Journal of Happiness Studies

, Volume 14, Issue 6, pp 1717–1737 | Cite as

Posttraumatic Growth and Subjective Well-Being among Caregivers of Chronic Patients: A Preliminary Study

  • Liat HamamaEmail author
  • Michael Sharon
Research Paper


This preliminary study focused on positive phenomena among Israeli family caregivers (spouse, adult child, or parent) of patients with chronic illness hospitalized in a medical rehabilitation hospital. We investigated these caregivers’ posttraumatic growth (PTG) and subjective well-being (positive and negative emotions, life satisfaction), and their associations with the demographic and illness characteristics of the caregivers and patients, respectively. Participants included 74 adult primary caregivers: 28 were the patient’s spouse; 21 were the patient’s child; and 25 were the patient’s parent. Caregivers completed four self-report questionnaires. No significant association emerged between caregivers’ PTG and their negative affect or life satisfaction. Nevertheless, caregivers’ positive affect correlated with their PTG and also predicted it. Moreover, different patterns emerged for the caregiver subgroups (spouse, adult child, or parent): Patients’ children reported lower negative affect and greater life satisfaction than patients’ parents or spouses. Various explanations were discussed, alongside implications for giving recognition and assistance from the medical system to patients’ caregivers.


Caregivers PTG Subjective well-being 



This study was partially supported by a Sara Peleg Grant from the School of Social Work at Tel-Aviv University. The authors would like to thank Reuth Medical Center’s social workers for their assistance in recruiting the participants and to Dee B. Ankonina for her editorial assistance.


  1. Abraid′o-Lanza, A. F., Guier, C., & Col′on, R. M. (1998). Psychological thriving among Latinas with chronic illness. Journal of Social Issues, 54, 405–424.Google Scholar
  2. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, UK: Sage.Google Scholar
  3. Argyle, M., & Martin, M. (1991). The psychological causes of happiness. In F. Strack, M. Argyle, & N. Schwarz (Eds.), Subjective well being: An interdisciplinary perspective (pp. 77–100). Oxford: Pergamon.Google Scholar
  4. Barakat, L. P., Alderfer, M. A., & Kazak, A. E. (2006). Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers. Journal of Pediatric Psychology, 31, 413–419.Google Scholar
  5. Barg, F. K., Pasacreta, J. V., Nuamah, I. F., Robinson, K. D., Angeletti, K., Yasko, J. M., et al. (1998). A description of a psycho educational intervention for family caregivers of cancer patients. Journal of Family Nursing, 4, 394–414.Google Scholar
  6. Barnes, C. L., Given, B. A., & Given, C. W. (1992). Caregivers of elderly relatives: Spouses and adult children. Health and Social Work, 17(4), 282–289.Google Scholar
  7. Barskova, T., & Oesterreich, R. (2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disability and Rehabilitation, 31(21), 1709–1733.Google Scholar
  8. Bender, T. A. (1997). Assessment of subjective well-being during childhood and adolescence. In D. G. Phye (Ed.), Handbook of classroom assessment: Learning, achievement, and adjustment (pp. 199–225). San Diego: Academic Press.Google Scholar
  9. Boerner, K., Schulz, R., & Horowitz, A. (2004). Positive aspects of caregiving and adaptation to bereavement. Psychology and Aging, 19, 668–675.Google Scholar
  10. Bonnano, G. A. (2004). Loss, trauma and human resilience: Conceptual and empirical connections and separateness. American Psychologist, 59(1), 20–28.Google Scholar
  11. Bradburn, N. M. (1969). The structure of psychological well-being. Chicago: Aldine.Google Scholar
  12. Brewer, L., & Chu, D. (2008). Caregivers at risk: The implications of health disparities. Journal of Loss and Trauma, 13, 205–221. doi: 10.1080/15325020701769246.Google Scholar
  13. Brodaty, H., Green, A., & Koschera, A. (2003). Meta-analysis of psychosocial interventions for caregivers of people with Dementia. Journal of the American Geriatrics Society, 51, 657–664.Google Scholar
  14. Cadell, S. (2007). The sun always comes out after it rains: Understanding posttraumatic growth in HIV caregivers. Health and Social Work, 32(3), 169–176.Google Scholar
  15. Calhoun, L. G., & Tedeschi, R. G. (1999). Facilitating posttraumatic growth: A clinician’s guide. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  16. Calhoun, L. G., & Teseschi, R. G. (2006). Handbook of posttraumatic growth: Research & Practice. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  17. Chida, Y., & Steptoe, A. (2008). Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosomatic Medicine, 70, 741–756. doi: 0.1097/PSY.0b013e31818105ba.Google Scholar
  18. Cohen, C., Colantonio, A., & Vernich, L. (2002). Positive aspects of caregiving: Rounding out the caregiver experience. International Journal of Geriatric Psychiatry, 17, 184–188.Google Scholar
  19. Collins, R. L., Taylor, S. E., & Skokan, L. A. (1990). A better world or a shattered vision? Changes in life perspectives following victimization. Social Cognition, 8, 263–285.Google Scholar
  20. Colville, G., & Cream, P. (2009). Post-traumatic growth in parents after a child’s admission to intensive care: Maybe Nietzsche was right? Intensive Care Medicine, 35, 919–923.Google Scholar
  21. Cordova, M. J., & Andrykowski, M. A. (2003). Responses to cancer diagnosis and treatment: Posttraumatic stress and posttraumatic growth. Seminars in Clinical Neuropsychiatry, 8, 286–296.Google Scholar
  22. Czaja, S., Eisdorfer, C., & Schulz, R. (2000). Future directions in caregiving: Implications for intervention research. In R. Schulz (Ed.), Handbook on dementia caregiving: Evidence-based interventions for family caregivers (pp. 283–320). New York: Springer.Google Scholar
  23. Dawson, J. F., & Richter, A. W. (2006). Probing three-way interactions in moderated multiple regression: Development and application of a slope difference test. Journal of Applied Psychology, 91, 917–926.Google Scholar
  24. Dekel, S., Ein-Dor, T., & Solomon, Z. (2012). Posttraumatic growth and posttraumatic distress: A longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 94–101.Google Scholar
  25. Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95, 542–575.Google Scholar
  26. Diener, E., & Chan, M. Y. (2011). Happy people live longer: Subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-Being, 3(1), 1–43.Google Scholar
  27. Diener, E., Emmons, R. A., Larson, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71–75.Google Scholar
  28. Diener, E., Suh, M., Lucas, E., & Smith, H. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125(2), 276–302.Google Scholar
  29. Engelkemeyer, S. M., & Marwit, S. J. (2008). Posttrau matic growth in bereaved parents. Journal of Traumatic Stress, 21, 344–346.Google Scholar
  30. Evers, A. W. M., Kraaimaat, F. W., van Lankveld, W., Jongen, P. J. H., Jacobs, J. W. G., & Bijlsma, J. W. J. (2001). Beyond unfavorable thinking: The illness cognitions questionnaire for chronic diseases. Journal of Consulting and Clinical Psychology, 69, 1026–1036.Google Scholar
  31. Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD. New York: Guilford.Google Scholar
  32. Fonagy, P., Target, M., Cottrell, D., Phillips, J., & Kurtz, Z. (2002). What works for whom? A critical review of treatments for children and adolescents. New York: Guilford Press.Google Scholar
  33. Frazier, P., Tennen, H., Gavian, M., Park, C., Tomich, P., & Tashiro, T. (2009). Does self-reported posttraumatic growth reflect genuine positive change? Psychological Science, 20(7), 912–917. doi: 10.1111/j.1467-9280.2009.02381.x.Google Scholar
  34. Frederickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2, 300–319.Google Scholar
  35. Fredrickson, B. L. (2009). Positivity. New York: Crown.Google Scholar
  36. Fried, T. R., Bradley, E. H., O’Leary, J. R., & Byers, A. L. (2005). Unmet desire for caregiver-patient communication and increased caregiver burden. Journal of the American Geriatrics Society, 53, 59–65.Google Scholar
  37. Gaugler, J., Kane, R., & Langlois, J. (2000). Assessment of family caregivers of older adults. In R. Kane & R. Kane (Eds.), Assessing older persons: Measures, meaning, and practical applications (pp. 321–359). New York: Oxford University Press.Google Scholar
  38. George, L. K., & Gwyther, L. P. (1986). Caregiver well being: A multidimensional examination of family caregivers of demented adults. The Gerontologist, 26(3), 253–259.Google Scholar
  39. Guralnick, M. J., Hammond, M. A., Neville, B., & Connor, R. T. (2008). The relationship between sources and functions of social support and dimensions of child- and parent-related stress. Journal of Intellectual Disability Research, 52, 1138–1154.Google Scholar
  40. Helgeson, V. S., Reynolds, K., & Tomich, P. L. (2006). A meta-analytic review of benefit findings and growth. Journal of Consulting and Clinical Psychology, 74(5), 797–816.Google Scholar
  41. Hungerbuehler, I., Vollrath, M. E., & Landolt, M. A. (2011). Posttraumatic growth in mothers and fathers of children with severe illnesses. Journal of Health Psychology, 16(8), 1259–1267.Google Scholar
  42. Isen, A. M., Daubman, K. A., & Nowicki, G. P. (1987). Positive affect facilitates creative problem solving. Journal of Personality and Social Psychology, 52, 1122–1131.Google Scholar
  43. Janoff-Bulman, R. (1992). Shattering assumptions: Towards a new psychology of trauma. New York: Free Press.Google Scholar
  44. Joseph, S., & Linley, P. A. (2006). Positive therapy. London: Routledge.Google Scholar
  45. Joseph, S., Williams, R., & Yule, W. (1993). Changes in outlook following disaster: The preliminary development of a measure to assess positive and negative responses. Journal of Traumatic Stress, 6, 271–279.Google Scholar
  46. Kahneman, D. (1999). Objective happiness. In D. Kahneman, E. Diener, & N. Schwarz (Eds.), Well-being: The foundations of hedonic psychology (pp. 3–25). New York: Russell Sage Foundation.Google Scholar
  47. Keith, P. M. (2009). Health care hassles of caregivers to the chronically ill. International Journal of Aging and Human Development, 69(1), 1–16. doi: 10.2190/AG.69.1.a.Google Scholar
  48. Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207–222.Google Scholar
  49. Keyes, C. L. (2006). Subjective well-being in mental health and human development research worldwide: An introduction. Social Indicators Research, 77, 1–10.Google Scholar
  50. Keyes, C. L., & Ryff, C. D. (2000). Subjective change and mental health: A self-concept theory. Social Psychology Quarterly, 63, 264–279.Google Scholar
  51. Keyes, C. L., Wissing, M., Potgieter, J. P., Temane, M., Kruger, A., & van Rooy, S. (2008). Evaluation of the mental health continuum–short form (MHC–SF) in Setswana-speaking South Africans. Clinical Psychology and Psychotherapy, 15, 181–192.Google Scholar
  52. Kleim, B., & Ehlers, A. (2009). Evidence for a curvilinear relationship between posttraumatic growth and post trauma depression and PTSD in assault survivors. Journal of Traumatic Stress, 22, 45–52.Google Scholar
  53. Kling, K. C., Malick-Seltzer, M., & Ryff, C. D. (1997). Distinctive late-life challenges: Implications for coping and well-being. Psychology and Aging, 12(2), 288–295.Google Scholar
  54. Kolanowski, A. M., Fick, D., Waller, J. L., & Shea, D. (2004). Spouses of persons with dementia: Their healthcare problems, utilization, and costs. Research in Nursing & Health, 27, 296–306.Google Scholar
  55. Konrad, S. C. (2006). Posttraumatic growth in mothers of children with acquired disabilities. Journal of Loss and Trauma, 11, 101–113. doi: 101080/15325020500358274.Google Scholar
  56. Lazarus, R. S., & Folkman, S. (1984). Stress appraisal and coping. New York: Springer.Google Scholar
  57. Levine, C. (1999). Home sweet hospital: The nature and limits of private responsibilities for home health care. Journal of Aging and Health, 11, 341–359.Google Scholar
  58. Lev-Wiesel, R., & Amir, M. (2003). Posttraumatic growth among Holocaust child survivors. Journal of Loss and Trauma, 8(4), 229–237.Google Scholar
  59. Lev-Wiesel, R., Goldblatt, H., Eisikovits, Z., & Admi, H. (2009). Growth in the shadow of war: The case of social workers and nurses working in a shared war reality. British Journal of Social Work, 39(6), 1154–1174.Google Scholar
  60. Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17, 11–21. doi: 10.1023/B:JOTS.0000014671.27856.7e.Google Scholar
  61. Luhmann, M., Hofmann, W., Eid, M., & Lucas, R. E. (2012). Subjective well being and adaptation to life events: A meta-analysis. Journal of Personality and Social Psychology, 102(3), 592–615.Google Scholar
  62. Magyar-Moe, J. L. (2009). Therapist’s guide to positive psychological interventions. New York: Elsevier Academic Press.Google Scholar
  63. Max, W., Webber, P. A., & Fox, P. J. (1995). Alzheimer’s disease: The unpaid burden of caring. Journal of Aging Health, 7, 179–199.Google Scholar
  64. McFarland, C., & Alvaro, C. (2000). The impact of motivation on temporal comparisons: Coping with traumatic events by perceiving personal growth. Journal of Personality Social Psychology, 79, 327–343.Google Scholar
  65. Milam, J. E., Ritt-Olson, A., & Unger, J. (2004). Posttraumatic growth among adolescents. Journal of Adolescent Research, 19(2), 192–204.Google Scholar
  66. Myers, D. G., & Diener, E. (1995). Who is happy? Psychological Science, 6, 10–19.Google Scholar
  67. Nachshen, J. S., Woodford, L., & Minnes, P. (2003). The family stress and coping interview for families of individuals with developmental disabilities: A lifespan perspective on family adjustment. Journal of Intellectual Disability Research, 47, 285–290.Google Scholar
  68. Nelson, S. D. (2011). The posttraumatic growth path: An emerging model for prevention and treatment of trauma-related behavioral health conditions. Journal of Psychotherapy Integration, 21(1), 1–42.Google Scholar
  69. Nezu, C. M., Palmatier, A. D., & Nezu, A. M. (2004). Problem-solving therapy for caregivers. In C. Edward, T. J. D’Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, and training (pp. 223–238). Washington, DC: American Psychological Association. doi: 10.1037/10805-013.Google Scholar
  70. Olsson, M. B., & Hwang, C. P. (2001). Depression in mothers and fathers of children with intellectual disability. Journal of Intellectual Disability Research, 45(6), 535–543.Google Scholar
  71. Ott, C. H., Sanders, S., & Kelber, S. T. (2007). Grief and personal growth experience of spouses and adult-child caregivers of individuals with Alzheimer’s disease and related dementias. Gerontologist, 47(6), 798–809.Google Scholar
  72. Park, C. L. (1999). The roles of meaning and growth in the recovery from posttraumatic stress disorder. In A. Maercker, M. Schutzwohl, & Z. Solomon (Eds.), Posttraumatic stress disorder: A lifespan developmental perspective (pp. 349–364). Seattle, WA: Hogrege and Huber.Google Scholar
  73. Park, C. L., Cohen, L. H., & Murch, R. L. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64, 1–35.Google Scholar
  74. Park, C. L., & Helgeson, V. S. (2006). Introduction to the special section: Growth following highly stressful life events-current status and future directions. Journal of Consulting and Clinical Psychology, 74, 791–796. doi: 10.1037/0022-006X.74.5.791.Google Scholar
  75. Pinquart, M., & Sorensen, S. (2003). Differences between caregivers and non caregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18, 250–267.Google Scholar
  76. Porter, L. S., Keefe, F. J., Hurwitz, H., & Faber, M. (2005). Disclosure between patients with gastrointestinal cancer and their spouses. Psycho-Oncology, 14, 1030–1042.Google Scholar
  77. Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health? Psychological Bulletin, 131(6), 925–971. doi: 10.1037/0033-2909.131.6.925.Google Scholar
  78. Ronen, T., & Seeman, A. (2007). Subjective well-being of adolescents in boarding schools under threat of war. Journal of Traumatic Stress, 20, 1053–1062.Google Scholar
  79. Saloviita, T., Itälinna, M., & Leinonen, E. (2003). Explaining the parental stress of fathers and mothers caring for a child with intellectual disability: A double ABCX model. Journal of Intellectual Disability Research, 47, 300–312.Google Scholar
  80. Schubert, C. C., Boustani, M., Callahan, C. M., Perkins, A. J., Hui, S., & Hendrie, H. C. (2008). Acute care utilization by dementia caregivers within urban primary care practices. Journal of General Internal Medicine, 23, 1736–1740.Google Scholar
  81. Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: The caregiver health effects study. Journal of the American Medical Association, 282, 2215–2219.Google Scholar
  82. Schulz, R., Hebert, R. S., Dew, M. A., Brown, S. L., Scheier, M. F., Beach, S. R., et al. (2007). Patient suffering and caregiver compassion: New opportunities for research, practice, and policy. The Gerontologist, 47, 1–13.Google Scholar
  83. Seligman, M. E. P. (2002). Authentic happiness. New York: Free Press.Google Scholar
  84. Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410–421.Google Scholar
  85. Shachar, K. (2005). Links between stress, positive and negative affect, and life satisfaction among teachers in special education schools (Unpublished master’s thesis). Tel-Aviv University, Israel. [Hebrew].Google Scholar
  86. Shmotkin, D. (1998). Declarative and differential aspects of subjective well being and implications of mental health in later life. In J. Lomranz (Ed.), Handbook of aging and mental health: An integrative approach (pp. 15–43). New York: Plenum.Google Scholar
  87. Shmotkin, D., & Lomranz, J. (1998). Subjective well-being among holocaust survivors: An examination of overlooked differentiations. Journal of Personality and Social Psychology, 75, 141–155.Google Scholar
  88. Solomon, Z., & Dekel, R. (2007). Posttraumatic stress disorder and posttraumatic growth among Israeli ex-POWs. Journal of Traumatic Stress, 20, 303–312.Google Scholar
  89. Sorensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. Gerontologist, 42, 356–372.Google Scholar
  90. Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161–1173.Google Scholar
  91. Taylor, S. E., & Armor, D. A. (1996). Positive illusions and coping with adversity. Journal of Personality, 64, 873–898. doi: 10.1111/j.1467-6494.1996.tb00947.x.Google Scholar
  92. Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage.Google Scholar
  93. Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471.Google Scholar
  94. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18. doi: 10.1207/s15327965pli150101.Google Scholar
  95. Tedeschi, R. G., & Calhoun, L. G. (2006). Expert companions: Posttraumatic growth in clinical practice. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth (pp. 291–310). Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  96. Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? [Extra issue]. Journal of Health and Social Behavior, 35, 53–79.Google Scholar
  97. Thompson, S. C. (1985). Finding positive meaning in a stressful event and coping. Basic and Applied Social Psychology, 6, 279–295.Google Scholar
  98. Updegraff, J. A., Taylor, S. E., Kemeny, M. E., & Wyatt, G. E. (2002). Positive and negative effects of HIV infection in women with low socioeconomic resources. Personality and Social Psychology Bulletin, 28, 382–394.Google Scholar
  99. Veenhoven, R. (1991). Question on happiness: Classical topics, modern answers, blind spots. In F. Strack, M. Argyle, & N. Schwarz (Eds.), Subjective well-being: An interdisciplinary perspective (pp. 7–26). Oxford, England: Pergamon.Google Scholar
  100. Vitaliano, P. P., Yi, J., Phillips, P. E. M., Escheverria, D., Young, H., & Siegler, I. C. (2005). Psychophysiological mediators of caregiver stress and differential cognitive decline. Psychology and Aging, 3, 402–411.Google Scholar
  101. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.Google Scholar
  102. Weiss, T. (2002). Posttraumatic growth in women with breast cancer and their husbands: An intersubjective validation study. Journal of Psychosocial Oncology, 20, 65–80.Google Scholar
  103. Weiss, T. (2004). Correlates of posttraumatic growth in married breast cancer survivors. Journal of Social and Clinical Psychology, 23(5), 733–746.Google Scholar
  104. Woodward, C., & Joseph, J. (2003). Positive change processes and post-traumatic growth in people who have experienced childhood abuse: Understanding vehicles of change. Psychology and Psychotherapy: Theory, Research and Practice, 76, 267–283.Google Scholar
  105. Zautra, A., & Reich, J. W. (1983). Life event and perception of life quality development in two factor approach. Journal of Community Psychology, 11, 121–132.Google Scholar

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© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  1. 1.Bob Shapell School of Social WorkTel-Aviv UniversityRamat AvivIsrael
  2. 2.Social Work DepartmentReuth Medical CenterTel-AvivIsrael

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