Discussion
The first hypothesis was supported, as received social support was directly, positively related to the global PTG score at the one-year follow-up. Received social support has been shown to be a PTG-promoting factor in the HIV infected sample (Cieślak et al.,
2009), as well as in many non-HIV samples (Nenova
2013). In particular, Cieślak et al. (
2009) found that received social support was positively associated with one PTG subscale (i.e. relating to others) and these authors argued that they examined the role of received support only 2 months prior to the study, so perhaps the significance of received support for the global PTG score appears over a longer period of time. Likewise, also in our study received social support was directly, positively associated with PTG score at the one-year follow-up. Finally, the model offered evidence that perceived support and need for support mediated the relationship between received support and stress coping. According to Tedeschi and Calhoun (
2004), the degree of perceived support and the need for support, which are displayed in the intensity of support seeking, can facilitate the use of more adaptive stress coping strategies. In particular, Peterson et al. (
2011) observed that social support may enhance various stress coping strategies, thus improving well-being among PLWH. Specifically, perceived support led to a lower level of substance use among participants, which corresponds with the findings of Rothman et al. (
2008), who observed that drug use were related to dissatisfaction in perceived social support among PLWH.
The second hypothesis was not supported. On one hand, a negative link between return to religion as a meaning-focused coping strategy (covariance) was observed and, at the same time, no association between positive re-evaluation as a meaning-focused coping strategy and the global PTG score among was found the study sample. Additionally, there were no direct links between avoidance coping (substance use) and the global PTG score among participants. The negative relationship between return to religion and the global PTG score was an intriguing result and can be explained in two ways. First, some authors highlighted that in certain situations religious coping may not only be unrelated to PTG but also hinder growth after trauma, when a person lays the blame and responsibility for his or her disease on God (or some other force majeure), which strengthens passivity and contributes to giving up on medical treatment (Pargament,
2007). Wanyama et al. (
2007) showed that religious beliefs about HIV may cause fatalistic attitudes and resignation from treatment. Furthermore, Zou et al. (
2009) observed that moral connotations usually associated with HIV infection can turn the religious community into a stigmatizing atmosphere for PLWH, which can lead them to withdraw from such a community. Conversely, the aforementioned result may be understood to indicate that receiving support in PLWH may have two, separate, positive consequences: an increase in the level of PTG or an increase in the intensity of return to religion, mediated by perceived support and need for support (see Table
1; Fig.
2). Perhaps those PLWH who engage in religious coping may not experience growth while those who experience growth are not interested in searching for relief in religion. Nevertheless, this latter explanation requires further study. In addition, the lack of association between positive-re-evaluation and PTG among the study sample proved that this coping strategy may not necessarily be important for PTG promotion, especially taking into account that the level of positive re-evaluation decreased over 1 year among participants. Even so, this needs further investigation. Finally, the lack of a direct relationship between substance use as an avoidance coping strategy and the global PTG score can likely be attributed to perceived support, which was negatively related to this stress coping strategy among participants.
The last hypothesis was supported, as resilience as a personality trait, in the first assessment, was positively related to the global PTG score in the first assessment. Likewise, the level of resilience in the second assessment was also positively related to the global PTG score in the second assessment. Interestingly, resilience level in the first assessment was negatively related to the global PTG score in the second assessment, while the global PTG score in the first assessment was controlled for, which means that participants with a higher level of resilience in the first assessment experienced a smaller increase in PTG between the two assessments. Moreover, this is not due to a ceiling effect, because there was only one participant with the highest possible PTG score in the second assessment, which is 105 points.
This result corresponds with those of other studies indicating that resilience facilitates the probability of PTG in various populations after traumatic events (Bensimon,
2012). Murphy and Hevey (
2013) showed that resilience was positively associated only with outcomes in the domains of personal strength and appreciation of life. According to Walsch (
2007), resilient people are capable of rebounding from traumatic or highly stressful events and adapt to change due to changes in cognitive schemas, which are similar to those observed in PTG. In addition, resilience is closely related to other personality factors, which are positively related to PTG, such as sense of coherence, self-efficacy or optimism (Bensimon,
2012). The role of this latter variable (i.e. optimism in PTG promotion among PLWH) was proven by Milam (
2006) in a longitudinal study.
No significant relationship between the level of PTSS and the global level of PTG was found among participants. Previous research has not reached a consensus on the link between PTG and PTSS. While Frazier et al. (
2001) observed a negative relationship between PTG and PTSS. Conversely, Tedeschi and Calhoun (
1996) found that higher level of PTSS is inevitable to facilitate growth after trauma. The positive link between PTG and PTSS was observed in HIV infected sample (Cieślak et al.,
2009). In particular, Rzeszutek et al. (
2016) in a cross-sectional study found a positive association between PTG and PTSS, but only among HIV infected women. In addition, Kleim and Ehlers (
2009) wrote about curvilinear relationship between this constructs PTG and PTSD. Furthermore, there are studies highlighting the lack of a significant association between PTG and PTSS (see, Salsman et al.,
2009), which was proven in this study.
There was also no significant relationship between the participants’ age and HIV infection duration and the global PTG score among participants. Studies on the link between age and PTG are equivocal. Some authors found a higher intensity of PTG among younger people (Helgeson et al.,
2006). Conversely, other studies showed that older people, facing the imminence of death, can have a greater sense of meaning and openness to spiritual issues (Karanci & Erkam,
2007). Similarly, inconsistent findings can be found in the literature regarding the link between the amount of time since a traumatic event and PTG. Frazier et al. (
2001) observed a negative correlation between PTG and time since a sexual assault. Conversely, Park and Fenster (
2004) found that the longer the period after a cancer diagnosis, the higher the intensity of PTG. Furthermore, Prati and Pietrantoni (
2009) in a meta-analysis, underlined that the time since trauma is not a significant moderator of the link between personal (optimism, stress coping) and social resources (social support) and PTG in many samples after trauma. The lack of an association between HIV infection duration and PTG in the study sample could indicate that HIV disease stage is not related to growth. Substantial progress in antiretroviral therapy has led to a decrease in HIV-related mortality in the last decade, and many authors now perceive HIV infection more as a chronic rather than terminal illness (Deeks et al.,
2013). Siegel and Shrimshaw (2005) underlined that the most critical moment for PLWH is the moment of being diagnosed with HIV, which may result in modifications in the individual’s current beliefs and cognitive schemas, comprising the core elements of PTG. Nevertheless, participants had various lengths of HIV infection, which may also explain the lack of association between HIV infection duration and PTG in this study.
Finally, it is worth mentioning that this study may be important for Polish HIV infected individuals, as each year the number of new HIV infections in Poland increases by 13–14% (Supreme Audit Office,
2015). In addition, HIV education and prevention in Poland remain at a relatively poor level. Particularly, the majority of the funds from the National Programme for Preventing HIV Infections and Combating AIDS is spent on treatment, and not on prevention and education, which is responsible for that increasing number recently infected individuals in Poland do not know about their HIV-positive status. Furthermore, high levels of HIV-related stigma and discrimination may be still observed in Poland and the access to mental health care for HIV/AIDS population is rather scarce (Skonieczna,
2013). In the light of aforementioned factors, continuing research on psychological aspects of HIV/AIDS in Poland, including research on PTG is fully justified.