Growing Forward: Exploring Post-Traumatic Growth and Trait Resilience Following the COVID-19 Pandemic in England

Abstract

The COVID-19 pandemic presented many potentially traumatic circumstances. Research continues to investigate pandemic-related Post-traumatic Growth (PTG). However, most studies fail to fulfil the parameters of PTG whereby a triggering event must be of seismic intensity and have ceased before PTG can manifest, producing significant validity and reliability issues. The relationships between PTG, trait resilience and fear are also under-researched, particularly in circumstances where the parameters of PTG are met. This study examined the relationship between PTG, COVID-19-related fear and trait resilience. Participants (n = 229) completed an online questionnaire incorporating the Post-Traumatic Growth Inventory and the Connor–Davidson Resilience Scale. The sample participants were moderately traumatised with moderate–low PTG (M = 50.85). Participants reported greater levels of PTG compared to participants from pre-COVID studies, notably in relation to the constructs of Relating to Other (d = 0.29), New Possibilities (d = 0.47), Personal Strength (d = 0.39), and Spiritual Change (d = 0.29). Higher levels of resilience (B = 0.48) and COVID-19-related fear (B = 0.16) were associated with greater overall PTG. Younger participants also reported greater levels of PTG (B = −0.29). The findings advance current knowledge regarding the potential relationship between fear and PTG and demonstrate that trait resilience is a promotional factor, presenting opportunity for future intervention formulation. However, reform is required within the PTG literature pool. Future research investigating PTG must reach both parameters. In circumstances where this is impossible, research concerning newfound positive cognition during adverse circumstances should be re-explored as Post-Adversarial Appreciation (PAA) to maintain validity.

1. Introduction

1.1. The COVID-19 Pandemic in England

The COVID-19 pandemic constituted an unprecedented global public health threat [1]. In response to rapidly increased infection rates, England entered its first nationwide lockdown on 23 March 2020 [2]. Lockdown and social distancing measures included the closure of schools [3] and public facilities [4], significantly restricted healthcare access and prevented most in-person social interactions [5,6]. Restrictions associated with the COVID-19 pandemic in England continued for just under two years, with all local lockdowns, service closures and travel bans being formally lifted on 24 February 2022 [7]. Despite globally saving lives [8], lockdowns and other resulting changes resulted in a cascade of novel, interconnected implications and issues [9], which undoubtedly impacted those who lived within them [10].

1.2. Post-Traumatic Growth and the COVID-19 Pandemic

It is possible to experience positive outcomes following traumatic events, most frequently referred to as post-traumatic growth (PTG) [11]. PTG describes the positive psychological changes that can sometimes follow traumatic or equivalently seismic events, including improved self-perception, relationships, perceived life purpose and wellbeing [12]. PTG has shown a positive relationship with trauma, meaning increased trauma intensity and occurrence can lead to higher levels of PTG [13].

Research regarding PTG and the COVID-19 pandemic spans from early 2020 to the present day. Across the temporal span of the COVID-19-PTG literature pool, authors have continually (and often prospectively) claimed the pandemic and its associated implications such as lockdowns as either potentially [14,15] or certainly traumatic [16]. Such claims have led to a significant and continued research interest regarding PTG and COVID-19, now persisting for several years post-pandemic, with new studies continuing to be published [17,18,19].

Occurrences of PTG have been widely explored during the COVID-19 pandemic [20]. Unsurprisingly, particular interest was taken in healthcare staff who were thought to have been exposed to the ‘most traumatic’ of experiences [21], including harsh working conditions, lack of protective equipment and exposure to continuous distressing images and death [22]. Yet despite frequent frontline samples, many of the PTG studies during the pandemic reported an overall moderate to low level of PTG globally [23,24,25]. Results often fell short of predictions, e.g., [26] and surprisingly diverged from previous research following traumatic events of similar scale [27]. Based upon this preliminary research, it could be suggested that little PTG took place in relation to the COVID-19 pandemic [28].

However, recent research has called into question the modern operationalisation of PTG [29]; including where a vast number of studies fail to meet the obligatory parameters of PTG, constituting invalid and unreliable results [30]. It is clearly stated that specific parameters must be met for PTG to take place [31,32]. Firstly, an individual must experience a traumatic or ‘highly challenging’ event [33]. To reach this seismic threshold, an event must shatter the previous views and beliefs held by the individual, causing them turmoil [34] and life-altering challenges to how they view the world [32]. This definition means that not all negative, ‘challenging’, stressful, or distressing experiences are sufficiently disturbing to elicit PTG [35].

Therefore, when studying PTG, investigation must take place to either confirm that the selected event is certainly traumatic or at least experienced as sufficiently seismic by those included in the chosen sample [36]. However, most studies within the COVID-19 PTG literature pool have failed, and continue to fail, to establish pandemic experiences as sufficiently traumatic or individually impactful to a transformational degree. Instead, many studies continue to rely upon probable trauma [37]. This can be seen best via the lack of assessment of individual traumatic COVID-19 experiences [38], the generalised nature of many samples [39], and some occasions of outright, unevidenced claims [9,16]. Whilst some researchers during the early pandemic argued that the mass classification of the pandemic as traumatic was a valid assumption [40], this was not supported as research developed. For example, when trauma levels were assessed within some PTG research during the pandemic, levels appeared significantly low, even within samples which may have been considered the most likely to be traumatised, such as frontline nurses [26].

Throughout the COVID-19 PTG literature pool, entire samples are commonly assessed for PTG when trauma has been established as likely too low to elicit PTG [41] or more commonly not established at all beyond assumption [42,43,44], causing significant validity and reliability issues [41]. This assumption of universal, guaranteed COVID-19-related trauma also shows a lack of consideration for the potential range of diverse pandemic experiences and their likely differing intensities [45]. It is likely that any physical and subsequent psychological impacts of COVID-19 will have varied greatly, depending on individual characteristics [46,47]. To consider all potential circumstances the same is invalid. Whilst a significant amount of research does highlight numerous negative experiences connected to COVID-19 [48], some instead present pandemic circumstances as neutral or even beneficial [49]. Globally, many people may have enjoyed or benefitted from the pandemic [50]. Therefore, as the universal assumption of COVID-19-related trauma has been demonstrated as inappropriate, further research which meets this criterion is urgently required, to bring clarity to how researchers understand COVID-19-related PTG moving forward. Exploratory research identifying specific traumas or stressors relating to the COVID-19 pandemic in England would also be of benefit to both provide evidence of COVID-19-related traumas and help improve understanding of what exactly may be eliciting PTG.

Next, most studies measuring PTG in relation to the COVID-19 pandemic took place before all pandemic restrictions were lifted [20], with some data collected as early as April 2020 [51]. It is explicitly stated within PTG theory that PTG only manifests in the aftermath of traumatic events, not during them [32,52,53]. For PTG to take place (and thus be measured), sufficient time must have passed since the traumatic event took place [54]. This is to allow the individual to move past the initial psychological survival phase which takes place during and directly after such an event, giving way to a pathway of rumination, distress management and self-analysis which results in the reconstruction of their fundamental schemas for acceptance of their new reality [32,55]. Therefore, the majority of COVID-19-related PTG studies [35] are invalid and unreliable as they take place before the traumatic event has finished, meaning we cannot be sure that such studies truly and accurately inform us of COVID-19 pandemic-related PTG.

These ongoing theoretical and methodological issues highlight that despite the plethora of studies within this literature pool, we in fact have a low level of valid information regarding COVID-19-related PTG, highlighting a significant research gap. This need for novel, representative data forms a significant aim of this study: to produce PTG research regarding the COVID-19 pandemic which is valid and reliable via meeting the parameters of PTG.

1.3. PTG and Fear

Fear has been defined as a negative emotional response elicited via the overestimation of a perceived threat paired with the underestimation of the perceived benefits of action [56] and is prevalent in individuals both during and post-trauma [57]. Intense fear is commonly associated with higher levels of psychological distress and negative coping when processing traumas [58], which may have an impact on PTG [54]. Arguably, the COVID-19 pandemic was underpinned by experiences of newfound perceived threat which most people were unable to truly address on an individual level. The increased possibility of infection and potential untimely death was rife, in addition to a lack of clarity around pandemic cessation and global recovery, experiences which may have induced states of fear. It is unsurprising that COVID-19-related fear during the pandemic was reportedly common [59].

Despite the known comorbidity of trauma and fear, research regarding fear and PTG is limited and significantly varied in its results. Some research has suggested an inhibitory effect of intense fear upon PTG in some cancer patients [60], which may be due to increased subsequent psychological distress preventing individuals from moving through the required cognitive stages that result in PTG. However, intense fear has been argued as a facilitator of PTG, whereby high levels of fear may motivate a person to try to find new meaning within their circumstances and drive increased connections with others [61]. This positive relationship has been uniquely demonstrated in a small number of COVID-19 pandemic-concerned studies [61,62,63], which may provide valuable new insight regarding the cognitive drivers of PTG. At the time of writing, research regarding the relationship between fear and PTG is significantly under-investigated, identifying a need for novel research.

Furthermore, upon review, most of the papers in existence investigating fear and PTG also fail to meet the parameters of PTG, a fact which poses significant questions about their validity and reliability. Therefore, further research investigating fear whilst meeting the parameters of PTG is required to reveal accurate information regarding this relationship.

1.4. PTG and Resilience

Another key area relating to PTG is trait resilience [64]; the innate personality trait which aids individuals in continuing to function normally despite exposure to trauma [65]. Trait resilience is distinguished from the restorative mechanism of general resilience [66,67] and is regarded as distinct from PTG [68].

Whilst trait resilience does not directly promote PTG [69], greater levels may render individuals more likely to develop PTG, as they may adapt to adversity in a more effective manner [70]. Debate regarding the nature of the relationship between trait resilience and PTG persists, with research supporting both a positive relationship [71] and no relationship [72] between the two factors.

Most research indicates a positive association between trait resilience and PTG during the COVID-19 pandemic across various sample types and geographical locations [73]. Upon first inspection, this appears to provide strong evidence that greater levels of trait resilience can predict significantly greater levels of PTG in relation to the COVID-19 pandemic. However, most research investigating the relationship between trait resilience and PTG during the COVID-19 pandemic also fails to meet the parameters of PTG [61,74]. Therefore, to validly and reliably understand and evidence this potential relationship, further investigation is required via research where it is certain that PTG is taking place.

Following the numerous and significant issues present in current PTG, resilience and COVID-19 research [73], this study was designed to present new research in which the parameters of PTG could be explicitly and reliably met. This included the establishment of trauma within the sample, data collection at a time after all pandemic restrictions had been lifted, and consideration of sample stress. An English sample was selected, as at the time of study conduction, England was one of the first and only countries to be officially relieved of all COVID-19 pandemic-related restrictions.

1.5. Aims and Hypotheses

This study had three core aims. Firstly, this study aimed to identify the prevalence of different potentially traumatic experiences during the COVID-19 pandemic in England.

Secondly, following previous indicative research, this study aimed to determine whether PTG is associated with resilience [73], age [75], trauma intensity [13] and COVID-19-related fear [61,62,63]. Three predictions were made in relation to this aim:

Hypothesis 1.

Self-reported trauma regarding the COVID-19 pandemic would predict levels of PTG, such that higher reports of trauma regarding the pandemic (measured on a 10-point Likert scale) would correspond to higher PGT scores.

Hypothesis 2.

Self-reported current fear of the COVID-19 virus would predict levels of PTG, such that higher reports of current fear of the COVID-19 virus (measured on a 10-point Likert scale) would correspond to higher PGT scores.

Hypothesis 3.

Participants who score higher on trait resilience on the CD-RISC-10 will have significantly higher levels of PTG on the PTGI compared to participants who score lower for trait resilience on the CD-RISC-10.

Thirdly, this study aimed to compare PTG scores from the present sample (post-COVID-19 pandemic) with data from the early pandemic which did not reach the parameters of PTG.

Hypothesis 4.

PTG levels of participants following the COVID-19 pandemic in England will be higher than those found in previous similar-scale trauma research on COVID-19 conducted at the start of the pandemic [76], due to previous research failing to meet the parameters of PTG.

2. Materials and Methods

2.1. Sample and Design

A power analysis was carried out (using G*Power 3.1.9 [77]) to determine the minimum sample size required to inferentially test our first aim, that is, to compare PTG dimension scores across a post- and early-COVID sample (i.e., one-sample t-test). The authors opted to base their power calculation on a small effect size (d = 0.2), following previous research demonstrating weak relationships between COVID-related stress and PTG (see [78]). Based on an alpha of 0.05, the calculation indicated that a minimum sample of 156 participants was required to achieve a power of 0.8. The second aim of the study required a series of multiple regression analyses to identify predictors of PGT. Due to limited existing research testing the same set of covariates as the present study, the authors were unable to determine a reliable and realistic effect size to inform an a priori calculation. In lieu of this, the authors followed the recommendation of [79] (n > 50 + 8 [n predictors]) which suggested a minimum requirement of 90 participants.

A cross-sectional survey design was used where participants completed an online survey (via Google Forms) between July to October 2022. Using an opportunity sampling approach that involved circulating weblinks to the survey on social media and internet groups as well as the lead author’s university student network, 230 responses were collected. After the removal of one participant due to failing to respond to the questions, the final dataset consisted of 229 respondents (mean age = 31.79, std dev = 14.03).

2.2. Measures

2.2.1. Demographic and Pandemic Experiences

A demographic questionnaire measuring participants’ age, gender, ethnicity, and employment status was devised by the research team.

In response to a lack of available questionnaires comprehensively measuring the common forms of traumatic experiences pertinent to the COVID-19 pandemic, a list of 35 potentially traumatic events connected to the COVID-19 pandemic were devised. The items were devised based on a review of news articles and empirical research on COVID-related stressors, see [80,81]. Participants were instructed to select events which they experienced. This measure was used to aid identifying traumatic experiences among participants, rather than for psychometric testing, thus factor analysis of the items was not performed.

Following this, participants were asked to indicate their levels of trauma (“How traumatic did you find the COVID-19 pandemic?”) and stress (“How stressful did you find the COVID-19 pandemic?”) during the pandemic, using a 10-point Likert scale (1 = no trauma/stress at all, 10 = extremely traumatic/stressful). To ensure response validity, participants were first presented with a definition of trauma corresponding to the shattering of pre-held personal assumptions as outlined by [82]. They were also asked to indicate their level of fear towards the COVID-19 virus at the time of survey completion (“What is your current level of fear for the COVID-19 virus?”) on a 10-point Likert scale (1 = no fear at all, 10 = extremely fearful).

2.2.2. The Post-Traumatic Growth Inventory (PGTI)

The PTGI [83] comprises 21 statements, presented alongside a five-point Likert-style scale ranging from 1 (I did not experience this change) to 5 (I experienced this change to a very great degree). Statements cover five domains of PTG including Relating to Others (e.g., ‘I am more willing to express my emotions’), New Possibilities (e.g., ‘I developed new interests’), Personal Strength (e.g., ‘I know better that I can handle difficulties’), Spiritual Changes (e.g., ‘I have a better understanding of spiritual matters’) and greater Appreciation of Life (e.g., ‘I can better appreciate each day’). Total scores range from 0–105, with higher mean scores indicating an overall higher degree of PTG. Mean scores can also be separately calculated per domain, to allow identification of specific areas of growth.

The PTGI’s introduction and rating scale were tailored to ensure answers were valid and linked to the study’s aims. Participants were asked to indicate for each of the provided statements the degree to which each change occurred in their life because of the COVID-19 pandemic.

The PTG-I was tested for internal consistency within the current data set. Good internal consistency was demonstrated across all domains and overall score. The Cronbach’s Alpha scores were as follows: Appreciation of Life α = 0.82, Relating to Others α = 0.89, New Possibilities α = 0.83, Personal Strength α = 0.87, Spiritual Change = 0.71, Total score α = 0.95.

2.2.3. Connor-Davidson Resilience Scale (CD-RISC-10)

The CD-RISC-10 is used to assess participant’s abilities to cope well with adversity or personal challenges [84]. The scale comprises 10 statements, presented alongside a Likert-style scale ranging from 0 (Not true at all) to 4 (True nearly all the time). Participants are asked to indicate how much they agree with the statements over the last month. Total scores range from 0–40, with higher scores indicating higher levels of personal resilience. The unidimensional scale demonstrated strong internal reliability (α = 0.91).

2.3. Procedure

The present study was designed in accordance with the British Psychological Society’s requirements for ethical practice [85] and ethical approval was granted by the lead author’s research institutional research ethics committee. After providing informed consent, participants were instructed to complete a battery of questionnaires measuring demographic details, life experiences during the COVID-19 pandemic, resilience, and PTG. The survey was disseminated through two means: first, social media advertisement (e.g., Facebook) and printed posters distributed around Greater Manchester were used to distribute information about the study along with a URL link (social media) or QR code (posters) for participants to access the survey. Following this, the authors circulated the online survey at the lead author’s institution by setting up a promotional stall; QR code links to the survey were provided here for participants to access the survey via their personal electronic devices. No financial compensation was provided for participation.

2.4. Statistical Analyses

All statistical analyses were performed using SPSS^® 26.0 (IBM Corporation, Armonk NY, USA) for Windows^®. Data analyses were carried out in three stages. The first stage used frequency distributions to identify the sample’s varying traumatic experiences during the COVID-19 pandemic.

The second stage of data analysis compared the PTG scores of participants with pre-recorded scores from a pre-pandemic sample. Preliminary inspection of kurtosis (i.e., <±2; see [86]) and skewness (<±1) indices indicated that data distribution for all PTG variables were approximately normal and suitable for parametric testing. Therefore, a series of one-sample t-tests were used. Due to repeated testing, Bonferroni corrections were applied, and the alpha level was adjusted to 0.008.

In the final stage of data analysis, linear regression models were used to determine how well the selected covariates (age, resilience, trauma, stress, and fear) predicted PTG outcomes. For all regression models, preliminary analyses were conducted to ensure no violation of the assumptions of linearity, and homoscedasticity. The collinearity statistics (VIF and Tolerance) for all models indicated that multicollinearity was unlikely to be a problem (Tolerance > 0.1 and VIF > 10 for all predictors; see [79]).

3. Results

3.1. Participant Demographics

162 participants were female (70.7%), 57 were male (25%) and 10 (4.3%) identified as other (e.g., transgender and non-binary). Most participants were white (78.3%) and a considerable minority were students at the time of the study (34.8%) (see

Table 1. Sample demographics.

	Frequency (N)	Percentage (%)
Gender Identity
Female	57	24.8
Male	163	70.9
Other	10	4.3
Age
18–24	111	48.3
25–72	119	51.7
Ethnicity
White	180	78.3
Black	18	7.8
Asian	19	8.2
Mixed Background	10	4.3
Other	3	1.3
Pandemic Relationship Status
Married	52	22.6
In a relationship (not married)	75	32.6
Single	87	37.8
Divorced	8	3.5
Mixed Group	5	2.2
Prefer not to say	3	1.3
Pandemic Living Circumstances
Adult family	102	44.3
Adult family and children under 18	52	22.6
Children under 18 only	10	4.3
Roommate/friends	22	9.6
Alone	22	9.6
Other	22	9.6
Pandemic Employment Status
Working Full-Time	53	23
Student	80	34.8
Furlough	22	9.6
Unemployed	14	6.1
Self-Employed	11	4.8
Other	23	10
Pandemic Financial Circumstances
Very Uncomfortable	12	5.2
Uncomfortable	28	12.2
Neither Comfortable nor Uncomfortable	73	31.7
Comfortable	97	42.2
Very Comfortable	20	8.7

for demographic breakdown).

3.2. Participant Experiences During the Pandemic

Our first aim was to explore the prevalence and nature of different traumatic experiences during the pandemic. Results indicated that all the traumatic experience items had been experienced by at least one participant during the COVID-19 pandemic (see

Table 2. Frequency of traumatic events experienced in relation to the COVID-19 pandemic.

Traumatic Item	Frequency (N)	Percentage (%)
Changes to life plans	113	49.3
Unable to travel to see friends and/or family	104	45.4
Inability to live regular life/routine	93	40.6
Social distancing	90	39.3
Social isolation	79	34.5
Cancellations/significant changes to personal events (ie weddings, funerals, etc.)	73	31.9
Loss of control over life	72	31.4
Working from home	67	29.3
Online school/lessons (child/student)	64	27.9
Having COVID-19	61	26.6
COVID-19 isolation	51	22.3
Inability to visit loved ones in care facilities/hospital	48	21
COVID-19 testing	45	19.7
Closure of public resources	44	19.2
Living in a state of fear/unsafety	44	19.2
Loss of household income	32	14
Loss of employment	31	13.5
Attending hospital/medical care alone	31	13.5
Unable to access medical care	30	13.1
Death of a loved one due to COVID-19, who did not live with you	29	12.7
Loss of taste and smell	29	12.7
Experiences relating to COVID-19 vaccinations	26	11.4
Difficulty finding employment	25	10.9
Being clinically vulnerable	23	10
Online school/lessons (parent/teacher)	23	10
None of the above experienced/experienced as traumatic	22	9.6
Long Covid and COVID-19-related physical symptoms	21	9.2
Working during the COVID-19 pandemic (non-hospital/healthcare)	20	8.7
Lack of understanding of the COVID-19 virus and transmission	19	8.3
Missing children/grandchildren growing up	18	7.9
Living alone during lockdown(s)	17	7.4
Working during the COVID-19 pandemic (hospital/healthcare)	12	5.2
Death of a loved one due to COVID-19, who lived with you	10	4.4
Living in an unsafe home during lockdown(s)	10	4.4
Staying in hospital	5	2.2

).

The second aim of the study sought to determine whether PTG rates were greater towards the end of the pandemic compared to the start. A series of one-sample t-tests were conducted to compare the current post-COVID sample’s scores on the PTG dimensions (Relating to Others, New Possibilities, Personal Strength, Spiritual Change, Appreciation of Life, and Total PTG) against the reported scores of a separate sample from a previous study that recorded PTG during the early stages of the pandemic [76]. Descriptive and inferential values are presented in

Table 3. A comparison of PTGI mean and standard deviation scores in a sample at the start of the pandemic versus the current post-COVID sample.

	[59] n = 440	Current Study, n = 229	t Test (df = 229)	d
Relating to Others	17.23 (8.22)	15.17 (7.34)	t = −4.36, p < 0.001	0.29
New Possibilities	9.55 (5.92)	12.62 (6.34)	t = 7.18, p < 0.001	0.47
Personal Strength	9.03 (4.70)	11.14 (5.31)	t = 5.87, p < 0.001	0.39
Spiritual Change	2.19 (2.63)	3.06 (2.99)	t = 4.38 p < 0.001	0.29
Appreciation of Life	8.88 (3.89)	8.8 (3.89)	t = 0.3 p = 0.38	0.02
Total score on PTGI	47.01 (20.02)	50.85 (22.51)	t = 2.42, p = 0.008	0.16

. The findings indicated that participants from the present study (post-pandemic) reported significantly higher scores for New Possibilities, Personal Strength, Spiritual change and overall PTGI; however, for the Relating to Others dimension, participants from the current sample reported lower scores than the early pandemic sample of [76]. No significant differences were found for the Appreciation of Life dimension.

3.3. Stress, Fear, Trauma, Resilience and Age as Predictors of PTG

Results suggested that overall, participants were moderately resilient (mean = 27.43, SD = 7.65); self-reports also indicated that on average, participants found the COVID-19 pandemic in England to be moderately stressful (mean = 6.77, SD = 2.49) and traumatic (mean = 5.78, SD = 2.37) but did not feel fearful of the pandemic at the time of the survey (mean = 3.9, SD = 2.46).

The final aim sought to determine whether the aforementioned factors, along with age, were associated with PTG. For this aim, six linear regression models were tested to investigate the ability of the covariates (age, resilience, trauma, stress, and fear) in predicting PTG outcomes (Relating to Others, New Possibilities, Personal Strength, Spiritual Change, Appreciation of Life, Total PGT). Inferential properties for each model and predictor are presented in

Table 4. Multiple linear regression models for PTG dimensions.

Variables	B	SE	Β	T
Relating to Others
Age	−0.15	0.03	−0.28 ***	−4.96
Resilience	0.39	0.05	0.41 ***	7.14
Trauma	0.25	0.3	0.08	0.81
Stress	0.29	0.27	0.1	1.05
Fear	0.68	0.2	0.23 ***	3.36
New Possibilities
Age	−0.14	0.03	−0.3 ***	−5.22
Resilience	0.36	0.05	0.44 ***	7.62
Trauma	0.13	0.27	0.05	4.78
Stress	0.29	0.24	0.11	1.22
Fear	0.36	0.18	0.14 *	2.05
Personal Strength
Age	−0.09	0.02	−0.24 ***	−4.19
Resilience	0.34	0.04	0.49 ***	8.62
Trauma	0.06	0.22	0.03	0.27
Stress	0.42	0.2	0.2 *	2.14
Fear	0.17	0.15	0.08	1.15
Spiritual Change
Age	−0.03	0.01	−0.14 *	−2.27
Resilience	0.9	0.02	0.22 ***	3.5
Trauma	0.38	0.14	0.31 **	2.8
Stress	−0.24	0.12	−0.2	−1.94
Fear	0.17	0.09	0.14	1.92
Appreciation of Life
Age	−0.06	0.02	−0.21 ***	−3.65
Resilience	0.22	0.03	0.44 ***	7.55
Trauma	0.3	0.16	0.18	1.8
Stress	0.17	0.15	0.11	1.17
Fear	0.12	0.11	0.08	1.12
Total PGT
Age	−0.47	0.09	−0.29 ***	−5.2
Resilience	1.38	0.16	0.48 ***	8.58
Trauma	1.11	0.91	0.12	1.23
Stress	0.93	0.81	0.1	1.14
Fear	1.5	0.6	0.16 *	2.49

Note: * p < 0.05, ** p < 0.01, *** p < 0.001.

.

3.3.1. Relating to Others

The model for Relating to Others was statistically significant [F (5,224) = 18.94; p < 0.001; R² = 0.297], with the full model explaining 29.7% of variance in the outcome variable scores. The model suggests that being younger in age, having greater resilience and reporting greater levels of fear were associated with greater growth in the ability to relate to others (see Table 4).

3.3.2. New Possibilities

The model for New Possibilities was statistically significant [F (5,224) = 17.59; p < 0.001; R² = 0.282], with the full model explaining 28.2% of variance in the outcome variable scores. As with the previous model, the results suggest that being younger in age, having greater resilience and reporting greater levels of fear were associated with greater growth in the ability to see new possibilities (see Table 4).

3.3.3. Personal Strength

The model for Personal Strength was statistically significant [F (5,224) = 19.6; p < 0.001; R² = 0.304], with the full model explaining 30.4% of variance in the outcome variable scores. The model suggests that being younger in age, having greater resilience and experiencing stress during the pandemic were associated with greater growth in personal strength (see Table 4).

3.3.4. Spiritual Change

The model for Spiritual Change was statistically significant [F (5,224) = 6.63; p < 0.001; R² = 0.129], with the full model only explaining 12.9% of variance in the outcome variable scores. Despite a weak model fit, the results suggest that having greater resilience and experiencing trauma during the pandemic were both associated with greater reports of spiritual change (see Table 4).

3.3.5. Appreciation of Life

The model for Appreciation of Life was statistically significant [F (5,224) = 17.85; p < 0.001; R² = 0.285], with the full model explaining 28.5% of variance in the outcome variable scores. The model suggests that being younger in age and having greater resilience were associated with greater appreciation of life following the pandemic (see Table 4).

3.3.6. Total PTG

The model for Total PTG was statistically significant [F (5,224) = 22.96; p < 0.001; R² = 0.339], with the full model explaining 33.9% of variance in the outcome variable scores. The model suggests that being younger in age, having greater resilience and reporting greater levels of fear were associated with greater overall PTG (see Table 4).

4. Discussion

Overall, the level of PTG within the sample was low (M = 50.85) [87]. Levels were significantly lower than expected when compared to similar-scale disasters [88], some research from during the pandemic [42,89,90] and when considering the high populations of females within the sample [91]. Due to the great variance in results reported in studies which violate the parameters of PTG produced during the pandemic, other results can be found which are both similar [92,93] and much lower [26,94].

When looking to the domain data, greatest PTG was seen in Relating to Others (M = 15.17), New Possibilities (M = 12.62), then Personal Strength (M = 11.14). Less PTG was seen in the domain of Appreciation of Life (M = 8.8) and little PTG was seen in the domain of Spiritual Change (M = 3.06). Whilst limited studies within the COVID-19 pandemic/PTG literature pool report domain data, the same ranking can be found [16] and the top prevalence of ‘relating to others’ has been frequently reported [43,95,96]. However, elsewhere, domain rankings vary [97], and it is essential to consider that none of the studies of comparison reach both parameters of PTG, so cannot be validly or reliably compared with the results of this study.

Such domain results can be seen as fairly expected when considering the unique nature of pandemic experiences. After the cessation of the pandemic and associated social isolation, many people will have reconnected with loved ones and found a deeper appreciation of their role within their lives. Individuals will have likely had to face many new, challenging experiences and find an alternative way of living, from which they may have drawn positives. Such a plethora of potential novel occurrences likely saw people rally within themselves to cope, prompting a newfound sense of personal strength.

Whilst the lower increase in Appreciation of Life was somewhat unexpected [98] such results may be partially explained by sample demographics, as a low level of participants recorded having experienced traumatic COVID-19-related deaths during the pandemic. Contact with death experiences can drive re-evaluation of the value of one’s life [99] and thus as many of our sample did not report such experiences, this may have limited PTG within this domain. Similarly, the limited development of Spiritual Change may also be both temporally representative and indicative of the majorly white British sample included, as modern England commonly lacks religiosity [100], particularly compared to other countries included in wider pandemic-related PTG research [72,101].

Further analyses were conducted to identify factors which were associated with PTG within this sample. Being younger in age was associated with greater overall PTG, as well as with greater PTG in all domains except Spiritual Change. This is both consistent with [25] and contrary to [97] and other similar research, albeit in those where the parameters of PTG are not met.

Younger age has been associated with the greater utilisation of adaptive coping methods such as approach-orientated coping, which in turn has been associated with greater PTG [102]. Also, younger people may have had greater access to social support via digital media during the social isolation of the pandemic in comparison to older participants, a further factor associated with greater PTG [75].

Furthermore, it may also be argued that younger people in England are less likely to value faith with modern attitudes [103] which may partially explain these results. Despite this, research regarding the differences in PTG manifestation across age groups is underdeveloped. Some research does support the reduced occurrence of PTG in older samples [88]; however, such research usually references comparisons with elderly groups [25] which were under-represented within this sample, so such evidence is unlikely fully explanative. Further research is required to understand the influence of age differences upon the manifestation of PTG.

4.1. COVID-19 Pandemic-Related PTG and Trauma Intensity

Overall, whilst those who scored higher for trauma did score higher for PTG on the PTGI, trauma intensity did not predict overall PTG. Only one domain of PTG was associated with trauma, such that experiencing trauma during the pandemic was associated with Spiritual Change. However, due to the lack of predictive association with the remaining domains of PTG, the first hypothesis could not be fully supported.

Despite research suggesting that trauma intensity can significantly predict levels of PTG [70,104], discourse does persist, with numerous studies suggesting no direct relationship between the two [105,106]. Additional factors may mediate the relationship between trauma intensity and PTG levels, particularly external support factors [107]. As numerous inhibitory factors to seeking both physical and emotional support were present during the pandemic, this could somewhat explain these results [108]. Wider research also suggests that it may be the quantity of traumatic experiences rather than the intensity of traumatic experiences that positively promotes PTG [109]. This too may offer an explanation. Such unexpected results could be particularly significant when considering the current lack of accurate research investigating PTG after the pandemic and may give indication of the unique shape of PTG following such a novel, diverse adverse event. Further replication where both parameters of PTG are met would be beneficial to better understanding this.

4.2. COVID-19 Pandemic-Related PTG and COVID-19-Related Fear

Overall, greater current fear of COVID-19 was associated with greater overall PTG, supporting Hypothesis 2. This relationship corresponds to previous PTG research conducted during the COVID-19 pandemic [58,92] and some wider literature, which has shown a direct positive effect of fear upon PTG [60].

The demonstration of an association between fear of COVID-19 and PTG moderated by resilience [110], including during the pandemic [61], may help explain our results, due to the significant level of trait resilience shown within our sample. Also, greater fear has been suggested as indicative of an event having a greater seismic impact on an individual [63], the occurrence required for the manifestation of PTG, which in turn may promote further PTG.

This study also found that PTG was also associated with greater current COVID-19-related fear within the domains of New Possibilities and Relating to Others. These findings advance current knowledge regarding the relationship between COVID-19-related fear and specific domains of PTG, indicating an opportunity for future research. Such research is particularly required to understand the mechanisms behind such results as this area is underdeveloped.

It could be theorized that a greater impact to one’s assumptive beliefs regarding the benevolence of the world (which includes others around us) [55] could begin to explain the relationship between current COVID-19-related fear and the increased occurrence of Relating to Others, as specific work may need to be done to rebuild and expand beyond the damage done to these relevant core beliefs. Fear may also drive an individual to discover innovative new ways of living or methods to manage their fears, which may support the development of PTG in the domain of new possibilities. However, such ideas are preliminary and must be subject to further exploration.

The role of fear in the promotion of PTG could be partially explained within the [32] model of PTG, where rumination is said to play a strong significant role within the manifestation of PTG. Whilst research appears limited, some studies suggest that fear can lead to increased reflective rumination as a positive coping mechanism which may further support PTG development indirectly [58]. Further research is required to explore the underlying mechanisms between the demonstrated positive relationship between fear and PTG.

4.3. COVID-19 Pandemic-Related Resilience

The sample was moderately resilient, and there was an association between resilience and PTG in all domains as well as overall level of PTG, supporting the third hypothesis. This result is well-supported by the previous literature, including research conducted during the pandemic [111,112,113].

There are several possible explanations for these results. It has been suggested that possessing greater trait resilience aids in the promotion of one’s ability to function normally when exposed to trauma, which may protect such individuals from the negative implications of traumatic experiences, which in turn may better allow the processes of PTG to take place [114].

Alternatively, trait resilience has been suggested to find individuals less susceptible to event-related mental health problems such as anxiety, which can otherwise inhibit PTG [115]. Despite these theories, the exact nature of any potential causal links between trait resilience and PTG is yet unknown and requires further exploration. It is essential when replicating such research that both parameters of PTG are met to ensure valid and reliable understanding of this relationship.

Beyond the need for further process understanding, this research does provide further support for the idea that nurturing resilience may aid in the acquisition of PTG [60], which may be relevant for the formulation of interventions to support PTG development. Such interventions may be of significant use to increase the likelihood of more positive outcomes in the event of future pandemics, or in similar traumatic circumstances involving life changes and disease. Resilience-fostering efforts can also be merged with wider wellbeing interventions such as skills training programs which have been found to improve the wellbeing of individuals coming from hardship and traumatic backgrounds [116].

4.4. Change in PTG Intra- and Post-Pandemic

Overall, PTG appeared slightly higher than recorded levels at the beginning of the pandemic (47.01) to post-pandemic (50.85), supporting the third hypothesis. Domains of New Possibilities, Personal Strength, and Spiritual Change were higher post-pandemic. However, PTG in the domain of Appreciation of Life did not change from the early pandemic to post-pandemic. PTG in the domain of Relating to Others was in fact lower post-pandemic than early within the pandemic. Some researchers may argue that such results indicate that despite the ongoing adversity of the pandemic in England, the development of PTG at some point plateaued and the resulting positive outcomes even started to diminish.

Various explanations could be suggested for these results. Individual differences when considering the diversity of potential trauma experiences could somewhat explain the inconsistencies [90]. As not every participant both within and between the samples experienced the same traumatic events in relation to the pandemic, we cannot truly reliably compare these outcomes. Also, other sample characteristics such as how our sample uniquely experienced the pandemic may make some contribution. The most frequently reported traumatic experiences from this sample were ‘changes to life plans’ (n = 49.3%), the ‘inability to travel to see friends/family’ (n = 45.4%), the ‘inability to live their regular life/routine’ (n = 40.6%) and ‘social distancing’ (n = 39.3%). Although experienced as traumatic, such events may have exposed participants to new ways of living as well as potential newfound appreciation of their pre-pandemic options, driving potential PTG. The trauma of being unable to see loved ones, social distancing, and social isolation (n = 34.5%) experiences which were prevalent within this sample may also have the potential to inhibit Relating to Others due to mental and social isolation, with similar results demonstrated in veterans [117].

Such results could also be said to be in line with the illusory model of PTG, if we are to regard PTG as a coping mechanism rather than an indicator of positive cognitive change [118]. Some debate continues regarding the actuality of PTG [39], and if we were to suppose that PTG is illusory, it could be that the perceived increase in appreciation of others was utilised during the pandemic as a psychological aid when socialisation was limited, which naturally reduced when socialisation was again permitted. However, this explanation is regarded as unlikely, as measurement continued until October 2022, 8 months after the cessation of the pandemic in England. As an illusory model states PTG functions as a coping mechanism during the fact and significant time had now passed after the pandemic, one would expect to see a similar trend in all other domains.

Despite these suggestions, it is essential to recall the current inaccuracies present within the PTG literature pool regarding the parameters of PTG [20,37]. Significant effort was made to ensure the sample measured within this study reached both parameters of PTG, i.e., that they were sufficiently traumatised for PTG to manifest, and that such traumatic events had ceased at the time of study measurement.

Despite this, only around half of our sample experienced ‘high trauma’, with a similar number of participants in the earlier sample [76] experiencing PTSD (n = 50.2%). In fact, our sample demonstrated significantly higher levels of pandemic-related stress than pandemic-related trauma in relation to the pandemic. This could be seen as in line with previous research, which has suggested that stress is a strong predictor of PTG [97] or possibly presents the alternative of Stress-Related Growth (SRG) [119]. Another explanation could be the additional presence of Adversarial Growth (AG) in those who experienced lower trauma within our sample; a concept similar to PTG but which explicitly states a lower threshold of triggering adversity is required for growth [120].

However, whilst these may offer a better explanation for the results of Hypothesis 1, they cannot fully explain the results of Hypothesis 4. Despite initial classification of the early pandemic data as a representation of PTG, the results of [76] do not reach the parameters of PTG, SRG (which is frequently described as a synonym of PTG [121]) or AG [120], as this initial study took place long before the pandemic had finished. Therefore, although positive pandemic outcomes were recorded by [76], these cannot be validly utilised to measure the change of PTG over time. This more likely explains why the temporal results of Hypothesis 4 are inconsistent and suggests the need for comparison research utilising pre-pandemic samples, to best understand the impact COVID-19 had on the development of PTG.

However, the results of [76] and similar PTG research captured during the pandemic still offer significant insight regarding the positive changes of some individuals during the pandemic. Rather than representative of PTG, it is suggested that such findings are the result of a separate, novel concept labelled Post-Adversarial Appreciation (PAA) [30]: the positive increases in appreciation of oneself, others, and one’s life often observed during periods of adversity. Further research is required to explore this concept and the subsequent positive changes that can take place during traumatic/adverse events to ensure valid understanding of individual experiences, research accuracy and to ensure the development of useful support programs to ensure good mental wellbeing during times of difficulty.

4.5. Limitations and Future Research

This study utilised a cross-sectional design preventing any causal inferences. Whilst digital self-reporting allowed easier distribution, it presented several limitations, including concerns regarding the introspective ability of participants to assess personal change, social-desirability bias and hindsight bias relating to the outcomes of the pandemic. Our data included a disproportionate number of both white and female participants in comparison to males, other genders and other ethnicities, which may impact the generalizability of results. Furthermore, the CD-RISC-10 required participants to rate their agreement with the displayed statements over the last month [84]. Whilst some do regard trait resilience as an innate quality [122], it is largely accepted that resilience levels can change over time [123]. In this way, we cannot be sure that current sample resilience levels reflect those they experienced during the pandemic, limiting insight into the relationship of PTG and resilience. In addition, the three questions about trauma, stress, and fear used in this study were not standardised and thus lacked robustness and replicability. This is particularly relevant due to the inclusion of Likert scales, which may have been subject to differing interpretations and biases regarding inflated scores due to methods of scale labelling [29], and thus further reliability issues.

Whilst this study made an effort to establish trauma within the sample to ensure eligibility for participation, participants with lower self-reported trauma were included within this study who may have experienced too little seismic impact from the COVID-19 pandemic to reliably elicit PTG. This may impact the validity of results. Future research is recommended to utilise standardised pre-screening measures such as The Core Assumptions Scale [124] to reliably establish the seismic impact of a targeted event within participants before measuring PTG, with low-scoring participants being excluded from participation in the study.

Finally, this study did not include mental health state as a control variable. Mental health conditions such as severe depression and anxiety can have an inhibitory impact upon the development of PTG [54] and therefore it cannot be known whether this may have impacted results.

The conduction of further post-pandemic research that meets both parameters of PTG is strongly recommended. Such replication should take care to ensure consistent participant recruitment styles and include a larger, more representative sample to ensure good validity and reliability. There is also opportunity to investigate the relationship between PTG and quantity of traumatic experiences to further clarify the results of this study. As there does not appear to be a quantitative measure of PTG that meets specificity needs for the unique experiences of the COVID-19 pandemic, it is recommended that semi-structured interviews be considered to investigate pandemic-related PTG, to prevent possible ceiling effects. Further research regarding the formulation of resilience interventions is also suggested, to help promote PTG and wellbeing in preparation for future pandemics or other traumatic events. Data regarding the specific traumas which occurred during the COVID-19 pandemic in England are required for consideration as points for future specific study regarding PTG, as well as in the event of a future similar-scale event, to allow the valid research of PTG, which could include study during future pandemics dependent on temporal factors.

5. Conclusions

The present study demonstrated the shape of PTG post-pandemic in England as well as the value of resilience in helping individuals achieve PTG following a period of mental, economic and physical hardship. Directions for further research regarding the relationship between fear and PTG were also revealed.

Whilst this paper brings into question the validity and reliability of much of the current PTG literature pool, the discussion of the potential shortcomings of the PTG literature remains rooted in modern theoretical and critical PTG literature [125]. Discussion and findings from the current study reveal the need for careful consideration regarding the validity and reliability of both previous and future PTG studies and provide support for the potential need for overhaul within the field of PTG. Exploration of alternative phenomena such as PAA may help explain previous invalid results [30].

Findings from the current study may also carry wider implications within other domains of practice where PTG following traumatic experiences is an issue. For instance, professionals involved within the criminal justice system (e.g., police officers [126]) are likely to encounter traumatic experiences indirectly which can result in secondary traumatic stress. Furthermore, incarcerated individuals are also more likely to have experienced trauma either before or during incarceration [127]. Whilst there are existing interventions in place to support the wellbeing of prisoners [30,128], less is known about whether these interventions support PTG; thus, further academic inquiry into supporting prisoners with traumatic experiences is needed.

As a method of protecting these individuals, it is important for scholars to explore how PTG can be fostered. This too may be useful for future similar-scale pandemics or disasters.