Post-traumatic growth enhances social identification in liver transplant patients: A longitudinal study

Highlights

• Research demonstrates that threatening illnesses are often followed by positive life changes and post-traumatic growth (PTG)

• Establishing and reinforcing interpersonal connections is seen as an important domain of growth in the aftermath of trauma

• The present study is the first one to investigate PTG in liver transplant survivors

• This is the first study exploring the influence of PTG on subjective identification with family and transplantees groups

• The longitudinal design of this study allows the assessment of the effects of PTG on social identity over time and vice versa

Abstract

Objective

The main aim of this paper is to investigate the prediction that greater subjective identification with relevant groups and social categories (i.e. ‘family’ and ‘transplantees’) can be an outcome of post-traumatic growth (PTG). To date there are no studies that have explored these relationships.

Methods

A longitudinal study was conducted with a group of 100 liver transplant patients from the outpatient populations of the participating centre. Data were collected by means of a self-report questionnaire, which was completed at two different time points (T1 and T2) that were 24 months apart. PTG was assessed using the Post-Traumatic Growth Inventory, while both transplantee and family identification were assessed using group identification scales. A path model was tested, using a structural equation model (SEM) approach, to examine the reciprocal effects among family identification, transplantee identification, and PTG over time.

Results

As predicted, we found that greater PTG T1 predicted both greater family identification T2 and marginally greater transplantee identification T2. However, the two identification variables did not predict PTG over time.

Conclusions

The results show that family identification and transplantee identification may be outcomes of the PTG process, confirming the importance of adopting a thriving multidimensional model of adjustment to medical illness, whereby people facing adverse life events, such as transplantation, may flourish rather than deteriorate psychologically.

Introduction

How do people who have survived cancer adjust psychologically to life? Until the mid-1990s, psycho-oncologists assumed that a traumatic life event such as cancer could only cause disruption and distress in one's life. As a consequence, experts considered that one had adjusted to cancer if one showed an absence of diagnosed psychological disorders, no psychological symptoms, no negative mood, or no limitations in physical functioning [1], [2]. Carver [2] aptly defined such exclusive focus on negative outcomes as an impairment model of medical illness.

More recently, however, researchers have become aware that positive adjustment is not simply the absence of distress [3], and that many individuals with medical illness such as cancer actually report positive adjustment [4]. As a consequence, an increasing number of researchers have begun to examine the positive outcomes of cancer survivorship [5], thereby proposing a thriving model of illness [2].

One positive outcome of particular interest is post-traumatic growth (PTG) [6], [7], [8], [9]. This refers to positive psychological changes in self, life directions, and interpersonal relationships, which are produced by a traumatic life event - for instance a life-threatening illness such as cancer - and may either replace or accompany negative consequences. A rapidly growing literature now shows the high prevalence of positive life changes and personal growth following cancer. Indeed, a recent meta-analysis [10] showed that 60–90% of people living with cancer report positive changes post-diagnosis.

As mentioned above, researchers consider interpersonal relationships to be an important domain of growth in the aftermath of trauma. Post-trauma interpersonal relationship enhancement is said to take different forms, such as placing increased value on one's relationships with close others, or experiencing greater feelings of compassion and empathy towards those feeling pain or grief [9]. However, according to social psychologists taking a social identity perspective towards human relations [11], [12], people do not only establish connections with others as individuals. People may also subjectively identify with (i.e., feel psychologically connected to) social groups and categories, such as one's own family, leisure group, support group, religious community, or people with cancer. Importantly, social identity researchers point to the fact that perceiving others as members of a group with which one identifies is a precondition for experiencing empathy, sympathy, compassion, and concern for others [13], [14]. Put differently, to the extent that one identifies with a group, his or her relationship with other members of that group will be affectively more intense and genuine.

In line with a social identity perspective, the main aim of this paper is to assess the assumption that greater identification with relevant groups and social categories can be an outcome of PTG. Specifically, we test the prediction that cancer survivors who have undergone liver transplantation will develop some degree of identification with both their family group and the group of transplantees over time, as a consequence of PTG. This is because people with cancer will normally rely upon family members for moral and instrumental support, and will almost inevitably perceive themselves as members of the category of ‘people with cancer’.

Because to date researchers have used group identification exclusively as a predictor of psychological well-being outcomes rather than as a psychological well-being outcome itself [15], [16], [17], we will also assess the alternative possibility that greater identification with both the family group and the group of transplantees will lead to greater PTG over time.