian Miller, Douglas Lehrer … (2009)
          Psychiatric comorbidities are common among patients with schizophrenia. Substance abuse comorbidity predominates. Anxiety and depressive symptoms are also very common throughout the course of illness, with an estimated prevalence of 15% for panic disorder, 29% for posttraumatic stress disorder, and 23% for obsessive-compulsive disorder. It is estimated that comorbid depression occurs in 50% of patients, and perhaps (conservatively) 47% of patients also have a lifetime diagnosis of comorbid substance abuse. This article chronicles these associations, examining whether these comorbidities are "more than chance" and might represent (distinct) phenotypes of schizophrenia. Among the anxiety disorders, the evidence at present is most abundant for an association with obsessive-compulsive disorder. Additional studies in newly diagnosed antipsychotic-naive patients and their first-degree relatives and searches for genetic and environmental risk factors are needed to replicate preliminary findings and further investigate these associations.
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            Positive Adjustment to Threatening Events: An Organismic Valuing Theory of Growth Through Adversity.

            Stephen Joseph, P. Alex Linley (2005)
            Article 0 comments Cited 181 times – based on 0 reviews     Review now
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              Mental illness and well-being: the central importance of positive psychology and recovery approaches

              Mike Slade (2010)
              Background A new evidence base is emerging, which focuses on well-being. This makes it possible for health services to orientate around promoting well-being as well as treating illness, and so to make a reality of the long-standing rhetoric that health is more than the absence of illness. The aim of this paper is to support the re-orientation of health services around promoting well-being. Mental health services are used as an example to illustrate the new knowledge skills which will be needed by health professionals. Discussion New forms of evidence give a triangulated understanding about the promotion of well-being in mental health services. The academic discipline of positive psychology is developing evidence-based interventions to improve well-being. This complements the results emerging from synthesising narratives about recovery from mental illness, which provide ecologically valid insights into the processes by which people experiencing mental illness can develop a purposeful and meaningful life. The implications for health professionals are explored. In relation to working with individuals, more emphasis on the person's own goals and strengths will be needed, with integration of interventions which promote well-being into routine clinical practice. In addition, a more societally-focussed role for professionals is envisaged, in which a central part of the job is to influence local and national policies and practices that impact on well-being. Summary If health services are to give primacy to increasing well-being, rather than to treating illness, then health workers need new approaches to working with individuals. For mental health services, this will involve the incorporation of emerging knowledge from recovery and from positive psychology into education and training for all mental health professionals, and changes to some long-established working practices.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2019
                Publication date (Electronic): 28 June 2019
                Volume: 9
                Issue: 6
                Electronic Location Identifier: e029342
                Affiliations
                [1 ] departmentInstitute of Mental Health , University of Nottingham School of Health Sciences , Nottingham, UK
                [2 ] departmentDepartment of Psychology , University of Nottingham , Nottingham, UK
                [3 ] departmentInstitute of Mental Health , NEON Lived Experience Advisory Panel , Nottingham, UK
                [4 ] departmentHealth Service and Population Research Department , Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, UK
                [5 ] departmentUnit of Social and Community Psychiatry , Queen Mary University of London , London, UK
                [6 ] departmentSchool of Health Sciences , University of Nottingham , Nottingham, UK
                [7 ] departmentDepartment of Community Mental Health , University of Haifa , Haifa, Israel
                Author notes
                [Correspondence to ] Professor Mike Slade; m.slade@ 123456nottingham.ac.uk
                Article
                Publisher ID: bmjopen-2019-029342
                DOI: 10.1136/bmjopen-2019-029342
                PMC ID: 6609070
                PubMed ID: 31256037
                SO-VID: dca6bc30-6fe1-48ce-821d-7acd90b6c648
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 23 January 2019
                Date revision received : 12 April 2019
                Date accepted : 31 May 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100007602, Programme Grants for Applied Research;
                Categories
                Subject: Mental Health
                Subject: Research
                Subject: 1506
                Subject: 1712
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: post-traumatic growth,mental health,recovery
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: post-traumatic growth, mental health, recovery

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