REPORT WRITING Impact of Traumatic Situation in Determing the Relationship Between Post Traumatic Growth and Quality of Life Submitted to

Etudes

REPORT WRITING
Impact of Traumatic Situation in Determing the Relationship Between Post Traumatic Growth and Quality of Life
Submitted to :
Dr.Saadia Malik
Submitted from:
Tayyaba Sultan
Roll no:155
MSC.(SEM II) S.S
Department of Psychology
University of Sargodha

List of contents
Relationship Between Traumatic Situations ,Post Traumatic Growth And Quality Of Life
Connectedness
Contents
List of tables
List of figure
List of Annexure
Abstract
Chapter 1:Introduction
Traumatic Situations
Post Traumatic Growth
Quality of Life
Rationale of the study
Conceptual frame work
Objectives
Hypothesis
Operational definition
Traumatic Situations
Post Traumatic Growth
Quality of Life
Chapter 2: Method
Research design
Sample
Inclusion and exclusion criteria
Instrument
Traumatic Situations
Post Traumatic Growth
Quality of Life
CHAPTER 3:RESULTS
CHAPTER 4: DISCUSSION
Conclusion
Limitation and suggestion
Implications
REFRENCES

Table No. LIST OF TABLE
Table 1 Demographic Characteristics of Sample (N=200)
Table 2 Descriptive statics and alpha reliabilities for all study variables
Table 3 Pearson Correlation among Study Variables (N=200)
Table 4 Comparison of age on Traumatic situtation and Quality of life (N=200)
Table 5 Comparison of Females and Male on post traumatic growth and quality of life (N=200)
Table 6 Comparison of status T.S and QOL

Figure NO: LIST OF FIGURE
Figure 1 Conceptual Frame Work

Annexure NO: LIST OF ANNEXURES
A Introduction and Informed Constent
B Demographic Information Sheet
C Traumatic Situation
D Post Traumatic Growth
E Quality of Life

ABSTRACT
The aim of the study was to infer the relationship between traumatic situation, post traumatic growth and quality of life among universities students. The study also aimed at findings out the effect of post traumatic growth and quality of life. The sample of present study (N=200) was collected from Sargodha universities. Study comprised on both female (N=200) and male (N=200).Traumatic Situations, Post Traumatic Growth and Quality of Life were used to measure the study variables. Results show that Traumatic Situations is negatively correlated with Quality of Life and Post Traumatic Growth has a significant positive correlation with Quality of Life. Gender difference were also found on Post Traumatic Growth and Quality of Life indicating that males have high level of Quality of Life as compared to females and females have high level of Post Traumatic Situation and Traumatic Situations as compared to male .Implication of the study along with its limitation were discussed and Suggestion for future research also discussed,
Keywords: Traumatic Situations, Post Traumatic Growth and Quality of life.

.

INTRODUCTION

Chapter 1
INTRODUCTION
The research paper is based on the greater findings of a Post Traumatic Growth Research Degree, conducted in the school of Psychology , at UOS. The study focused on the qualitative responses among adults. The agency provides various community, care and support services to adults people and people with disabilities. The original study had three main components of inquiry, each exploring issues related to QOL amongst adults and particularly introduced the post traumatic growth ,traumatic situations and quality of life.
The experience of adverse situations often leads to stressful or traumatic reactions and changes in psychological functioning. Nevertheless, some people exposed to adversity report positive changes as a result of their experiences. Such changes are characterized by a greater appreciation for life, the perception of new opportunities, increased feelings of personal strength, improved relationships with people and an enhanced religiosity or spirituality. This positive transformation is known as posttraumatic growth and contrasts with earlier literature that has long-considered only the negative consequences associated with adversarial events. Individual perception of their position in life in the context of the culture and value system in which they live and in relation to their goals ,expectations, standards ,satisfaction and concern. “Recognizing the importance of the role trauma plays in the lives of disaster survivors is essential to developing adequate preparation and response protocols”.
The relationship between different levels of post-traumatic growth and quality of life and to compare post-traumatic growth and lower levels of post-traumatic growth are associated with lower quality of life. The negative association between time since transplantation and quality of life is based on the assumption that recipients may increasingly suffer from adverse side effects of immune suppressants such as pain. Furthermore, in the course of time they may develop serious comorbidities. .
Under these circumstances, the concept of post-traumatic growth, which is the idea that stressful life events may create the opportunity to activate one’s resources, leading to a higher level of functioning than before, is highly relevant. This concept, developed by Tedeschi and Calhoun, is associated with the positive psychology movement. Basically post-traumatic growth can be regarded as a protective factor that enables patients to reframe threats into challenges, thereby strengthening their psychological well-being. Previous studies have found high levels of post-traumatic growth after lung transplantation, which were even higher than those observed in patients suffering from chronic heart disease, cancer or HIV. High levels of post-traumatic growth have also been found after haematopoietic stem cell transplantation (HSCT). However, lung transplantation and HSCT have markedly lower survival rates than liver transplantation, which may have important implications regarding traumatisation as well as post-traumatic growth.
To the best of our knowledge, there are only two previous studies dealing with post-traumatic growth in liver transplant recipients. In a longitudinal study, Scrignaro et al used a sample of 100 liver transplant patients from the outpatient population. Participants filled in the Posttraumatic Growth Inventory (PTGI) and group identification scales at two different times 24 months apart. The results showed that post-traumatic growth positively predicted identification with the family group and the transplantee group over time. The second study by Zi?ba et al examined 48 liver transplant recipients about 10 weeks after surgery. Recipients told two stories about freely chosen important events in their lives. The measurement of post-traumatic growth 10–12 months later showed that the affective tone of the narratives was associated with the level of post-traumatic growth, and that positive affective tone was related to greater post-traumatic growth. Both studies unveiled potentially important mechanisms by which post-traumatic growth may positively affect well-being. However, the association of post-traumatic growth and quality of life, which is of central importance in the present study, was not dealt with in those papers.
Post-traumatic growth is also highly relevant for close relatives, particularly caregivers of the liver transplant recipient, who is dependent lifelong on medical care and intensive social support. In this situation, the caregiver is confronted with the profound impact of liver transplantation on his or her personal life and its challenging implications. There is growing evidence regarding the great amount of stress in caregivers before and after liver transplantation, which may even result in symptoms of post-traumatic stress.The close mutual relationship between transplant recipient and caregiver makes it understandable that caregiver stress may also negatively affect the patient’s quality of life and therapy adherence.
Even though post-traumatic growth is thought to contribute to well-being and quality of life after transplantation, not all previous studies have found a significant positive association between these two variables. For example, Fox et al found in a sample of 64 lung transplant recipients a minimal association between post-traumatic growth and physical functional quality of life. This result illustrates that post-traumatic growth is not related per se to higher quality of life. The relationship between both constructs could be interpreted in the sense that post-traumatic growth increases the likelihood of a flexible adaptation to a new situation, which in the long run is thought to be beneficial to personal well-being.
Quality of life is a broad concept that encompasses a number of different dimensions (by which we understand the elements or factors making up a complete entity, that can be measured through a set of sub dimensions with an associated number of indicators for each). It encompasses both objective factors (e.g. command of material resources, health, work status, living conditions and many others) and the subjective perception one has of them. The latter depends significantly on citizens’ priorities and needs. Measuring quality of life for different populations and countries in a comparable manner is a complex task, and a scoreboard of indicators covering a number of relevant dimensions is needed for this purpose.
The protection of the environment has been very high on the European agenda over the last few decades. The vast majority of European citizens believe that protecting the environment is important 2. Exposure to air, water and noise pollution can have a direct impact on the health of individuals and the economic prosperity of societies. Environment-related indicators are very important for assessing quality of life in Europe and in general. Both subjective (individuals’ own perceptions) and objective (the amount of pollutants present in the air) indicators are included.
Health is an essential part of the quality of life of citizens. Poor health can affect the general progress of society. Physical and/or mental problems also have a very detrimental effect on subjective well-being. Health conditions in Europe are mainly measured using objective health outcome indicators such as life expectancy, infant mortality, the number of healthy life years, but also more subjective indicators, such as access to healthcare and self-evaluation of one’s health.
In our knowledge-based economies, education plays a pivotal role in the lives of citizens and is an important factor in determining how far they progress in life. Levels of education can determine the job an individual will have. Individuals with limited skills and competences are usually excluded from a wide range of jobs and sometimes even miss out on opportunities to achieve valued goals within society. They also have fewer prospects for economic prosperity. In Europe, currently available indicators of education that are relevant for quality of life are a population’s educational attainment, the number of early school leavers, self-assessed and assessed skills and participation in life-long learning.
The right to get involved in public debates and influence the shaping of public policies is an important aspect of quality of life. Moreover, providing the right legislative guarantees for citizens is a fundamental aspect of democratic societies. Good governance depends on the participation of citizens in public and political life (for example, involvement in political parties, trade unions etc.). It is reflected also in the level of trust of citizens in the country’s institutions, satisfaction with public services and the lack of discrimination. Gender discrimination measured in terms of the unadjusted pay gap is the only indicator included in this sub-dimension at the moment, but more indicators will be developed in the future.
Traumatic Situations:
A traumatic situation is an incident that causes physical, emotional, spiritual, or psychological harm. The person experiencing the distressing event may feel threatened, anxious, or frightened as a result. In some cases, they may not know how to respond, or may be in denial about the effect such an event has had. The person will need support and time to recover from the traumatic event and regain emotional and mental stability.
Examples of traumatic events include:
Death of family member, lover, friend, teacher, or pet divorce physical pain or injury (e.g. severe car accident)
• Serious illness
• war
• Moving to a new location
• Parental abandonment
• Witnessing a death
• Rape
• Domestic abuse
Four Elements Related to Traumatic Stress 1. The event was unexpected 2. Person was unprepared for the event 3. Nothing could be done to prevent the incident 4. The event happened repeatedly Traumatic stress is an acute distress response that isexperienced after exposure to a catastrophic event Traumatic stress occurs because the event poses a serious, Or perceived threat to: ? The individual’s life or physical integrity ? The life or a family member or close friend ? One’s surrounding environment
Key Components of the Recovery Phase 1. Physical/Structural Recovery 2. Business Recovery 3. Restoration of Academic Learning 4. Psychological/Emotional Recovery ? Changes to thoughts and behavior patterns. ? Sensitivity to environmental factors. ? Strained interpersonal relationships. ? Stress-related physical symptoms Prevention
Trauma is when we have encountered an out of control, frightening experience that has disconnected us from all senses of resources fullness or safety or coping or love.(Tara Barach, 2011).
A Traumatic Event can involve e a single experience or enduring repeated events that completely overwhelm the individual ability to cope or integrate the ideas and emotion involved in that experience.
Traumatizing events can take a serious emotional toll on those involved even if the event did not cause physical damage. this can have a profound impact on the individual identity ,resulting in negative effects in mind ,body ,soul and spirit.
Regardless of its source, trauma contains three common elements:
It was unexpected
The person was unprepared
There was nothing the person could do to stop it from happening.
Simply put, traumatic events are beyond a person’s control.
It is not the event that determines whether something is traumatic to someone, but the individual experience of the event and the meaning they make of it.
“Trauma” can mean different things, depending on the context. Semantically, trauma refers to an experience or event; nevertheless, people use the term interchangeably to refer to either a traumatic experience or event, the resulting injury or stress, or the longer-term impacts and consequences (Brier & Scott, 2006).
When medical doctors talk of trauma, they mean the sudden and severe bodily wounds that result from physical injury, ranging from the minor cuts and bruises sustained after an accidental fall to the life-threatening lacerations and bone fractures resulting from a car crash. Similarly, the recently modified federal legal definition of trauma is “an injury that results from exposure to either a mechanical force or another extrinsic agent, including an extrinsic agent that is thermal, electrical, chemical, or radioactive” (Improving Trauma Care Act of 2014).
Behavioral health professionals more broadly define trauma as resulting “from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being” (Substance Abuse and Mental Health Services Administration SAMHSA, 2012, p. 7). This is sometimes referred to as “psychological trauma” to distinguish it from other types of trauma.
The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013), which is used by psychiatrists to diagnose behavioral conditions, is even broader. DSM-5 expands the definition of trauma to include vicarious exposure:
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event(s); witnessing, in person, the traumatic event(s) as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend (in case of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental); or experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (p. 271).
However, as Briere and Scott (2015) pointed out, despite its breadth, the DSM–5 definition is limiting because actual or threatened death, serious injury, or sexual violence need not occur for people to perceive an event as traumatic. Furthermore, as SAMHSA observed, trauma is subjective. “A particular event may be experienced as traumatic for one individual and not for another.
Quality of life is a highly subjective measure of happiness that is an important component of many financial decision. Factors that play a role in quality of life vary according to personal preferences, but they often include financial security, job satisfaction, family life, health and safety. Financial decisions usually involve a tradeoff wherein quality of life is decreased in order to save money or, conversely, quality of life is increased by spending more money.
POST TRAUMATIC GROWTH
PTG was positively related to approach acceptance, the belief in a positive life . The extent to which participants felt they had learned something positive from life’s most traumatic situations was negatively related to death avoidance and fear of death, and positively related to a neutral acceptance of death as a normal part of life.
PTG from life’s most traumatic situations was positively related to growth and quality of life. Perceptions of having learned something positive from life’s biggest trauma were also negatively correlated with depressed mood at Time 2, and positively correlated to mental health and role physical health. The extent to which life’s most traumatic event was perceived as helpful in coping with a current stressor was negatively related to depressive mood, and positively correlated to vital health, general health, and physical health. Psychological trauma is a genetic risk factor for mentall health problem. Physical health problem as well as reduced quality of life. Traumatic situations occurs because the event poses a serious, or perceived threat to:
To work provides a good example. It is possible to save money on housing by living farther away from popular job centers and commuting to work. However, commuters do not have as much time to spend with family or on hobbies because of the extra time spent sitting in traffic or using mass transit. Some people consider this tradeoff worthwhile, while others choose to maximize their quality of life by spending more money to live closer to work.
Hours spent at the job versus free time can be another measure of quality of life. Professionals may choose to take high-paying jobs that require extended or late work hours on a regular basis in order to earn the income they desire. This may include prolonged business travel for in-person meetings at distant locations. While such choices can increase liquidity to fund their private lives, this limits the hours available to spend on vacation or other personal endeavors.
Workplace conditions are another aspect of quality of life. Different jobs may require workers to perform under extreme exertion such as heavy lifting or repetitive labor that can tax the body over time, possibly leading to long-term physical impairments. Conversely, a job might drastically restrict the movements of the worker because of limited space to perform their tasks, such as staffing a toll booth or a remote security guard station. There are also jobs that can expose employees to potential hazards such as harmful chemicals, heavy machinery, and high-risks of falling or other injury. The possibility for harm that could affect their enjoyment of life is weighed against earning a salary to provide the type of lifestyle the worker desires for themselves and their family members.
QUALITY OF LIFE
Quality of life is also an issue when developing a personal savings plan. In this case, the tradeoff involves a sacrifice of current quality of life in order to improve future quality of life. This may include limiting immediate expenditures by purchasing lower cost items rather than buying higher cost, premium items.
As medical advances have helped to increase longevity, our focus has shifted from the quantity to the quality of life.
While scientists may resort to rating scales to measure pain, or scoring systems to quantify disabilities, the authors believe that trying to measure “quality of life” this way may be going too far.
“Quality of life” is subjective and multidimensional, encompassing positive and negative features of life. It’s a dynamic condition that responds to life events: A job loss, illness or other upheavals can change one’s definition of “quality of life” rather quickly and dramatically.
Even though measuring it is difficult, clarity is extremely important, especially for medical practitioners, who often take “quality of life” into account when considering whether life-sustaining medical intervention should be withheld for severely disabled or ill patients. As such, coming up with a distinct definition is ethically important, and not just a case of splitting hairs.
An analysis of scientific papers over the past 20 years shows that a precise, clear and shared definition is a long way off. Often researchers don’t even attempt to define the concept, using it instead as an indicator. Among the observations made about “quality of life” is that it encompasses:
• life satisfaction, which is subjective and may fluctuate.
• multidimensional factors that include everything from physical health, psychological state, level of independence, family, education, wealth, religious beliefs, a sense of optimism, local services and transport, employment, social relationships, housing and the environment.
• cultural perspectives, values, personal expectations and goals of what we want from life.
• not just the absence of disease but the presence of physical, mental and social well-being. The authors stress the need for multidisciplinary medical teams who can develop a perspective on psychosocial needs and not just physical care.
• our interpretation of facts and events, which helps to explain why some disabled people can report an excellent “quality of life” while others can’t.
• our level of acceptance of our current condition, and our ability to regulate negative thoughts and emotions about that condition.
RATIONALE :
The extent to which participants felt they had learned something positive from life’s most traumatic situations was negatively related to death avoidance and fear of death, and positively related to a neutral acceptance of death as a normal part of life.
PTG from life’s most traumatic situations was positively related to growth and quality of life. Perceptions of having learned something positive from life’s biggest trauma were also negatively correlated with depressed mood at Time 2, and positively correlated to mental health and role physical health. The extent to which life’s most traumatic event was perceived as helpful in coping with a current stressor was negatively related to depressive mood, and positively correlated to vital health, general health, and physical health. Psychological trauma is a genetic risk factor for mentall health problem. Physical health problem as well as reduced quality of life. Traumatic situations occurs because the event poses a serious, or perceived threat to:

Conceptual frame work

IV

DV DV

OBJECTIVES
1. The basic objective of this study is to find the correlation between these three variables.
2. To find the impact of traumatic situations on Post Traumatic Growth.
3. To find the impact of traumatic situations on Quality of Life.
Hypothesis
1. Traumatic situations will be effect on quality of life.
2. Traumatic situations will be effect on Post Traumatic Growth.
3. One variable will be related with other variables
4. The relation between variables will be positive or negative.

METHOD

Chapter 2
METHOD
This section will describe research design, sample and sampling techniques, instruments and procedure of data collection.
Research Design
The research design used for this research study was survey research design.
SAMPLE
The sample of the study will be N=200 out of population of young adults,age range of 20 to 39(or 40).Probability sampling technique will be used which is further two types ,stratified sampling technique and simple random sampling.
Including criteria ;All the people coming under the category of young adults will be the criteria of study.
Excluding criteria; All people except the

Demographic Variables F %
Gender
Male 100 49.8
Female 100 49.8
Age
19 to 21 144 47.7
21 to 25 156 52.3
Table 1

Table 1 show frequency and percentage of students with respect to gender and age

Table 1 shows frequency and percentage of all demographics used in the present study.

Inclusion and Exclusion criteria
Only university students of B.S.C and M.S.C were included in the study.Other students were excluded.Data were taken from the student of the university of Sargodha.
Instrument
Three variable scale, one is quality of life ,,it consist of 1.terrible,,2.unhappy 3.mostly dissatisfied,,4.mixed,,5.mostly satisfied,6.pleases,7.delighted..,,,second variable is IES-R its 1.not at all,,2.a little bit,,3 moderately,,4.quite a bit ,5.extremely,,,,Third variable, post traumatic growth, its 1.did not experience 2. Very small degree 3.small degree, 4.moderate, 5.great degree, 6.v.great degree
This consists of 21 items answered on a Likert scale ranging from 0 (‘no change’) to 5 (‘very great degree of change’), thereby evaluating the perception of personal benefits in survivors of traumatic events. Test interpretation provides a total score of post-traumatic growth and the following five subdimensions: relating to others, new possibilities, personal strength, spiritual change and appreciation of life. We used the Spanish version provided by Weiss and Berger. For patients in this study, the Cronbach’s alpha was 0.94 for the sum scale and ranged from 0.73 to 0.88 for the subscales. For caregivers, the Cronbach’s alpha was 0.95 for the total scale and ranged from 0.77 to 0.90 for the various subscales.

Post Traumatic Growth
Posttraumatic growth (PTG) is positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to their way of understanding the world and their place in it. Posttraumatic growth is not about returning to the same life as it was previously experienced before a period of traumatic suffering, but rather it is about undergoing significant ‘life-changing’ psychological shifts in thinking and relating to the world, that contribute to a personal process of change, that is deeply meaningful.
Quality of life
Quality of life (QOL) is the general well-being of individuals and societies, outlining negative and positive features of life. It observes life satisfaction, including everything from physical health, family, education, employment, wealth, religious beliefs, finance and the environment. QOL has a wide range of contexts, including the fields of international development, healthcare, politics and employment. It is important not to mix up the concept of QOL with a more recent growing area of health related QOL (HRQOL2). An assessment of HRQOL is effectively an evaluation of QOL and its relationship with health
Procedure
The population of interest is young adult students. The participants in the Archival dataset were recruited from university of Sargodha. The specific university is selected because it completes all the requirements which the research demands. Before to conduct the research the researcher has to take permission from his departmental head. Then he has to take permission from other departmental heads from where his participants belong. Researcher has to signed the inform consent from the participants to make them fully aware that for which purpose they are selected. Attach the inform consent.
After this every student will be provided with the questionnaire to response it. When all the data is collected then it will go through analysis phase.

RESULT

CHAPTER III
RESULTS
Table I
Table 1 shows frequency and percentage of students’ with respect to gender and age.

Demographic Variables F %
Gender
Male 100 37.8
Female 100 37.8
Age
19 to 31 95 44.5
31 to 45 105 65.5

Male students ( f=100,37.8%) were equal in numbers as compared to female students(
f=100,37.8%). students of age range 19 to 31 (f=95,44.5%) are less in number as compared
to age range of 31 to 45(f=105,65.5%).

Table II
Psychometric properties of study variables ( N= 200).
Variables N M SD ? Range
Potential
Actual Skewness
PTG
200 14.2
21.3 .511 0-22 .062 -.620
QOL 200 24.1 1.42 .420 0-16 .12 -.216

This table shows that mean standard deviation and t-values for male and female students on PTG and QOL. Results indicate non-significant gender differences on PTG with t (198) = .51 and QOL t (198) = .42s

Table III

Correlation among Study Variables (N=200)

Variables 1 2
Post Traumatic Growth – .217*
Quality of Life .217*

Table III shows Pearson correlation among study variables. The findings indicate that PTG has significant positive correlation with QOL (r = .029, p < .001).

Table IV
Comparison of status on Post Traumatic Growth and Quality of Life(N=200)

Variables Male(100) Female(100) t(198) P CI 95%
M SD M SD LL UL
QOL 27.54 6.01 21.26 5.97 .97 .062 -.332 1.50
PTG 18.25 22.38 18.72 2.96 .23 .56 -1.4 2.45
Table IV shows mean standard deviation and t-values for male and female students on QOL and PTG. Results indicate non-significant gender differences on QOL with t (198) = .97 and PTG
t (298) =.23.
Table V

Comparison of age on Traumatic situation and QOL (N=200)

Age(19-31) age(31-45)
Variables Male(100) Female(100) t(198) P CI 95%
M SD M SD LL UL
QOL 2.54 3.01 1.26 5.9 .32 .02 -.362 2.50
TS 8.25 2.3 1.72 2.9 .51 .16 -1.8 1.45
Table IV shows mean standard deviation and t-values for male and female students on QOL and TS. Results indicate non-significant gender differences on QOL with t (198) = .32 and TS
t (298) =.51

Table VI

Comparison of Male and female on Traumatic situation and QOL (N=200)

Variables Male(100) Female(100) t(198) P CI 95%
M SD M SD LL UL
QOL 1.54 2.01 2.26 2.9 .52 .05 -.262 3.50
TS 3.25 2.02 2.12 3.9 .59 .16 -1.4 1.25
Table IV shows mean standard deviation and t-values for male and female students on QOL and TS. Results indicate non-significant gender differences on QOL with t (198) = .52 and TS
t (298) =.59

DISCUSSION

Chapter 4
DISCUSSION
The present study was carried out with an aim to see the relationship between Post traumatic growth ,traumatic situation and quality of life in order to achieve above objectives three instrument Post traumatic growth scale among students behavior problem.before asseing the relationship among variables or present study the psychometric property of the instrument for measuring the variance construct were examines.as hypothesized students exposed to value had higher level of traumatic situation behavior in students life .Then those exposed to neither whohad both witnesses of that situation and had been direct victims of students were more consistently at risk for entire range of internalizing and externalizing behavior investigated than those who experienced only one form exposure.in fact dual violence exposure was predictive of higher scores on all nine outcomes addressed,in this study the effect of gender which itself emerge as a strong main effect predictor of all outcomes expect depression.additionally e vans al.(2008) found that boys exposed to post traumatic growth were at higher risk for externalizing behavior problems than were their female counter parts .however several other reviews and primary research studies documented no evidence of gender moderation of outcomes similar to those we examined(kit man et al; 2003;Stemberg ,2006;rogen bg et al; 2003).because of our sample contains youth who range in age during students .previous studies have shown who were exposed to situation between are often exposed to a variety of other risk factor known to increase internalizing and externalizing behavior in students (herrenkonl et al;2008).however ,rarely are these risk factors taken into account when investigating development outcomes related to quality of life .It is possible that as students progresss through challenging development stages of students ,those exposed to multiple forms are more likely to experience higher level of depression .it is also possible that the effect of dual exposure associated with depression in particular would be accounted for by other variables.
CONCLUSION:
This study identified different relationship between post traumatic growth on quality of life and traumatic situation behavior outcomes while all violence exposed groups showed higher level of the outcomes compared to the no exposure group only those in the dual exposure group were at higher risk after accounting for other risk factor while not a classic double whammy or dual exposure effect that finding suggest their may be increased for those student exposed to both traumatic growth and adults of more typical double effect emerged only for youth depression the most important conclusion to be generated from this study is that the relationship between in post traumatic exposure outcomes is more complicated than the literature would suggested .results shows the need to disentangle the unique and combined effects of child exposure in children present study also focus on the psychological consequences of meaning in life among students different research support are available that support the results of the study .gender wise difference were also seen in the study different demographic variable wwre used to see the difference but that variable were not proper categories but the gender categorization were proper.failure to account for dual exposure may lead researchers to overstate or understate the risk of later problems on youth associated with child traumatic situation exposure alone.
Limitation and suggestion :
The survey research design of present study prevent from making causal inference information was collected through self report measure which are reliable for social desirability ,single ,source, biasness and technically common method. the present study focus on traumatic situation and its psychological outcomes behavior problems study focus on both post traumatic and psychological outcomes.scale that used in the study was used in the study individualistic culture not for collectivistic scale in English language due to language barrier it is only applied for literate population who know about English language .many of the student problem in filling the questionnaire due to tough vocallbary the sample of present study should be large as a sample of present study is draw from different private and school and colleges from Sargodha district ,sample taken from different private and school and colleges but future research might examine among general population present study also just focus on the view of only students and just their views cannot be generalized ,future research must take the views of other people for the generalization of data ,improper categorization of residence and educational class differences effect the result of study researches should pay attention on proper categorization of demographic ,the questionnaire that used in study were lengthy,it is also suggest that for better results that future researcher try to use shorten versions of question are because students hesitate to fill large scale having a lot of items.
IMPLICATION:
Post traumatic growth is important component to stop psychological behavior problems among students of university need help and support to overcome this problem for their well being .if this development needs are satisfied at an early stage the students likely to become more component students future research is needed to explore other variables and correlate them.the information taken from the results of the study can helpful in making plan about the intervention used for the prevention of physical and psychological problems related with students intervention to finish every type of intelligence can be help ful to improving psychological problems of behavior counselor can help students to become more forgiving and their prevent can be teach to deal with each other and with their children in good way so that psychological condition of students must be improve.

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