Do POWs Experience "Post-Traumatic Growth"?

ANN ARBOR --- The adverse effects experienced by repatriated prisoners of war are well-documented, but what's not well-known is whether POWs realize positive outcomes from their traumatic experiences. Now, a research team, led by a University of Michigan Health System investigator, is launching a study to examine that question.

It's part of an emerging field of study called "post-traumatic growth"---positive changes in self-perception, interpersonal relationships and philosophy of life for people who have undergone significant trauma. Anecdotal evidence indicates that some former POWs not only adjust well to their trauma, but actually report finding personal meaning and growth from the experience. Previous research on the post-traumatic growth phenomenon has shown that coping with significant traumas can lead to psychological growth for some people.

Investigators in the study, "Changes in Outlook Among Vietnam Veterans and Prisoners of War," will attempt to determine whether Vietnam Navy and Air Force POWs have developed post-traumatic growth to a greater extent than a control group made up of Vietnam vets who were not POWs. The two-year study is funded by the Center for Naval Analysis.

"Post-traumatic growth is a phenomenon which has only recently been investigated," says Jeffrey Sonis, M.D., M.P.H., principal investigator on the study, and assistant professor of family medicine and of epidemiology at the U-M. "Most of the research on this phenomenon has investigated people who have sustained moderate trauma. This study will be the first to investigate this phenomenon in people who have sustained severe, overwhelming trauma---POWs."

The study will be divided into two phases. During the first part, Sonis and his colleagues will spend eight months on qualitative work to make sure they are asking the right questions. They will interview a sample group of POWs and POW experts, and examine autobiographical writings from POWs to identify all of the key aspects of captivity and repatriation. From this, they will develop a comprehensive survey questionnaire.

The second phase will be a mail-survey study of three groups:

1) Navy POWs and a control group made up of U.S. Navy aviators matched with the POW group for age and military characteristics.

2) Siblings of Navy POWs---to assess whether a study subject's self-rating mirrors other people's perceptions.

3) Air Force POWs and a matching control group of Air Force pilots and aviators who had at least one Southeast Asia combat tour.

Survey data from the Navy POWs and controls will be linked to data on physical and psychological health, collected by the Mitchell Center for POW Studies during annual health exams on Navy POWs and controls since the mid-1970s. Data from Air Force POWs and controls will be linked to records on self-concept changes in these men, collected in a 1976 study by William Sledge, M.D., professor of psychiatry at Yale University.

The research team has developed five fundamental questions they wish to answer:

1) Did Navy and Air Force POWs develop post-traumatic growth to a greater extent than the matched control groups?

2) What are the predictors of post-traumatic growth?

3) Does psychological distress inhibit post-traumatic growth?

4) Is post-traumatic growth simply an indicator of denial or unrealistic positive self-evaluation?

5) Are there changes in post-traumatic growth over time?

To answer these questions, the mail survey will consist of questions pertaining to outcomes and factors that might predict those outcomes.

The outcomes Sonis and his team of investigators will measure include post-traumatic growth and other positive outcomes, such as satisfaction with life and general well-being, and adverse outcomes, such as depression and post-traumatic stress disorder. Post-traumatic growth will be measured using a test developed by Sonis' colleague, Richard Tedeschi, Ph.D., professor of psychology, University of North Carolina-Charlotte, which includes five categories of "growth": relating to others, personal strength, spiritual change, appreciation of life, and new possibilities.

Factors that might predict these outcomes include captivity experiences, repatriation experiences, enduring personality characteristics, and military variables such as flight hours and training.

"If we can discover what factors are associated with post-traumatic growth, particularly if they are modifiable factors," Sonis says, "then perhaps we can have some positive impact on the repatriation experience for POWs in such a way that we can foster growth and help people deal with these awful experiences."

Sonis says the study could have potential benefits for a wide variety of people.

"I think this study will have significance on several levels," says Sonis. "First, for POWs and their families. Second, for the military, which would likely be interested in the potential to select personnel who perform well under traumatic conditions for dangerous missions. Finally, advances in basic understanding of post-traumatic growth might be applicable to survivors of a wide range of traumas, such as torture, rape, motor vehicle accidents and natural disasters."