Post-Traumatic Growth Following Adverse Childhood Experiences and the Role of Coping Strategies as Predictors of Growth

Abstract

Objectives: The aim of this investigation was to explore the relationship of post-traumatic growth following adversity in childhood, and assess which coping strategies are best for predicting this outcome.

Design: The design of this study is cross-sectional, in which participants completed self-reported, retrospective measures.

Method: One hundred and fifty adults (over 18 years old) were recruited for this study and the PTG inventory, ACE questionnaire, and Brief COPE were measured along with a sociodemographic questionnaire through an online survey. Pearson’s correlation and multiple regression were used to test for relationships between PTG and ACE, and coping strategies as predictor.

Results: PTG was found in participants that had ACE scores. The PTG and ACE relationship was found to be non-significant, however the subscale Appreciation of Life was positively correlated with higher ACEs. Religious coping was found to be the strongest predictor for PTG, and strategies including active coping, emotional support, instrumental support, planning, positive reframing were found to correlate positively with PTG. Acceptance was also found to correlate both with PTG and ACE score.

Conclusion: This study corroborates with previous studies in the importance of religion and acceptance for PTG, which seem to implicate that these two factors are key towards acquiring growth as an outcome of adversity. Studying this phenomenon could be of significance to health and social care systems globally, who are making robust efforts to prevent early childhood adversity given the implications these pose in adult health and behaviour.

Introduction

The most critical stage of life is when our brains are just developing; it is rapidly absorbing information and responding to stimulants in our surroundings. This susceptibility to our environment not only aids us in our growth process, but also makes us vulnerable against any stressors or adverse experiences. Exposure to severe stressors during this early stage of life has been found to pose detrimental consequences by research in the area, suggesting these consequences can persist in adulthood and even be an early cause of death (Feldcamp, Doucet, Pawling, Fadel, Fletcher, Maunder, Dennis & Wong, 2016; Shonkoff & Garner 2012).

Felitti and his colleagues (1998) were the first whom published a large-scale investigation on the topic, which later became known as the Adverse Childhood Experiences (ACE) Study, having gained much momentum given its findings. Their aim was to investigate the relationship of exposure to emotional, physical, or sexual abuse and household dysfunction during childhood and its repercussions in adult health behaviour and disease. Strong relationships were found between exposure to adverse childhood experiences and multiple risk factors for the leading causes of death in adults, such as: cancer, ischemic heart disease, skeletal fractures, liver disease, sexually transmitted diseases, and health risk behaviours like substance abuse, smoking, severe obesity, physical inactivity, and suicide attempts (Felitti et al., 1998).

It is clear now, almost 20 years later, that there is an overwhelming amount of evidence suggesting the connection between adversities in childhood and negative impact it has in an adult’s overall wellbeing (physical, mental, and emotional) which naturally follow such an experience. However very little research has been directed towards a more positive light; the possibility of an individual who is exposed to adversity during childhood not only suffering negative consequences but actual growth as a result. Positive psychology has long studied the possibility of attaining some sort of improvement emerging from struggle (Tedeschi & Calhoun, 1996). Therefore, in the midst of these scarring experiences, is there something other than negativity that may be obtained?  If so, what marks the difference, and can the manner in which they cope with stresses in daily life serve as a buffering factor for experiencing growth following a trauma?

Thus, this brings us to the development of the present investigation: in which ACEs will be explored in a distinctive manner by searching for the growth in the presence of adversity during childhood. In other words, search for the “good” in the “bad”.

Adverse Childhood Experiences

The ACE study in the United States was the first to evaluate the long-term health consequences of having experienced adversity during the first 18 years of life using the ACE questionnaire. This questionnaire was designed by Felliti and his colleagues (1998) to screen for childhood trauma in a retrospective manner; the study had a sample of 17,000 adults complete the questionnaire of whether they had experienced a range of 10 adversities during their childhood and measured current health status and behaviour using a variety of assessments. In the questionnaire, ACEs were assessed the following way: three categories of childhood abuse (physical, emotional and contact sexual abuse) and four categories of household dysfunction (exposure to substance abuse, mental illness, violent treatment of mother or stepmother and criminal behaviour) and respondents had to respond “yes” or “no”. The total number of “yes” responses add up to form the total ACE score which was later used to correlate with health outcomes in adulthood (Felitti et al., 1998).

In the United Kingdom, this study was replicated by Bellis, Lowey, Leckenby, Hughes & Harrison in 2013 and named “Adverse Childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population”. With a sample of 1500 residents in relatively deprived and ethnically diverse neighbourhoods, findings suggest that ACEs contribute to deficits in adult health and social outcomes in a UK population. Compared to those with no reported ACEs, those who scored a 4 or higher were 3 times likelier to have a mental illness, almost 4 times more likely to smoke and drink heavily, and almost 9 times more probable to be incarcerated (Bellis et al., 2013).

Another study by the same author published the following year with a sample of over 3 thousand people found that diseases such as cancer, diabetes, stroke had a 2.76 higher rate for those with 4 ACEs or more (Bellis et al., 2014a). It was also speculated that approximately 11.9% of binge drinking, 13.6% of poor diet, 22.7% of smoking, 52.0% of violence perpetration, 58.7% of heroin/crack cocaine use, and 37.6% of unintended teenage pregnancy in the UK could be credited to suffering from adversity in an early life (Bellis et al., 2014b) Likewise, the effect of ACEs seem to have a snowball effect; with risks of poor outcomes increasing with the number of ACEs a person has, and those with high ACE scores could put their own descendants at risk for ACEs. (Bellis et al., 2014b).

The implications this poses on public health systems, on a national and global scale, are countless; so much that the World Health Organization has named reducing child maltreatment a priority in their agenda (WHO, 2013) and in the UK the REACh program was initiated, aiming to train health and social care providers’ on the impact of ACEs and how to enquire their patients regarding this issue (McGee, Hughes, Quigg, Bellis, Larkin & Lowey, 2015). However, the prevention of ACEs is challenging; given that about 90% of childhood maltreatment goes unnoticed (WHO, 2013), and therefore interventions in the area may be difficult to target.

Consequently, the study of possible acquisition of growth following a trauma is beneficial in many aspects, given the variables that serve as protective factors against trauma can be studied and therefore interventions can target how to inspire growth in an individual following such events. For instance, certain adversities that happen in early life have been observed to have profound and enduring effects in adult psychopathology (Van der Vegt et al., 2009), but consequently previous studies suggest benefit finding is associated with better mental well-being in trauma survivors (Prati & Pietrantoni, 2009).

Also, in a longitudinal study of survivors of a tsunami, higher levels of PTG was associated with high quality of life and lower depression (Siqveland et al., 2015). These findings set the stage for the importance of exploring this relationship because attempting to prevent child maltreatment may be essential but understanding how damage repair works will also be necessary.

Post-Traumatic Growth

In the unfortunate event of experiencing a trauma, a person will either survive, recover or thrive from what has occurred. The thought that one can, not only recover from an adverse event, but experience positive changes from it, has been suggested for ages in philosophy, religion and ancient literature. However, during the last 15 to 20 years this topic of research has been investigated as an important concept of social science and received great interest and support (Calhoun & Tesdeschi, 2006).

The terms commonly used for this positive outlook or change is: benefit finding, resilience, and post-traumatic growth.The term we are basing our research on is post-traumatic growth, which is unique in its definition given that it’s an voluntary or involuntary process in which many factors including personality and coping intervene. It is defined as “the positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (p.1; Tedeschi & Calhoun, 2004).

The Post-Traumatic Growth Inventory is the most commonly used standardized measure for PTG, in which the authors Tedeschi and Calhoun (1996) identified five subscales: Relating to Others (e.g. expressing compassion or closeness towards others), New Possibilities (e.g. developing new interests), Personal Strength (e.g, “I discovered I was stronger than I thought I was”), Spiritual Change (an enhanced understanding of spiritual matters), and Appreciation of Life (e.g., gratefulness for the value of the individual’s life).  The five subscales of PTG been supported through evidence to be separate and meaningful, but they also correlate with each other (Taku et al., 2008). This implicates that research using the PTGI should evaluate PTG not only a single construct, but correspondingly one that is five-dimensional.

To understand the acquisition of growth, first we must comprehend what happens when an individual suffers from a traumatic experience. A model proposed by Park (2010) describes that the distress a person feels when they’ve experienced a trauma originates from the incongruities that exist between their global beliefs and the appraised meaning of the occurrence. This crisis leads to the individual attempting to restore meaning by reducing or completely eliminating the incongruities (Park & Ai, 2006).

Consequently, the model of life crises by Schaefer & Moos (1992), details the process by which growth may be developed through time:

1) the root of growth are the personal and environmental systems that exist within the individual,

2) the individual comes into a life crisis as a result of trauma, which in turn

3) influence cognitive reappraisals and coping responses, and therefore

4) positive outcomes develop.

This model explains the many variables that come into play during this process, to name a few: sociodemographic characteristics, personality traits, social support, and severity and timing of the traumatic event. Tedeschi and Calhoun (2004) seem to corroborate, given they theorize that a person’s core beliefs establish the basis for acquiring growth given these are shaken with the occurrence of a trauma or stressor. They add that PTG is not the outcome of the trauma or stressor itself, but of this reappraisal or re-calibration of the person’s core beliefs (Tedeschi & Calhoun, 2004). This might be the reason why religion has been found to be the strongest predictor of PTG (Harris et al., 2010).

Trauma theorist have focused on individual differences to explain for the variance in how a person responds after a traumatic event in terms of both distress and growth (Owens, 2016). Previous research has found that around 45-60% of individuals who report trauma will also report some form of growth; a study of veterans with PTSD found that nearly 75% of moderate PTSD will also experience PTG (Angel, 2016). Therefore, studies regarding acquisition of post-traumatic growth do not imply that the person’s traumatic experience is only positive; it is in fact a complex interaction of both growth and suffering.

One might ask why some individuals experience PTG whereas others don’t, or not to a high degree. Recent studies have searched for the factors that mediate the attainment of PTG including variables such as time since trauma, personality, coping strategies, severity of trauma, social support. Some variables that have been associated to PTG are social support, optimism, intrinsic religiosity, and having a purpose in life (Tsai et al., 2016).

Also, positive and outgoing personality traits, low levels of avoidant attachment style, and meaning making have been found to lead to more growth in individuals (Owens, 2016). Coping strategies can be considered to take on mediating roles between individuals, the context and post-trauma outcome of the individual. Specifically, active coping strategies: problem-focused, positive reappraisal and acceptance coping achieve better and more enduring outcomes of growth than strategies that are avoidant or disengaging (Akbar & Witkur, 2016).

Coping Strategies

The act of coping is defined by Lazarus (1966) as the process of executing a response to a stressor, where stress is viewed as the experience of encountering relevant difficulties in one’s goal-related efforts. In Schaefer and Moos’ model (1998), coping is divided into two categories: approach and avoidance coping. The first is defined as the process of trying to analyze and find a solution to the situation, seeking social support from others, and possibly develop a positive outcome from it.

On the other hand, avoidance coping is the act of minimizing the situation or crisis, becoming unreasonably emotional, and leading to an unresolved process of recovery, choosing to indulge in rewards instead. Avoidance coping can also be defined as the act of making efforts towards avoiding or ignoring the stressor or the feelings associated with it (Litman, 2006). This model states that an individual may acquire psychological growth if they adopt approach-oriented coping strategies and their personal and environmental circumstances are favourable (Schaefer & Moos’, 1998). Carver and his colleagues developed the COPE inventory to assess the 14 coping styles and strategies that weren’t useful to coping with stress (Litman, 2006).

Recent studies have tested the relationships coping have with phenomenon such as PTG or trauma. In a meta-analysis of factors contributing to PTG by Prati and Pietrantoni (2009), acceptance coping, reappraisal coping, religious coping, and seeking support coping were found to be associating with PTG. They add that coping strategies promote PTG through the process of the person making active efforts to solve the problem, and therefore it serves as a partial mediator (Prati & Pietrantoni, 2009).

Another study of coping strategies and post-traumatic growth in paramedics by Jurisova (2016), found that coping strategies such as active coping, planning, suppression of competing activities, restraint coping, seeking emotional support – instrumental, use of emotional social support, religious coping, focus on and venting of emotions, behavioral disengagement, mental non-disengagement are the origins of PTG.

Perlman and his colleagues (2016), state that coping strategies are a representation of the intra and interpersonal processes of human beings that manifest as trait-like behaviour. These same authors investigated coping strategies and attachment styles that 225 university students took on following childhood maltreatment and found that avoidant attachment style explained the association between maladaptive coping and maltreatment. A high extent of childhood maltreatment was associated to lesser adaptive coping strategies and anxious and avoidant attachment styles were linked to maladaptive coping. In addition, maladaptive coping has been found to be the main predictor of depression, anxiety and stress in other studies, and the reduction of these traits may have the most effect in decreasing these symptoms (Raja, 2012).

Aim of Study

The aim of this study is to explore whether post-traumatic growth (PTG) can occur in adulthood following an adverse childhood experiences (ACEs), the relationship between these two variables and the role of coping strategies in the acquisition of growth in an individual.

Hypothesis

Our first hypothesis is that some degree of PTG will be found in adults that have suffered from ACEs. As far as our research knows, no study has tested ACEs and PTG specifically, however previous studies on childhood abuse and PTG have been completed and have found significant results (Doane, 2011).

Secondly, we hypothesize that higher ACE scores will correlate positively with higher PTG, whereas participants with no ACEs will produce lower PTG results. This hypothesis is supported by founders of the Post-Traumatic Growth Inventory, indicating that in their study of young adults (aged 19-25) positive change was stronger in those that had experienced trauma than those who had not (Tesdeschi and Calhoun, 1996).

Lastly, we assume that coping strategies such as use of emotional support, venting, positive reframing, acceptance and religion will have a positive correlation with post-traumatic growth after experiencing adversities during childhood. This hypothesis is supported by various studies, including one on coping strategies and post-traumatic growth in paramedics by Jurisova (2016), which found significantly positive relationship between seeking emotional support, religious coping, active coping, venting, etc., with PTG.

Method

Design

This research is cross-sectional in design, which was found to be the most convenient method given the time frame of the investigation. With this design, the data obtained can estimate our outcome of interest and based on this we can casually infer on the variables tested.

Participants

The demographic data obtained from our descriptive statistics reveal that the sample (n=150) consisted of 51 male (34%) and 99 female (66%) participants, ranging from ages 19 to 69 (M=32.9; SD=12.26). The sample had ethnical diversity, with 35.3% White, 31.3% Black/African/Caribbean, 17.3% Mixed/multiple ethnic groups, 10.7% Asian, and 5.3% were from other backgrounds that weren’t listed. The majority of participants were highly educated, with 52.6% having at least some college education and 38.7% a Master’s degree, and only 4.6% of the sample were only high school graduates or less. Christianity was the most common religion (56.7%), following participants who defined themselves as having no religion (24.7%), and 7.3% Muslims, 4.7% other religion, 4% Hindu, and 1.3% Buddhist.

Measurements

A sociodemographic questionnaire will be used to assess factors such as age, gender, education, cultural background, and religion.

The Adverse Childhood Experiences Questionnaire (ACEQ) is an 11-item scale developed to assess an adult’s exposure to adversity during their childhood (0-18 yrs). It uses 7 categories in total; three categories for childhood abuse (physical, psychological or contact sexual abuse), and four of exposure to household dysfunction (exposure to substance abuse, mental illness, violent treatment of parent, and criminal behavior) (Felitti et al., 1998). The ACE questionnaire screens for childhood trauma in a retrospective manner, and previous studies have found that it has had good to excellent test–retest reliability, is highly interrelated and correlated with other measures, and has obtained a Cronbach’s α= .88 (Murphy et al., 2013). The ACE study and questionnaire has been replicated and adapted several times, and world-wide organizations like United Nations and the World Health Organization are now spreading awareness on the subject, also having created an international ACE questionnaire as a useful tool to screen for severe childhood stressors globally (WHO, 2011).

The Brief Coping Orientation to Problems Experienced (Brief COPE) by Carver (1997) is a 28-item scale that assesses 14 different types of coping styles using 2 questions for each style. The results tell us which coping styles the person uses the most: self-distraction (items 1 and 19), active coping (2 and 7), denial (3 and 8), substance use (4 and 11), use of emotional support (5 and 15), use of instrumental support (10 and 23), behavioral disengagement (6 and 16), venting (9 and 21), positive reframing (12 and 17), planning (14 and 25), humor (18 and 28), acceptance (20 and 24), religion (22 and 27), self-blame (13 and 26). The COPE has been long used to measure coping mechanisms and its styles, while this Brief COPE will help us keep the evaluation short so participants won’t feel tired by all the questions. The study by Monzani et al., (2015) concluded that “the empirical evidence supports the usefulness of the situational version of the Brief COPE for the valid and reliable assessment of 14 specific coping responses to stressors”.

The 14 dimensions of the Brief COPE scale demonstrated adequate reliability and relationships with goal commitment and progress, attesting the reliability and usefulness of this measure to evaluate coping responses to specific events (Monzani et al., 2015).

Post-Traumatic Growth Inventory (PTGI) is a 21-item scale that is used to assess positive outcomes in people who have suffered traumatic experiences. This scale includes factors such as new possibilities (5 items), relating to others (7 items), personal strength (4 items) spiritual change (2 items) and appreciation of life (3 items) (Tedeschi et al.,1996). Participants respond to items using a 6-point Likert scale (0 to 5), with a total score ranging from 0-105. It has good internal consistency, acceptable test-retest reliability over 2 months (.76), and it is not correlated with measures of social desirability (Baker et al., 2008).

Procedure

The Qualtrics online software was used to create the survey and collect the data. All information about the investigation was also provided by means of an information sheet, consent and debrief. Participants were invited to participate in the survey through email, social media, or word of mouth. The survey pack included an information sheet, an informed consent in which they would tick “yes” or “no”, and a debriefing sheet where they were explained the nature of the investigation, and a final consent where they would approve of the use of their data for research. Participants were provided with a unique random survey number that could be used to anonymously withdraw their data.

A total of two-hundred and forty people were invited to participate in the survey, of which 154 (64%) completed the entire survey. Four participants did not consent to participate in the completion, leaving a total of 150 participants to include in our data analysis. The inclusion criteria were to be above 18 years old, have access to internet through their electronic devices and understand the English language, however there were no exclusion criteria. Those with no ACE score would be included in a comparison group between those with high ACEs in the data analyses.

The data obtained from the sociodemographic survey will be used to find the descriptive statistics  (mean, range, and standard deviation), which will be used to test for individual differences. The ACE Questionnaire is scored by adding every “yes” response for a total ACE score that could range from 0-11. The Brief COPE includes 28 items, which are scored from one (“I haven’t been doing this at all”) to four (“I’ve been doing this a lot”). It explores 14 strategies: active coping, planning, use of instrumental support, positive reframing, acceptance, use of emotional support, denial, venting, self-blame, humor, religion, self-distraction, substance use and behavioral disengagement. Higher scores reflect a higher tendency to implement the corresponding coping strategies.

The Post-Traumatic Growth Inventory is scored by rating each item using a 6-point Likert scale, with values ranging 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). The possible total scores can therefore range from 0 to 105. Recent research (Taku et al., 2015) defends the use of the original five dimensions of the PTGI, which are calculated by summing the following numbers of items: Personal Strength (4 items) New Possibilities (5 items), Relating to Others (7 items), Spiritual Change (2 items) and Appreciation of Life (3 items). Pearson’s correlation will be used to test the relationship between ACEs, coping strategies, demographics, and PTG. Also, multiple regression will be used to predict which coping strategies predict the highest outcome for PTG.

Results

The descriptive statistics in relation to PTG scores, mean was 64.9 (SD=24.3), in which the maximum score is 105- resulting in an intermediate score. Male participants had an average PTG score of 60.2 (SD=23.8) and females had a slightly higher score with a 67.5 (SD=24.3). We separated age groups into two: below 30 (N=87) and and above 30 (N=66). Both had similar means regarding PTG scores, the first scored a mean of 66.3 and the second 64.0. Other sociodemographic results such as ethnicity displayed that PTG was higher in those who defined themselves as other ethnic group not listed (84.2), than those of other groups such as Black (67.2) and White (62.9). The religion with the highest PTG score was Hinduism (75.7), following other religion not specified (69.6), Christianity (68.15), and the lowest being those with no religion (57.1).

Regarding the ACE scores, 118 (78.7%) participants reported having experienced at least one ACE; 21.3% reported experiencing no ACEs, 56.0% reported between one and three, and 22.7% reported four or more ACEs. Forty-one percent of the sample reported parental separation or divorce during the first 18 years of life, 28% lived with someone with substance abuse problems, and 24.7% of the sample had a household member who was mentally ill. On average, participants had an ACE score of 2.32, and females reported higher ACE scores than men with 2.49, meanwhile males had a mean score of 1.98. Concerning age groups previously specified, little difference was also seen in the ACE scores (M= 2.44 in those below 30 and M=2.15 in those above)

For the interpretation of the Brief COPE, all 14 strategies are analyzed and interpreted. Out of a maximum of 8, on average participants scored: 5.71 in Acceptance, 5.47 in Active Coping, 5.46 in Planning, 5.1 in Self-Distraction, 4.9 in Positive Reframing, 4.8 in Emotional Support, 4.6 in Instrumental Support, 4.6 in Religion, 4.15 in Venting, 4.1 in Self-Blame, 3.9 in Humor, 3.1 in Behavioral Disengagement. The least common coping styles used are both Substance Use and Denial, both with a 2.9 average in the sample.

To test our first hypothesis of whether PTG would be found in those experiencing ACE, we separated the sample into two groups: those with no ACEs and those with one or more. We found that mean PTG score was slightly higher (M=66.0) in the group of participants who reported at least one ACE, than those who reported zero ACES (M=61.2). Roughly the same mean was maintained for the following comparison group consisting of participants who reported 3 or more ACES (M=66.2). Thus, this provides evidence that some degree of growth was found in those participants who reported at least one adversity in their childhood.

A Pearson’s correlation test was undertaken to assess the relationship between PTG and ACE scores to assess our second hypotheses, in addition to evaluating the coping strategies adopted by participants. No significant relationship was found between total PTG scores and total ACE scores, meaning our second hypothesis about PTG being higher among those with high ACE scores was found to be false. Despite this, what we did find was that total ACE score was has a significant positive relationship with one of PTG’s subscales: Appreciation of Life (149) 0.179 = 0.15.

This finding suggests that, despite our hypothesis being false, some degree of PTG was actually found among those with ACEs. This positive relationship proposes that those with a higher ACE score also produced higher PTG scores on the subscale Appreciation of Life. A strong significant relationship was found between the ACE scales Childhood Abuse and Household Dysfunction (149).720 = 0.00, meaning that the probabilities of those who suffered childhood maltreatment/abuse in our sample also had high chances of having lived in a dysfunctional household.

Correspondingly, the relationship of PTG and ACEs were assessed with coping strategies and found significant results. Positive, significant relationships were found when the relationship between PTG and the following coping strategies was tested: active coping, emotional support, instrumental support, positive reframing, religion, acceptance, and planning all correlate positively with PTG. This finding suggests that these coping strategies were the most adopted by those with higher PTG, and vice-versa; those with higher PTG tend to use these styles. Total ACE score was also tested for correlations with coping strategies and found significant results. Our findings reveal that those with self-distraction, substance use, behavioral disengagement and acceptance coping styles also scored higher on the total ACE score.

Linear multiple regression was used to test our third hypothesis of which coping strategy predicts the most PTG in this study. Our findings suggest that 21.4% of the variance in PTG can be explained by the coping strategies adopted, with an α = 0.00. The style we found to predict best for PTG of the 14 tested was Religion; (149) 2.72 = 0.01. Meanwhile, coping strategies may also be a good indicator of ACE scores; our findings suggest 12.7% of the variance in ACE is explained through coping styles. Substance use is a predictor of ACE on a (149) 2.55 = 0.01, as well as behavioural disengagement with a result of (149)2.55 = 0.01. Lastly, acceptance was also found to be a predictor of ACE score with a (149)1.94=0.05.

Discussion

The findings suggest our sample had an intermediate score in the PTGI. Regardless of the age group in which the sample was divided, PTG mean score didn’t fluctuate greatly, suggesting that in our sample age (which ranged from 19 to 69) did not associate with the amount of PTG scored. This contradicts previous findings to some degree, in which younger individuals were found to produce higher ACE scores than older ones, since the first are more open to the thought of change and growth in contrast with those whom reach a certain age in which they have by now learned their life lessons (Tedeschi & Calhoun, 2004). Other findings also state that PTG may increase with the passage of time (Hegelson et al., 2006), however our findings might indicate that regarding adversity in childhood and acquiring growth in adulthood, a certain degree of time has passed so that the growth acquired did not increase through the years for our participants.

Curiously, women participants in our investigation produced both more ACE score and more PTG, which leads to the indication these women might be better equipped at acquiring growth than men as Tesdechi and Calhoun (1996) suggest, or that the adversity they went through during childhood prepared them to handle more difficulty and this process evolved into psychological growth through their life courses. Whichever it may be, a prospective study might be needed to clarify what this link between gender differences for the acquisition of growth through time.

Our first hypothesis proved to be true, given that mean PTG scores were slightly higher in those with at least one ACE count. The concept that one may grow from a traumatic experience is in fact supported by the findings of our sample given that those with no ACEs averaged lower mean scores for PTG. However, in regards to our second hypothesis about those with higher ACE scores producing more PTG, the inferential statistics obtained from correlations did not indicate there was a positive significant relationship between these two variables, as many other studies of PTG did find.

This could be due to the misinterpretation of the PTG inventory, which participants might have completed in a general manner, and not basing their answers on their childhood as was specified. Some growth has been found in those with little or no traumatic experiences, as one might acquire growth through the course of time but not necessarily as a result of an adversity. Individuals would also need a certain amount of insight to analyze their possible growth from what they interpret from their childhood experiences, as they could regard their psychological development as a normal process.

Despite the total PTG score not being associated with the total ACE score, there was one subscale of PTG that did correlate to ACEs: Appreciation of Life. Interestingly, this finding could indicate that, in our sample, those with a higher number of adversity also reported higher value to their personal lives more than others with possibly lower ACEs. Enduring difficult experiences during childhood could change the person’s vision towards recognizing the full worth of the good times. This positive relationship could mean that the more adversity in childhood a person experiences, the more they learn to appreciate their lives in adulthood.

Our findings corroborate the ones in Jurisova (2016)’s study and Hegelson and colleagues’ meta-analysis (2006), given that PTG was correlated to the approach coping strategies: positive reframing, emotional and instrumental support, active coping, planning, and religion. This investigation explains that these coping strategies provide relief from the stress caused by the traumatic experience, help restore their perception of control and safety by means of support from others and from faith.

Religion was found to relate to PTG in the demographic data, given the results which indicate those whom define their beliefs as “No religion” had lower mean PTG than those who did describe themselves as religious, irrespective of which. As Tedeschi and Calhoun (2010) describe, regardless of which spiritual of religious belief a person has, experiences such as grief cause an individual to existentially question the situation, which could lead to deepening faith and convictions and increasing their sense of meaning in life.

This idea is supported by the significant, positive relationship found in our sample between religious coping and PTG. Not only did this relationship mean that more PTG was found among those who practiced religious coping strategies, but this approach was also found to be the strongest predictor of PTG among all other coping styles, as other studies have also found (Harris et al., 2010). This finding correlate with that of Prati and Pietrantoni (2009)’s study; they explain that believing in a certain religion may aid in the process of providing comfort and meaning in hard times or crises, giving the person more perceived control over an obstacle, and might also help build personal bonds with members of their church community which may serve as social support during hard times.

Our findings indicate the importance of acceptance, given that both PTG and ACE had significant positive correlations to this coping strategy, despite the two variables not correlating with each other. This could indicate to be a possible link between adversity and growth; the idea that it is necessary to accept a situation in order to overcome it, and consequently this acceptance could be key towards acquiring growth. This corroborates Zoellner and Maercker’s (2006) hypothesis that the ability to accept a situation that is beyond one’s control is crucial for one’s adaptation to unalterable circumstances.  However, Owens’ paper (2016) indicates that meaning making or the acceptance of this event does not imply growth, given this depends on the severity of the trauma. She adds that one may accept that an event happened (e.g. a loss, or rape), but not necessarily grow from the crisis this caused. Further research in the area could clarify this possible link between adversity in early life, post-traumatic growth and the use of acceptance as a coping strategy.

Another interesting finding was that two maladaptive coping strategies correlated positively and even predicted ACE score to a certain degree; substance use and behavioral disengagement. This could mean that a person’s ACE score could be determined by the degree to which they use these coping styles, or vice-versa, people with adverse childhood experiences could tend to adopt these coping styles. This correlation would explain why in past studies of ACEs those with high counts are much more likely to engage in health-risk behaviors like binge drinking and smoking (Bellis et al., 2014).

Limitations

The nature of this investigation did not permit the research to be longitudinal, which might have been a better design to use for studying PTG. However, a meta-analysis found no significant differences between estimates from longitudinal and cross-sectional designs regarding PTG (Prati & Pietrantoni, 2009). Further analysis on the subject would clarify the voids that still exist in regard to this phenomenon. Also, a larger sample size would give the investigation more statistical power when it comes to inferring about the data obtained. We are aware that given the response rate, many of those who were invited did not participate in the study which could be because of the sensitive topic of the study, and as a result data could have been affected by the absence of those responses. The risk of under or over reporting ACEs is a possibility, given this measure is based on self-report and in retrospective. Therefore, these issues also limit our ability to infer about causality from our findings.

We suggest further analysis is needed to investigate the relationship between ACE scores and PTG given our thought-provoking findings in regards to adversity during childhood meaning higher growth in adulthood.

Implications

This investigation could have a number of implications given the importance of ACEs in the health and social systems. Our findings seem to indicate that approach coping strategies such as emotional and instrumental support, planning, religion, acceptance active coping and positive reappraisal are linked to the acquisition of growth. Adverse experiences in early life had implications for health and mental health care, child welfare services and criminal justices, as is a cause of health and social inequalities within and between countries (WHO, 2013b).

The understanding of the possible outcomes (positive and negative) of a traumatic experience in childhood serves as base for interventions. As many results seem to point towards the importance of religious coping in the acquisition of PTG, it might be of interest to inspire the use of this strategy in trauma survivors. Our results also seem to point that acceptance of an occurrence is associated with PTG; which could mean that in order to not only heal, but thrive following adversity in childhood one might need to come to terms with what happened. Interventions focusing on the adaptation of approach coping styles could improve the stances of health and behaviour that a person who went through adversity in childhood might have in the future.

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