Christopher G. Davis

Searching for meaning in loss: are clinical assumptions correct.

Three assumptions guiding research and clinical intervention strategies for people coping with sudden, traumatic loss are that (a) people confronting such losses inevitably search for meaning, (b) over time most are able to find meaning and put the issue aside, and (c) finding meaning is critical for adjustment or healing. We review existing empirical research that addresses these assumptions and present evidence from a study of 124 parents coping with the death of their infant and a study of 93 adults coping with the loss of their spouse or child to a motor vehicle accident. Results of these studies indicate that (a) a significant subset of individuals do not search for meaning and yet appear relatively well-adjusted to their loss; (b) less than half of the respondents in each of these samples report finding any meaning in their loss, even more than a year after the event; and (c) those who find meaning, although better adjusted than those who search but are unable to find meaning, do not put the issue of meaning aside and move on. Rather, they continue to pursue the issue of meaning as fervently as those who search but do not find meaning. Implications for both research and clinical intervention are discussed.Three assumptions guiding research and clinical intervention strategies for people coping with sudden, traumatic loss are that (a) people confronting such losses inevitably search for meaning, (b) over time most are able to find meaning and put the issue aside, and (c) finding meaning is critical for adjustment or healing. We review existing empirical research that addresses these assumptions and present evidence from a study of 124 parents coping with the death of their infant and a study of 93 adults coping with the loss of their spouse or child to a motor vehicle accident. Results of these studies indicate that (a) a significant subset of individuals do not search for meaning and yet appear relatively well-adjusted to their loss; (b) less than half of the respondents in each of these samples report finding any meaning in their loss, even more than a year after the event; and (c) those who find meaning, although better adjusted than those who search but are unable to find meaning, do not put the issue of meaning aside and move on. Rather, they continue to pursue the issue of meaning as fervently as those who search but do not find meaning. Implications for both research and clinical intervention are discussed.

Social desirability biases in self-reported alcohol consumption and harms

AIMS Self-reports remain the most common means of assessing alcohol consumption despite concern for their validity. The objective of this research is to assess the extent to which social desirability biases relate to self-reported consumption, hazardous use, and harms. METHODS In each of two studies presented, undergraduate students (N=391 and N=177) who reported that they had consumed alcohol in the past year completed online confidential surveys. RESULTS Both studies show consistent associations between impression management bias and self-reported consumption such that high impression managers report 20 to 33% less consumption and are about 50% less likely to report risky drinking. No significant correlations involving consumption were found for self-deception bias. Study 2 also indicated that high impression managers report 30-50% fewer acute harms following a drinking episode, and that these effects are maintained after controlling statistically for trait impulsivity/constraint. CONCLUSIONS Impression management bias represents a significant threat to the validity of self-reported alcohol use and harms. Such bias may lead to misspecification of models and under-estimates of harmful or hazardous use.

The Undoing of Traumatic Life Events

Counterfactuals generated by victims of traumatic events were examined to elucidate their significance for the coping process. In Study 1, respondents were interviewed 4-7 years after the loss of their spouse or child in a motor vehicle accident. In Study 2, respondents were interviewed at 3 weeks and 18 months following the death of their child from Sudden Infant Death Syndrome. Across both studies, (a) counterfactuals were commonly reported; (b) the focus of counterfactuals was typically on ones own (in)actions, rather than on the behavior of others; (c) the more frequently respondents were undoing the event, the more distress they reported; and (d) this relation held after controlling for more general ruminations. These field studies demonstrate that even in situations that lack the highly mutable circumstances described in scenario research, people coping with traumatic events appear unhindered in their ability to generate counterfactuals. Theoretical implications, with an emphasis on field studies of undoing, are discussed.

Social capital, health and life satisfaction in 50 countries.

We explored links between social capital and self-rated health and life satisfaction in a diverse sample of rich and developing countries. A four-factor measure of social capital was developed using data on 69,725 adults in 50 countries that were collected in the World Values Survey. Multilevel analyses showed links between country social capital and health and life satisfaction. However, cross-level interactions indicated that the benefits of social capital were greater in women than men, in older adults and in more trusting, affiliated individuals. Social inequalities in the contributions of social capital to population health are worthy of further study.

Learning to live with what you can't rise above: control beliefs, symptom control, and adjustment to tinnitus.

The relations between 3 types of perceived control, symptom severity, and 2 adaptational outcomes, depressive symptoms and psychological well-being, were examined in a sample of 319 people with tinnitus. Consistent with previous studies of control and adjustment to chronic health conditions, general health and symptom control were associated with better psychological adjustment, and retrospective control was associated with worse psychological adjustment. Only symptom control emerged as a significant moderator in the symptom severity-adjustment relationship, such that stronger beliefs in ones ability to control symptoms were most strongly associated with better adjustment among those with more severe tinnitus symptoms. These findings were consistent with coping perspectives and cognitive adaptation theory and suggest that symptom-related perceptions of control may be an effective coping resource to nurture in chronic health contexts with severe symptoms.

Profiles of Posttraumatic Growth Following an Unjust Loss

The dominant model of posttraumatic growth (PTG) suggests that growth is precipitated by significant challenges to ones identity or to core assumptions that give ones life meaning, and develops as one goes through meaning-making or schema reconstruction processes. Other perspectives suggest, however, that such growth occurs by other means. We use a numerically aided phenomenological approach to elucidate common profiles of growth in a sample of 52 adults who lost a loved one in a traumatic mine explosion 8 years earlier. Of the three clusters extracted, 1 captured the essence of the PTG model, including threat to sense of self, meaning-making, and personal growth; 1 featured an inability to find meaning and an absence of growth; and 1 featured minimal meaning threat with modest growth. Those most likely to report PTG interpreted the experience as threat to self, with growth coming from development of new self-understanding. The data suggest that a better understanding of the processes of PTG may be realized by taking a more refined approach to the assessment of loss and growth, and by drawing distinctions between personal growth and benefits.

The process of re-engagement in personally valued activities during the two years following stroke

Purpose: Engagement in valued activities is often difficult for people who have experienced stroke. A deeper understanding of the process of re-engagement in personally valued activities would be helpful to those designing interventions to address participation post-stroke. Method: Six community-dwelling individuals recovering from a first stroke were interviewed at 6, 9, 12, 18 and 24 months post-stroke. A grounded theory approach was used to construct a substantive theory of re-engagement in valued activities during this period. Results: Two core concepts, social connection and being in charge were identified. Both led to activity engagement and risk taking to test abilities. These led to lowering of current expectations and activity adaptation which supported hope for recovery and further testing. Alternatively, difficulties perceived to be related to ageing led to disengagement. Conclusions: Rehabilitation practice that addresses and supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke. Implications for Rehabilitation This qualitative study shows that the process of re-engagement in valued activities during the 2 years following stroke was constructed around two core concepts: social connection and being in charge. Rehabilitation practice that supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke.

Financial strain, social capital, and perceived health during economic recession: a longitudinal survey in rural Canada

Although the health consequences of financial strain are well documented, less is understood about the health-protective role of social capital. Social capital refers to a sense of community embeddedness, which is in part reflected by group membership, civic participation, and perceptions of trust, cohesion, and engagement. We investigated whether perceptions of social capital moderate the relation between financial strain and health, both mental and physical. This longitudinal study surveyed adults in two communities in rural Ontario where significant job losses recently occurred. Data were collected on financial strain, social capital, perceived stress, symptoms of anxiety and depression, and physical health on three occasions over 18 months (Ns = 355, 317, and 300). As expected, financial strain positively related to perceived stress, poor physical health and symptoms of anxiety and depression, whereas social capital related to less stress, better physical health, and fewer symptoms of anxiety and depression. Effects of financial strain on perceived stress and depressive symptoms were moderated by social capital such that financial strain related more closely to perceived stress and depressive symptoms when social capital was lower. The findings underscore the health-protective role of community associations among adults during difficult economic times.

Meaning-making following spinal cord injury: Individual differences and within-person change.

OBJECTIVE Several studies of people coping with trauma or loss suggest that finding meaning in ones experience predicts better adjustment. However, these studies assume that meaning is a stable individual-difference construct. We assess the temporal stability of searching for and finding meaning in a sample of people with spinal cord injury (SCI), and test the effect of change in searching and finding meaning on depressive affect, subjective well-being (SWB), and perceived growth. METHOD Sixty-seven adults with SCI were interviewed on 3 occasions over the first 13 months of their injury. RESULTS Searching for and finding meaning are moderately stable over time. Multilevel analyses indicated that in addition to between-person effects of searching for and finding meaning on depressive symptoms and well-being, there was also evidence of within-person effects of searching for and finding meaning, such that more frequent searching was associated declines in adjustment, whereas increases in found meaning were associated with improved adjustment. Finding meaning, at both the between-person and within-person levels, was associated with greater perceived growth, but such growth was not associated with depressive symptoms or SWB. CONCLUSIONS The within-person analyses demonstrate that meaning-making is a process that is not necessarily linear yet is important for understanding the process of adaptation for many people coping with SCI.

Participation and Well-Being Poststroke: Evidence of Reciprocal Effects

OBJECTIVE To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke. DESIGN Prospective cohort study. SETTING Community. PARTICIPANTS An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income. RESULTS Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment. CONCLUSIONS Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.