Academic journal article Health and Social Work

The Sun Always Comes out after It Rains: Understanding Posttraumatic Growth in HIV Caregivers

Academic journal article Health and Social Work

The Sun Always Comes out after It Rains: Understanding Posttraumatic Growth in HIV Caregivers

Article excerpt

Coping theory and research have long focused on dealing with negative outcomes. Historically, little or no attention has been paid to possible positive outcomes. However, a growing body of literature has indicated that individuals may experience certain benefits from stressful life events. In recent years, various names have been suggested for the occurrence of benefits from adversity. It has been referred to as "posttraumatic growth" (Tedeschi & Calhoun, 1995; Tedeschi, Park, & Calhoun, 1998), "stress-related growth" (Park, Cohen, & Murch, 1996), and "positive by-products" (McMillen, 1999; McMillen & Cook, 2003). Similarly, resilience has been defined as the ability to adapt to, cope with, and even be strengthened by adverse circumstances (Masten, Best, & Garmezy, 1990; Scannapieco & Jackson, 1996).Yet the concept of growth goes beyond resilience in that it encompasses thriving: a gain that surpasses a return to the prestressful state (Ickovics & Park, 1998). People have been observed to benefit from experiences as diverse as natural disasters (Thompson, 1985), war (Aldwin, Levenson, & Spiro, 1994; Elder & Clipp, 1989), disability (Dunn, 1994), rape (Burt & Katz, 1987), incest (Silver, Boon, & Stones, 1983), and bereavement (Calhoun & Tedeschi, 1989; Frantz, Trolley, & Farrell, 1998; Kessler, 1987; Lehman et al., 1993).

Caregiving has been widely acknowledged as a stressful experience (Gignac & Gottlieb, 1997; Gottlieb & Gignac, 1996; Schulz, Visintainer, & Williamson, 1990; Zarit, 1989). In the literature, considerable attention has been given to the burden or distress that is experienced by caregivers (Hooker, Monahan, Shifren, & Hutchinson, 1992: Pearson, Verma, & Nellett, 1988; Pruchno & Resch, 1989; Stephens, Ogrocki, & Kinney, 1991 ; Zarit, Reever, & Bach-Peterson, 1980). Recently, however, the positive aspects of general caregiving have been gaining attention. Kramer (1997) called for the incorporation of positive aspects of caregiving into theories of caregiver adaptation. Cohen and associates (2002) investigated the positive aspects of caregiving in 289 Canadian caregivers. They found that positive feelings about caregiving were associated with less depression, lower perceptions of burden, and better perceived health.

In a qualitative study with 23 caregivers, Tebb (1994) found that caregivers identified feelings of being needed and useful, which gave meaning to their lives as caregivers and allowed them to tolerate their difficult circumstances. The meaning that is derived in the coping process is crucial, especially in chronically stressful situations (Gottlieb, 1997). Meaning in caregiving, or the sense that people make of their caregiving experiences, has also been explored with caregivers of frail older adults (Noonan & Tennstedt, 1997). It was one of many factors contributing to caregiver well-being. Higher levels of meaning in caregiving indicated lower levels of depression and higher stir-esteem.

Caregiving in the context of AIDS is particularly stressful. The stigma associated with the disease (Herek & Glunt, 1988; Powell-Cope & Brown, 1992) and the lived experience of losing friends. acquaintances, and family to HIV disease make the situation additionally traumatic (Klein, 1998; Nord, 1997; Ryan, Hamel, & Cho, 1998). Although the literature on AIDS caregiving and bereavement is scarce, especially studies that investigate positive outcomes, there is some indication that caregivers grow from the experience (Folkman, 1997; Garfield, 1995; Moskowitz, Folkman, Collette, & Vittinghoff, 1996; Viney, Crooks, Walker, & Henry, 1991). In a seven-year longitudinal study, positive meaning from caregiving was found to be an important mediator ill experiencing depression by gay men caring for partners with AIDS (Folkman, Chesney, Collette, Boccellari, & Cooke, 1996).

THEORETICAL FRAMEWORK ON STRESS AND COPING

This research is part of the paradigm shift to incorporate positive aspects of coping; it is grounded in the theoretical framework of stress and coping as proposed by Folkman (1997). …

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