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CORRELATES OF POSTTRAUMATIC GROWTH IN PATIENTS DIAGNOSED WITH CORONARY HEART DISEASE.

Byline: Syeda Mariam Masood and Rafia Rafique

ABSTRACT

Objective: The purpose of this research was to investigate the correlates of Posttraumatic Growth (PTG) in patients diagnosed with Coronary Heart Disease (CHD). It was hypothesized that posttraumatic growth is associated with optimism and coping styles. It was further hypothesized that there are gender differences in PTG and optimism.

Research Design: Within group research design was used in this study.

Place and Duration of the Study: Data was gathered from two government hospitals having a functional cardiology unit, situated in the city of Lahore over a period of six months.

Sample and Method: The sample consisted of 80 patients, males (n=60) and females (n=20), drawn through non probability based purposive sampling technique. Self-administered standardized scales translated into Urdu language; Posttraumatic Growth Inventory , Life Orientation Test-Revised and Brief Cope Scale were used to measure posttraumatic growth, optimism and coping respectively.

Results: The above proposed hypotheses were inferred by carrying out hierarchical multiple regression. Results of our study indicated that PTG is significantly predicted by optimism and problem focused coping. Moreover males were found to be more optimistic as compared to females. Though, no statistically significant differences were found on posttraumatic growth between male and female patients with coronary heart disease. Implications for future research and psychological interventions are hereby discussed.

Conclusion: Findings emphasize the importance of psychological interventions to enhance optimism and teach problem focused coping strategies to increase post traumatic growth in patients with Coronary Heart Diseases.

Key Words: Posttraumatic growth; coronary heart disease; coping

INTRODUCTION

For middle to low income countries it has been endorsed that for the year 2001, 1/3rd of deaths arise from CHD. 85% of CHD death burden has been reported for developing countries . For year 1990 to year 2020, premature morbidity and mortality from cardiovascular diseases is most probable to increase from 85 million disability adjusted life years (DALY) to 140 to160 million DALY. Globally, 80% of CHD burden is predictable to take place in Pakistan and other developing countries . Global burden of CHD in Pakistan as well as other developing countries presently accounts for 78% of all deaths .

CHD is more common in men than women and the onset tends to be earlier in men. The incidence of CHD in women increases rapidly at menopause, and is similar to that seen in men over 65 . CHD has two main subtypes Angina Pectoris and Myocardial Infarction . Posttraumatic growth (PTG) is an optimistic transformed experienced as a consequence of struggle with a most important life stressor, crises or a traumatic event for e.g. a debilitating health condition like CHD. PTG is a high level of coping strategy for the enhanced quality of life .To investigate Posttraumatic Growth, Posttraumatic Growth Inventory (PTGI) has extensively been employed. It assesses PTG linked to five factors including "personal strength, new possibilities, relating to others, appreciation of life and spiritual change"1. The five factors of posttraumatic growth demonstrate positive changes that may occur after a traumatic event.

While posttraumatic growth does not necessarily occur for every person who is faced with trauma, some trauma survivors may experience one or more of these factors .

Optimism is the tendency to believe that one will generally experience good versus bad outcomes in life. It is generally accepted that this belief is a stable characteristic . Optimism has been consistently related to posttraumatic growth1. Optimism is not only a defensive reserve to cope with stress but perhaps is largely and mainly documented factor to envisage posttraumatic growth and associates to positive cognitions .

Coping process tends to change from time to time, as the person and its environment are constantly in a dynamic, reciprocally influential relationship . There are two major types of coping; problem focused coping and emotion focused coping. Problem focused coping is also referred to as active coping style. These efforts engage to directly adjust to the problem and its solution. Coping focuses in deal effectively with the forces that are the cause of problems . Emotion focused strategies in coping are referred to as passive coping strategies. These comprise of efforts to stabilize emotional experiences as an outcome of stressful experiences .

Patients diagnosed with cardiovascular diseases reporting higher level of optimism also report higher posttraumatic growth compared to those having low level of optimism and a more rapid rate of recovery , . Scheier et al.?? characterize health benefits related with optimism and problem-focused coping. Optimists have reported excessive use of adaptive problem-focused coping techniques, i.e., they are more willingly ask for social support and put stress on the constructive aspects of the disease and have better acceptance of events having irrepressible outcomes . Excessive utilization of an active or problem-focused coping style leads to improved adjustment, better posttraumatic growth and increased psychological health , .

In the light of the above literature it was hypothesized that posttraumatic growth will be predicted by optimism and problem-focused coping styles. Second hypothesis was that there will be significant difference in posttraumatic growth in male and female patients diagnosed with CHD. Third hypothesis of the study was that there will be significant difference on optimism in male and female patients diagnosed with CHD. Lastly it was hypothesized that there will be a significant difference on the types of coping styles used by male and female patients diagnosed with CHD.

METHOD

Sample

A sample of 80 patients both men and women diagnosed with CHD fulfilling the study inclusion and exclusion criteria were recruited. Purposive sampling strategy was employed. Sample was gathered from two hospitals situated in the city of Lahore. Data was gathered from hospitals predominantly designed for catering of cardiovascular diseases as well as government hospitals with a serviceable cardiology unit and equivalent coronary care unit.

Inclusion criteria

Out patients diagnosed with coronary heart disease both men and women, aged 35-65 years were recruited in the study.

1. Patients who have been hospitalized at least one year back and not more than five years ago, having an established diagnosis of coronary heart disease by the cardiologist on duty; diagnosis formed on clinical symptoms, cardiologist summary and symptom score.

2. Patients, who could read and write Urdu language, as well as were ready to give a written consent.

3. Patients confirmed as having CHD through a resting Electrocardiogram (ECG):

(a) Presence of T-wave inversion or Q-wave.

(b) Depression of ST to a greater extent

(c) Inversion of T-wave during pain (a marker of CHD).

4. Patients confirmed as having CHD through raised or reduced level of cardiac troponins.

(a) Elevation of CK-MB level.

(b) Low level of troponin

Exclusion criteria

Pregnant females were excluded from the study. Patients diagnosed with psychiatric illness or currently on any psychiatric medication were excluded from the study.

Measures

Posttraumatic Growth Inventory (PTGI)

Posttraumatic Growth Inventory by Tedeschi and Calhoun1 was employed to determine posttraumatic growth in patients with coronary heart disease. The Posttraumatic Growth Inventory (PTGI) was developed to assess the dimensions of growth after facing any trauma like a debilitating illness/disease. The PTGI consists of 21 items. Higher score indicates a greater experience of posttraumatic growth and comprises of 5 factors that establish the main areas of posttraumatic growth include: connecting to others (7 items with a .70), novel possibilities (5 items with a .86), personal strength (4 items with a = .86), and higher appreciation of life (3 items with a .69) as well as spiritual changes (2 items with a =.68). It has five response categories, (0) no change occurred, (1) very small change occurred, (2) small change occurred, (3) moderate change occurred, (4) great change occurred, (5) very great change occurred. Moderate test-retest reliability over two months period has been identified.

The Urdu version of PTGI was used in the current study. Previous researches have reported the scale has overall alpha value .71 for the indigenous sample.

Life Orientation Test-Revised (LOT-R)

Revised Life Orientation Test (LOT-R) was developed by Scheier et al. 2. The measure has 10-items to assess general level of optimism (versus pessimism). Items are assessed on a 5-point Likert-type scale (0 = Strongly disagree, 1 = Disagree, 2 = Neutral, 3= Agree and 4= Strongly agree). The scale includes four filter items (2, 5, 6 and 8), that compute general expectancies for positive vs. negative outcomes and four items (3, 6, 7 and 9) are scored in a reverse order. The total score on optimism was obtained by adding scores on items (1, 3, 4, 7, 9, and 10). The score on this scale can range from 0 to 32, higher scores representing greater optimism, and internal reliability of the scale is (a =.82).

Brief Cope Scale (BCS)

Brief Cope Scale by Carver3 is a 15-item self-report scale that appraises adaptive and maladaptive coping skills. The Brief COPE was based on concept of coping presented by Lazarus and Folkman12. This scale is composed of two types of coping i.e. problem focused and emotion focused coping. For the present study Likert scale scoring method (0-1-2-3) was used. Reliability of the subscales ranged from .75 to .82.

Procedure

Letters were signed by Chairperson of Department of Applied Psychology for getting permission from the concerned hospitals. Institutional consent was taken from two hospitals of Lahore, Pakistan. Regulatory and ethics committee of these hospitals provided formal approval before starting the research. After explaining the purpose of the study to the participants, patients were asked to give a written consent for participation in the study. Patients with a confirmed diagnosis of CHD (one to five years back) aged amid 35 and 65 were requested to take part in the study. Demographic information was gathered through a brief self constructed demographic information sheet. Permission of the authors was sought for translation and use of scales on the indigenous sample. To ensure rigorous process of forward and backward translation and to achieve equivalence between the original version and translated versions of scales complete procedure of forward and backward translation was followed.

This helped to decrease risks of errors and improve the precision of the translations. Reliability coefficients were calculated for the study measures for the national sample. Results were analyzed by using SPSS version 16.

RESULTS

Table 1 Demographic and Clinical Characteristics of Study Sample (n=80)

Characteristics###M###SD###f###%

Age###52.78###5.27###-###-

Mean and Median income###M= (20518.46)

###Mdn=(15000.00)###

Duration of disease###2.90###1.43###-###-

Duration of treatment###2.87###1.43###-###-

Gender

Male###-###-###60###75.0

Female###-###-###20###25.0

Education

Middle###-###-###21###26.2

Matric###-###-###21###26.2

Intermediate###-###-###17###21.2

Bachelors###-###-###15###18.8

Masters###-###-###6###7.5

Occupation

Business###-###-###21###26.2

Job###-###-###39###48.8

Unemployed###-###-###20###25.0

Marital status

Married###-###-###78###97.5

Unmarried###-###-###2###2.5

Family history of heart disease

Yes###-###-###36###45.0

No###-###-###44###55.0

Past smoker

Yes###-###-###23###28.8

No###-###-###57###71.2

Current smoker

Yes###-###-###4###5.0

No###76###95.5

No. of cigarettes smoked per day

1-10###-###-###3###75

11-20###-###-###1###25

Diabetes

Yes###-###-###33###41.2

No###-###-###47###58.8

Hypertension

Yes###-###-###49###61.2

No###-###-###31###38.8

Any other physical illness

Yes###-###-###5###6.2

No###-###-###75###93.8

Note. M = Mean, SD = Standard Deviation, f = frequency; Monthly income is expressed in Pakistani Currency (Rupees).

Table 2 Characteristics of Continuous Variables

Variable###M###SD###No. of items Alpha

PTGI###3.54###.58###21###.81

RTO###25.05###4.55

NP###15.15###4.31

PS###15.05###3.52

SC###8.13###1.50

AOL###11.01###2.56

BCS###2.72###.35###15###.63

PFC###2.91###.49

EFC###2.64###.36

LOTR###2.82###.52###10###.69

Note. PTG = Posttraumatic Growth; RTO = Relation to Others; NP = New Possibilities; PS = Personal Strength; SC = Spiritual Change; AOL = Appreciation of Life; BCS = Brief Cope Scale; PFC = Problem Focused Coping; EFC = Emotion Focused Coping; LOR = Life Orientation Test. Revised.

Table 3 Predictors of Posttraumatic Growth through Hierarchical Multiple Regression Analysis

Predictors###Delta R2###Beta

Step 1

Control variables a###.06

Step 2

###.27

Optimism###.40

Problem focused coping###.31

Emotion focused coping###-.10

Total R2###.32

N###80

Note. P less than .01, (one-tailed). a Control variables included Gender, Occupation, Monthly income, Marital Status, Family History of Heart Disease.

A hierarchical regression analysis was carried out as the main aim of the study was to find the effect of predictor variables on outcome variable while controlling for the effect of gender, occupation, monthly income, marital status, family history of heart disease. Control variables were entered in the first step and predictor variables were entered in the second step. Control variables were non significant, revealing that these variables were not significant predictors of posttraumatic growth. The R2 of this regression equation was 0.32 indicating that optimism and problem focused coping predicted 32% of variance in the outcome variable after controlling for gender, occupation, monthly income, marital status, family history of heart disease.

Table 4 Gender differences on Posttraumatic Growth, Optimism and Coping in Patients Diagnosed with CHD

Variables###Male###Female

###(n= 60)###(n=20)###t###p

###M###SD###M###SD###Cohen's d

PTG###3.59###0.57###3.37###0.58###1.75###0.83###0.32

Opt###2.90###51.87###2.55###0.44###3.18###0.02###0.58

PFC###2.89###0.48###2.98###0.53###-0.90###0.36###-0.15

EFC###2.64###0.35###2.65###0.37###-0.69###0.94###-0.11

PTG: Posttraumatic growth; Opt: optimism; PFC: problem focused coping; EFC: Emotion focused coping

Independent sample t-test was used to compare male and female CHD patients on posttraumatic growth, optimism and two types of coping. Male CHD patients showed more optimism as compared to female CHD patients. However no significant gender differences were observed on PTG and problem focused and emotiona focused coping.

DISCUSSION

Exposure to highly stressful events has turned out to be a common incidence. Literature endorses that such traumatic events are neither rare nor unusual . Though, it is seen that not all people undergoing traumatic events tend to develop stress related disorders .Though, to a large extent attention has been given to the negative squeal of trauma like development of post traumatic syndrome. Existing literature has been un-mitigated to acknowledge that positive psychological changes might arise subsequent to an exceedingly distressing event including the sudden onset of a debilitating disease. It is seen that many people experiencing a trauma tend to undergo post traumatic growth instead of post traumatic stress disorder as a consequence of their effort in dealing with an exceedingly challenging, stressful, and traumatic happening .

Hence the present research was designed to investigate correlates of PTG; in short the researchers wanted to infer whether posttraumatic growth could be predicted by optimism and coping style in patients with CHD. Moreover a secondary focus of this study was to infer gender differences in PTG, optimism and types of coping (emotion focused and problem focused). Results of our study highlighted that optimism predicts posttraumatic growth in CHD patients. Moreover, problem focused coping was found to be a significant predictor of posttraumatic growth in CHD patients. Moreover optimism was the only construct on which significant gender difference was observed.

The results from the present study are in line with available literature at hand. Levine et al. found a direct relationship between optimism and PTG suggesting that optimist individuals emerge from trauma, relatively changed.

Consequently, they are more likely to engage in positive meaning making of the negative events necessary to experience PTG .

Baltes conducted a study on 345 patients diagnosed with cardiac diseases. The main imperative finding of the study was that patients high in optimism reported greater level of posttraumatic growth as compared to those low in optimism. Systematic review of literature has endorsed an association between posttraumatic growth and dispositional optimism, explicitly in relation to health trauma .

Moreover problem focused coping was found to be another significant predictor of PTG. A strong relationship has been established by researchers between optimism and styles of coping. Studies have documented that greater use of an active or problem-focused coping style is associated with posttraumatic growth, enhanced adjustment and better psychological health19, . Individuals having higher optimism scores have a propensity to employ more problem-focused coping strategies. This finding is likely due to the fact that problem-focused coping requires an active approach and that optimism is connected to positive expectancy as well as a positive outlook towards a situation. On the other hand individuals scoring low on optimism may not be motivated to take an active coping approach. Indeed, a lower level of dispositional optimism has been connected with use of a maladaptive style of coping i.e. avoidance coping , . Optimistic explanatory style is negatively related to stress .

Learned optimism is associated with more effective coping in response to life stressors solution to persistent effects of negative emotions diminished vulnerability to depression and better physical health and post traumatic growth . The results from present study suggested gender differences on optimism, male CHD patients compared to females were found to score higher on optimism. A research was conducted by Charles et al. to infer gender differences in level of optimism. The findings of the study revealed that women with cardiac disease indicated significantly low levels of optimism than men with cardiac disease.

Social and cultural context in early life are important influences why women compared to men have lower level of optimism35. In a longitudinal study of health and social development optimism seemed to decline in young girls over a 2 years of follow-up period. However researchers were irresolute whether pubertal development or the effects of social context lead to this decline .

No significant gender differences in CHD patients on posttraumatic growth were established. Lechner and Antoni conducted a study on a sample of 31 males and 157 females. Finding revealed that there are no gender differences on posttraumatic growth in patients diagnosed with cardiac diseases. A meta-analysis was carried out to infer the direction and magnitude of gender differences in self-reported posttraumatic growth. 70 studies endorsed a small to moderate gender difference, with women reporting greater posttraumatic growth as compared to men. Moderator analyses highlighted that age was the only significant moderator, older women reported more PTG . Inconsistent findings with regard to present inferences can be attributed to difference in age of the patients included in our study , patients recruited in or study were comparatively younger. However, inconsistent findings point towards need for future research on a national sample of CHD patients.

The present study has some limitations which need to be mentioned here. As the sample size was small and data was gathered from only two major hospitals situated in the city of Lahore, caution should be taken in generalizing the results to the larger population, due to representativeness issues. Moreover, determinants of posttraumatic growth may vary in samples and populations other than those who survived a cardiac event, and therefore, the results should be interpreted only in the context of the traumatic exposure of heart disease.

Measures employed in this study were developed for western population; it might be likely that a few items were culturally biased. There are other correlates and predictors of posttraumatic growth e.g. self-esteem that could be unraveled in future. We cannot ignore the inherent limitations while relying absolutely on self-report scales. For example, even though it is likely that problem focused coping behaviors direct to post traumatic growth (as hypothesized in our study), it is also likely that individuals who have experienced growth tend to employ certain other types of coping strategies not investigated in our study.

Findings of this study highlight that optimism and problem focused coping are predictors of PTG. So interventions targeting to increase level of optimism and problem focused coping can help enhance PTG. Increasing social support can also increase PTG; researchers have found that improved social support buffers health problems and increase sense of well-being. Moreover PTG is associated with faster recovery rate faster recovery rate can help in reducing disease burden in an economically developing country like Pakistan.

Department of Applied Psychology, University of the Punjab, Lahore, Pakistan

Tedeschi, R.G., and Calhoun L.G. (1996). The Posttraumatic Growth Inventory: Measuring the Positive Legacy. Lawrence Erlbaum Associates, Inc.

Scheier, M. F., Carver, C. S., and Bridges, M. W. (1994). Distinguishing optimism from neuroticism and trait anxiety, self-mastery, and self-esteem: A re-evaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063-1078

Carver, C. (1997). You want to measure coping but your protocol's too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92-100.

World Health Organization. (2002). Death and DALY estimates for 2002 by cause for WHO member states. Retrieved from http://www.scribd.com/doc/2350316/ Death-and-DALY-Estimates-for-2002-by-Cause-for-WHO-Member-States.

Murray, C.J., and Lopez, A. D. (1996). Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet, 349, 1498-1504.

World Health Organization. (1999). World health report: Mortality by sex, cause and WHO Regions, Estimates for 1998. Retrieved from http://www.who.int/whr/ 1999/en/whr99_annex_en.pdf.

Ramrakha, P., and Hill, J. (2006). Oxford Handbook of Cardiology. Ameena Saiyid Oxford University Press.

Martz, E. and Livneh, H. (2007). Coping with Chronic Illness and Disability: Theoretical, Empirical and Clinical Aspects. New York: Springer.

Chesler, M., and Ungerleider, S. (2003). Post-traumatic growth: Understanding a new field of research. The Prevention Researcher, 10 Supply.

Weiss, T., and Berger R. (2010). Posttraumatic Growth and Culturally Competent Practice. John Wiley and Sons, Inc.

Scheier M. F., and Carver, C.S. (1985). Optimism, Coping and Health: Assessment and Implications of Generalized Outcome Expectancies. Health Psychology, 4, 219-47.

Tedeschi, R.G., and Calhoun, L.G. (2006). Handbook of Posttraumatic Growth: Research and Practice. Lawrence Erlbaum Associates, Inc.

Lazarus, R.S., and Folkman S. (1984). Stress, Appraisal and Coping. New York: Oxford University Press.

Hood, C., Rothstein, H., and Baldwin, R. (2002). The Government of Risk: Understanding Risk Regulation Regimes. Oxford: Oxford University Press.

Taylor, S. E. (1999). Health Psychology (4th ed.). USA: McGraw-Hill Companies, Inc.

Baltes, M. M. (1987). Successful aging as an expression of behavioral competence and environmental quality. Frankfurt-am-Main, Germany: Suhrkamp.

Agarwal, M., Dalal, A. K., Agarwal, D. K., and Agarwal, R. K. (1995). Positive life orientation and recovery from myocardial infarction. Social Science and Medicine, 40, 125-30.

Scheier, M. F., Matthews, K. A., Owens, J. F., Magovern, G. J., Sr., Lefebvre, R. C., Abbot, R. A., and Carver, C. S. (1989). Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. Journal of Personality and Social Psychology, 57, 1024-1040.

Carver, C. S., Scheier, M. F., and Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283. doi:10.1037/0022-3514.56.2.267.

Aspinwall, L.G., and Taylor, S. E. (1992). Modeling cognitive adaptation: A longitudinal investigation of the impact of individual differences and coping on college adjustment and performance. Journal of Personality and Social Psychology, 63, 989-1003.

Major, B., Richards, C., Cooper, M., Cozzarelli, C., and Zubek, J. (1998). Personal resilience, cognitive appraisals, and coping: An integrative model of adjustment to abortion. Journal of Personality and Social Psychology, 74, 735-752.

Kausar, R., and Hyas, M. (2000). A longitudinal study of anxiety in cancer patients before and after receiving chemotherapy. Journal of Indian Academy of Applied Psychology, 26(12), 57-63.

Freedy, J. R., and Donkervort, J. C. (1995). Traumatic Stress: An Overview of the Field. In: J.R. Freedy, and S.E. Hobfoll, (Eds.). Traumatic Stress: From Theory to Practice (pp. 328). New York: Plenum Press.

Quarantelli, E. L. (1985). An assessment of conflicting views on mental health: The consequences of traumatic events. Pp. 173-215 in C. R. Figley (Ed.), Trauma and Its Wake: The Treatment of Post-Traumatic Stress Disorder. N.Y: Brunner/Mazel.

Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., and Solomon, Z. (2009). Examining the relationship between resilience and posttraumatic growth. Journal of Traumatic Stress, 22, 282-286

Luthar, S. S., Cicchetti, D. and Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543-562. doi: 10.1111/1467-8624.00164.

Baltes, M. M. (1987). Successful aging as an expression of behavioral competence and environmental quality. Frankfurt-am-Main, Germany: Suhrkamp.

Bostock, L., Sheikh, A. I., and Barton, S. (2009). Posttraumatic growth and optimism in health related trauma: a systematic review. Journal of Clinical Psychology Medical Settings, 16(4), 281-96. doi:10.1007/s10880-009-9175-6.

Aspinwall, L.G., and Taylor, S. E. (1992). Modeling cognitive adaptation: A longitudinal investigation of the impact of individual differences and coping on college adjustment and performance. Journal of Personality and Social Psychology, 63, 989-1003.

Friedman, H. S. and Vandenbos, G. R. (1992). Disease-prone and self-healing personalities. Hospital and Community Psychiatry, 43, 1177-1179. doi: 354000 03267045.0020.

Karademas, E. C., Karvelis, S., and Argyropoulou, K. (2007). Short communication: Stress-related predictors of optimism in breast cancer survivors. Stress and Health, 23, 161-168.

Dykema, J., Bergbower, K., and Peterson, C. (1995). Pessimistic explanatory style, stress, and illness. Journal of Social and Clinical Psychology, 14, 357-377.

Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3), 504-511.

Fredrickson, B. L., and Levenson, R. W. (1998). Positive Emotions Speed Recovery from the Cardiovascular Sequelae of Negative Emotions. Cognition and Emotion, 12(2), 191-220.

Affleck, G., Tennen, H., Croog, S., and Levine, S. (1987). Causal attribution, perceived benefits, and morbidity following a heart attack: An eight-year study. Journal of Consulting and Clinical psychology, 55, 29-35.

Charles, F. E., et al. (2004). Gender Differences among Cardiac Patients. American Psychosomatic Society.

Daukantaite, D., and Bergman, L. (2005). Childhood roots of women's subjective wellbeing: the role of optimism. Euro Psychology, 10 (4), 287-297.

Lechner, S. C., and Antoni, M. H. (2004). Posttraumatic growth and group-based interventions for persons dealing with cancer: What have we learned so far? Psychological Inquiry, 15(1), 35-41.

Patton, G. C., Tollit, M.M., Romaniuk, H., Spence, S.H., Sheffield, J., and Sawyer, M.G. (2011). A Prospective Study of the Effects of Optimism on Adolescent Health Risks. Pediatrics, 127(2), 308 -316 doi: 10.1542/peds.2010-0748.
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Author:Masood, Syeda Mariam; Rafique, Rafia
Publication:Pakistan Journal of Clinical Psychology
Article Type:Report
Geographic Code:9PAKI
Date:Dec 31, 2013
Words:4355
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