Predictive Relationship Between War Posttraumatic Growth,Values,and Perceived Social Support

Introduction

Accidents, natural disasters, physical or sexual violence, life-threatening diseases, unexpected death of a dear one, physical or sexual abuse, terrorist attacks, torture, and many more life events are among common types of trauma that adult individuals may face throughout their lives (Werdel & Wicks, 2012). A general feature of traumatic incidents that deeply upset people is that they occur suddenly at an unexpected time; they are intensive and cause a severe anxiety in sufferers (Öztan, Aydın, Eroğlu, & Stuvland, 2001). Although some of the events that lead to trauma are natural disasters, some others are catastrophes perpetrated by people (Martz, 2010). Wars, which are a kind of trauma performed by human beings, are among the most destructive traumatic events that are commonly witnessed today. Unlike traumatic events experienced individually, people exposed to war undergo numerous stressful experiences in a constantly insecure environment (Rosner & Powell, 2006). Individuals may experience a phenomena such as injury at war or in an armed conflict, disability, or an incident where they do not experience direct physical impact loss of family, friends or relatives, loss of job, being deprived of health insurance and other resources they normally access (food, clean water, electricity, etc), and destruction of buildings in a city (Martz, 2010). Giving rise to numerous socio-political and economic problems, wars (Ai, Tice, Whitsett, Ishisaka, & Chim, 2007) may force civilians to leave where they live (Rosner & Powell, 2006). Another traumatic aspect of war occurs when civilians who experience a war are faced with the phenomenon of migration, which leads to separation, conflict, loss, and various changes (Berger & Weiss, 2003).

Despite all these negative consequences of wars, there are studies in the literature indicating that refugees undergo some positive changes in the postwar era (Ai, Peterson, & Huang, 2003; Ai et al., 2007; Kılıç, Magruder, & Koryürek, 2016; Kroo & Nagy, 2011; Powell et al., 2003; Shakespeare-Finch, Schweitzer, Kin, & Brough, 2014). Powell, Rosner, Butollo, Tedeschi and Calhoun (2003) The most commonly used term to describe the positive changes emerging in the wake of traumatic experiences is posttraumatic growth (Dekel, Hankin, Pratt, Hackler, & Lanman, 2016; Tedeschi & Calhoun, 1995). The concept of posttraumatic growth expresses the positive changes that occur as a result of a struggle against highly challenging life conditions (Tedeschi & Calhoun, 2004). Posttraumatic growth involves the transformation of some situations and challenges that enable individuals to make sense of the world they live in into positive resources (Tedeschi, Park, & Calhoun, 1998).

At first sight, the concept of posttraumatic growth seems to be a new concept that falls within the province of positive psychology (Joseph, 2009). However, it has been emphasized in literary and philosophical texts that agonies experienced throughout the history of mankind will generate some personal gains. In addition, the assumption that stressful and traumatic events will give rise to positive psychological changes have been expressed in major religions such as Buddhism, Christianity, Hinduism, Islam, and Judaism (Joseph & Linley, 2008; Joseph, 2009; Tedeschi & Calhoun, 1995; Tedeschi et al., 1998; Tedeschi & Calhoun, 2004; Werdel & Wicks, 2012). Existentialist philosophy and humanistic psychology also emphasize that positive changes may arise as a consequence of suffering pains (Joseph, 2009; Tedeschi & Calhoun, 1995; Tedeschi et al., 1998).

Dimensions of the positive changes that may occur as a result of a trauma involve changes in perceptions of the self, changes in interpersonal relationships, realizing the worth of life, changes in the belief system, and noticing new options . All dimensions of the concept of posttraumatic growth emphasize, paradoxically, that there is again within the loss (Tedeschi & Calhoun, 2004). Moreover, individuals may experience growth in different ways, in different areas, and at different periods of time (Tedeschi & Calhoun, 2004; Tedeschi et al., 1998).

The process of posttraumatic growth takes place within a social environment in an interpersonal context (Joseph & Linley, 2008; Weiss, 2004a). The social environment in which individuals live affects their cognition and their coping ability because when individuals become exposed to a traumatic and shocking experience, they need the support of other people and professionals or people close to them with whom they will talk and who will help them remember who they are. The support they obtain from others directly influences people’s emotions, their coping, their memories of past experiences, and their ability to make sense of things (Joseph & Linley, 2008). The social context that individuals find within themselves may facilitate the process of posttraumatic growth by providing emotional relief and offering an alternative point of view against the unfavorable experience (Weiss, 2004b).

The quality of the relationships with the family and friends before and after the trauma plays an important part in determining the extent of the growth. If good relationships can be maintained or developed, growth may take place (Calhoun & Tedeschi, 1998; Tedeschi & Calhoun, 1995). In the conceptual model, they offer, Schaefer and Moos (1992) state that environmental and personal systems combine to determine the possibility and characteristics of crises in life. The environmental system involves social, domestic, and financial life conditions as well as relationships with the family, friends, and colleagues. Personal systems, on the other hand, consist of self-efficacy, motivation, state of health, cognitive skills, personal resources, and sociodemographic features. These components determine the cognitive evaluation process and the coping strategies that individuals employ after the traumatic experience and accordingly enable their fulfillment of posttraumatic growth.

Traumatic experiences that cause people to be shocked psychologically may lead to the questioning of values they hold and even to their reconstruction. Schaefer and Moos emphasized that experiencing unfamiliar or life-threatening conditions such as loss of a relative or developing a serious illness completely disrupt people’s belief in themselves and the world. These crises and emotional chaos compel people to question fundamental values and priorities and reconstruct their objectives in life painfully (Schaefer & Moos, 1992). When individuals acknowledge the reality of the traumatic loss, it becomes possible for values such as awareness, the point of view, gratitude, happiness, freedom, creativity, courage, forgiveness, receptiveness, patience, extroversion, and hope to emerge (Werdel & Wicks, 2012).

Values are actions or behaviors that individuals find meaningful for themselves and others and the schema that produces these actions (Dökmen, 2002); they are our beliefs and assumptions about what is “good” and “beautiful,” “right,” and “sacred” (Hökelekli, 2013), and they are standards that guide behaviors and pass judgments about principles and fundamental convictions, beliefs, and actions concerning what is ideal and worth fighting for (Halstead & Taylor, 2000). Rokeach (1973) defined “values” and “standards guiding life” and stated that values are the determiners of social attitude and behaviors.

Values have various functions for the society and individuals. When seen from a psychological perspective, functions on individuals in terms of respect are noteworthy. Values involve such functions as protecting the ego, which keeps mental health in balance (Rokeach, 1973), rendering life meaningful, which is one of the essential needs of human beings (Akıncı, 2005), serving to set goals (Santrock, 2014), and assisting in the process of decision-making (Ersoy, 2006).

Method

Posttraumatic growth was measured using the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996). Turkish adaptation of this scale had been done by Dürü (2006). This inventory is a 21-item self-report measurement and consists of five subscales: new possibilities (5 items), relating to others (7 items), personal strength (4 items), spiritual change (2 items), and appreciation of life (3 items). Each item is rated on a 6-point Likert-type scale (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 Cronbach’s alpha coefficient in the Turkish sample was α = .93. The construct validity of the scale was executed by factor analysis method. Psychometric properties of the scale demonstrated that five-factor valid for Turkish society.

Multidimensional Scale of Perceived Social Support

Perceived social support was measured using the Turkish version of the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988). Turkish adaptation of this scale was done by Eker and Arkar (1995). The scale was revised by Eker, Arkar, and Yaldız, and validity and reliability studies were carried out in 2001. This inventory is a 12-item self-report measurement and consists of three subscales: family, friends, and a significant other. Each item is rated on a 7-point Likert-type scale (1 = strongly disagree to 7 = strongly agree). Psychometric properties of the scale demonstrated that three-factor valid for Turkish society. The Cronbach’s alpha values were found to be between .80 and .95 in Turkish sample (Eker et al., 2001).

Values Scale

Human values were measured using the Human Values Scale. This scale was developed by Dilmaç, Arıcak, and Cesur (2014) to determine adults’ values. The scale measures the human values processed through 39 items under the following nine subdimensions: social values, career values, intellectual values, materialistic values, spiritual values, romantic values, the honor of humanity, freedom, and fütüwwat (munificence/courage). Each item is rated on a 10-point Likert-type scale (0 = strongly disagree to 9 = strongly agree). The Cronbach’s alpha internal consistency coefficients of the values scale were calculated on a factor basis. As a result of the analyses, the Cronbach’s alpha values were found as .78 for “intellectual values,” .78 for “materialistic values,” .90 for “social values,” .61 for “human dignity,” .80 for “career values,” .81 for “spirituality,” .78 for “materialistic values,” .65 for “freedom,” .66 for “romantic values,” and .63 for “fütüwwat” (generosity and courage). According to the results of confirmatory factor analysis, all values under the factors were found to have factor loads between .48 and .85.

Data Analysis

First, missing values, outlines, and normality distribution were checked using SPSS 20 package software. Skewness and Kurtosis coefficients were calculated to determine whether there was a normality distribution.

The structural equation modeling analysis, which was conducted to determine the relationships among posttraumatic growth, perceived social support, and the values of the individuals who experienced war trauma and to test the relationships between these variables using the structural equation modeling, was conducted with AMOS 19 Program. Structural equation modeling is a statistical approach that, to test a theoretical model, reveals the causal and reciprocal relationships between observed and potential variables (Schumacker & Lomax, 2004).

Findings

Table 1 shows means, standard deviations, and skewness–kurtosis values of study variables. The skewness values of the data set were between −1.759 and −.377, while kurtosis values were between −.750 and 2.347. If the skewness coefficients the scores received from the posttraumatic growth scale, perceived social support scale, and values scale were within the range of ±2 and their kurtosis coefficients were within the range of ±7, this meant that the normality distribution hypothesis or assumption was met (Byrne, 2010). Therefore, the data were distributed normally.

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Table 1.

Descriptive Statistics of Observed Variables.

Variables	Mean	Standard deviation	Skewness	Kurtosis
New possibilities	16.8742	4.86878	−.602	.296
Relationships with others	24.0430	6.40765	−.159	−.555
Personal strength	14.3841	4.13696	−.444	−.723
Appreciation of life	10.5099	3.39213	−.417	−.750
Spiritual development	7.5298	2.19576	−.725	−.087
Friend	19.5960	5.69161	−.377	−.530
Family	21.0397	5.07404	−.653	.066
Significant other	18.9901	6.34997	−.393	−.667
Social	79.2450	9.90115	−1.064	.649
Career	38.4272	5.56206	−1.046	.896
Intellectual	47.9040	6.68022	−1.074	.239
Spirituality	32.1656	4.49131	−1.053	.138
Materialistic	19.7053	5.05280	−.980	.929
Human dignity	24.6788	3.51071	−1.759	2.347
Romantic	20.6159	5.11445	−.904	.077
Freedom	23.7980	3.41711	−1.205	1.068
Fütüwwat	15.8411	2.64912	−1.219	.764

Structural Model

The model’s final form (χ² = 305,983, df = 109, p < .001) has nine exogenous (career, intellectual, social, materialistic, spiritual, romantic, human dignity, freedom, and fütüwwat) and two endogenous (posttraumatic growth and perceived social support) sets of data. All paths shown in the model is found to be statistically meaningful. The Tucker-Lewis coefficient fit index (TLI), the Bentler–Bonett normed fit index (NFI), and other fit indexes show that the model is quite acceptable (Table 2). Each of the two-way correlations between the endogenous data in the model has high values, which are statistically significant. This situation, a natural result of the values scale, includes a high relationship of subdimensions used in the model.

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Table 2.

Statistical Values Related to the Fitting of Structural Equation Model.

Measure	Perfect fit indices	Acceptable fit indices	The model indices
(χ2/SD)	≤3	≤4–5	2.807
RMSEA	≤0.05	0.06–0.08	.077
SRMR	≤0.05	0.06–0.08	.0629
NFI	≥0.95	0.94–0.90	.898
CFI	≥0.97	≥0.95	.931
GFI	≥0.90	0.89–0.85	.886
AGFI	≥0.90	0.89–0.85	.839
TLI	≥0.95	0.94–0.90	.914

Note. RMSEA = root mean square error of approximation; SRMR = standardized root mean square residual; NFI = normed fit index; CFI = comparative fit index; GFI = goodness of fit; AGFI = adjusted goodness of fit; TLI = Tucker–Lewis Index.

When the fit indices in Table 2 are examined, the following values are found: χ²/SD = 2.807, root mean square error of approximation = .077, standardized root mean square residual = .0629, normed fit index = .898, comparative fit index = .931, goodness of fit index = .886, adjusted goodness of fit index = .839, and TLI = .914. Overall, it can be seen that the model has the fit values at the desired level (Browne & Cudeck, 1993; Byrne, 2010; Hu & Bentler, 1999; Kline, 2011). The tested single-factor model is shown in Figure 1. All paths shown in the model are significant at .001 level.

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Figure 1.

The path diagram of the study’s model. PTG = posttraumatic growth; PSS: perceived social support.

Examination of the model in the data in Table 3 and Figure 1 shows that the most important independent variable affecting posttraumatic growth (t = 8.079, p < .01) values. The correlation coefficient value of this factor is calculated as β = .623. There is a positive and linear relationship between posttraumatic growth and values. This finding suggested that an increase in adults who have had a war experience values would positively contribute to their posttraumatic growth level.

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Table 3.

Model on Predictor Relations Between Posttraumatic Growth, Values and Perceived Social Support.

Predictor variable	Dependent variable	Total effect	Direct effect	Indirect effect	Standard error	Critical value
Values	PTG	.623	.623	0	.011	8.079*
Values	PSS	.243	.243	0	.026	3.559*
PSS	PTG	.387	.387	0	.025	5.587*

Note. PTG = posttraumatic growth; PSS: perceived social support.

^aTotal effect = Direct effect + Indirect effect.

*p < .01.

According to the tested model, the second most important variable affecting posttraumatic growth is the perceived social support (t = 5.587, p < .01). The correlation coefficient value related to this factor is found to be β = .387. There is a positive and linear relationship between posttraumatic growth and perceived social support. This finding suggested that an increase in adults who have had a war experience perceived social support would positively contribute to their posttraumatic growth level.

It can be seen in the model that the most important independent variable affecting perceived social support (t = 3.559, p < .01) is values. The correlation coefficient value of this factor is calculated as β = .243. The predictor relationship between adults who have had a war experience values and their perceived social support levels is a positive linear relationship. In other words, findings indicated that as adults who have had a war experience values increased, their levels of perceived social support increased as well.

Conclusions and Discussion

According to the research findings, one of the most important variables that predicted the posttraumatic growth levels of the refugees who underwent a war experience was the values they possessed. Values are fundamental principles that shape up our lives (Dilmaç et al., 2014). They affect individuals’ attitudes, beliefs, and behaviors (Güngör, 1998). Values, which occupy a significant place in human life and which are among the research topics of psychology as they have the power to guide behaviors, also have a significant influence on mental health and general well-being. Bergin (1991) emphasizes that while assessing individuals’ mental health and during therapies, their value systems should also be taken into consideration. However, there are a limited number of studies in the literature about the effect of values on mental health and general well-being. According to the results of a study in which Seki and Dilmaç (2015) investigated the relationships among the values adolescents possessed, subjective well-being, and social appearance anxiety, the values that adolescents possessed directly predicted social appearance anxiety and subjective well-being level. According to the results of a study which Uğurcu (2015) conducted to reveal whether university students’ values and their forgiveness predicted their depression, anxiety, and stress levels, university students’ forgiving attitudes and social values, values for guild members and freedom values subdimensions of the values scale, were significant predictors of depression. In other words, as university students’ values increased, their depression levels would decrease. Moreover, university students’ forgiving attitudes and their freedom values were found to be significant predictors of their anxiety. In a similar study, İşler and Dilmaç (2016) investigated the relationships among the values of 600 inmates spending their terms in prisons, their forgiveness behaviors, and social anxiety levels. According to the results of the study, the prisoners’ forgiveness levels were important predictors of their values, and the most important variable predicting the social anxiety level was values. There was a negative and significant correlation between the humanitarian values the prisoners had and their social anxiety levels and an increase in the values the prisoners had indicated that their social anxiety levels would decrease.

Given that the values people have directly affect their emotions, ideas, and behaviors, it can be said that those who experience a traumatic event make sense of the incident they have been exposed to with reference to the values to which they attach importance. In this way, individuals will interpret the trauma they have experienced in terms of the values they have, and this will probably affect positive changes that might arise following the trauma. Schaefer and Moos (1992) stated in their theory that one of the positive changes that took place following a trauma involved changes in fundamental values and priorities in life.

According to the results of the study, it was seen that another important variable that predicted posttraumatic growth level of refugees who experienced war was perceived social support. Theoreticians working on posttraumatic growth have frequently emphasized the importance of social support (Calhoun & Tedeschi, 1998; Joseph & Linley, 2008; Schaefer & Moos, 1992; Tedeschi & Calhoun, 1995). In addition, there are many studies in the relevant literature supporting the finding of this study (Kroo & Nagy, 2011; Schweitzer, Melville, Steel, & Lacherez, 2006; Sleijpen, Haagen, Mooren, & Kleber, 2016; Stewart et al., 2008). According to the findings of a study by Kroo and Nagy (2011) linley in which posttraumatic growth processes of Somali refugees living in Germany were investigated, the refugees who had experienced war experienced growth in various areas. In the study, perceived social support, hope, religiosity, and negative religious coping style were found to be in positive correlation with posttraumatic growth. Moreover, according to the research findings, it was seen that family factors were not in a significant correlation with posttraumatic growth, whereas cultural features were found to be in a positive and significant relationship with posttraumatic growth. Likewise, in a study they conducted, Sleijpen et al. (2016) aimed to reveal the relationship between the traumatic event which the adolescent refugees living in a refugee center, their optimism bias, perceived social support, symptoms of posttraumatic stress disorder, and life satisfaction and their posttraumatic growth levels. According to the results of the study, no significant relationship was found between posttraumatic stress disorder and posttraumatic growth, whereas a positive and significant relationship was found between posttraumatic growth, optimism bias, and perceived social support. Feder et al. (2008) investigated the posttraumatic growth experiences of 30 veterans who had been captured and imprisoned during the Vietnam War. Diagnostic interviews structured by experienced clinicians were held with the participants and posttraumatic growth scale and optimism bias, religious coping, social support, and goals in life scales were administered to them. According to the regression analysis conducted, duration of captivity, optimism bias, and social support had the power to predict posttraumatic growth, whereas goals in life and positive religious coping did not have a significant predictive power.

According to the research findings, one of the most important variables that predicted the perceived social support levels of the refugees who experienced war was the values they had. The concept of social support is considered to be one of the components of values. Therefore, perceived social support can theoretically be explained by values (Deniz, Dilmaç, & Hamarta, 2016). There are limited studies in the relevant literature investigating the relationship between the values people had social support and perceived social support. Goodwin, Costa, and Adonu (2004) investigated the relationships between individual values , self-esteem, and received and perceived social support on a sample consisting of four different nations (England, Portugal, Ghana, and Mozambique). According to their findings, the power of values to predict the perceived social support was twice that of the received social support. According to the path analysis conducted, values were an important predictor of perceived social support, while perceived social support was an important predictor of self-esteem. According to the results of a study which Deniz et al. (2016) conducted on university students to test whether values predicted self-esteem and perceived social support, subdimensions of the values scale were predictors of perceived social support and self-esteem scale. The stepwise analysis conducted revealed that stimulation, achievement, and tradition subdimensions of the values scale were an important predictor of social support received from the family; helpfulness and traditionalism subdimensions were an important predictor of peer support, whereas helpfulness and stimulation subdimensions were an important predictor of support received from a special person.