Post-traumatic growth in depression and its association with coping strategies: a cross-sectional study

OBJECTIVE: To determine the level of post-traumatic growth (PTG) and its association with coping strategies among individuals with major depressive disorder (MDD). METHODS: Patients aged ≥18 years with a diagnosis of MDD who had received treatment for at least 1 year (to ensure adequate time for the development of PTG) and could understand Bahasa Malaysia were invited to participate. Lifetime exposure to potentially traumatic events was assessed using the Malay version of the Life Events Checklist for DSM-5. Coping strategies were assessed in three domains (problem-focused coping, emotion-focused coping, and avoidant coping) using the Malay version of the 28-item Brief Coping Orientation to Problems Experienced. PTG was assessed in five domains (new possibilities, relating to others, personal strength, spiritual change, and appreciation of life) using the Malay version of the 10-item Post-Traumatic Growth Inventory-Short Form (PTGI-SF). RESULTS: In total, 122 patients with MDD (mean age, 35.5 years) were included in the analysis. On average, participants reported lifetime exposure to 7.08 traumatic events. The mean PTGI-SF score was 32.65, indicating a moderate level of PTG. The PTGI-SF score was positively correlated with the problem-focused coping strategies of active coping, planning, and instrumental support, as well as the emotion-focused coping strategies of positive reframing, acceptance, religious coping, emotional support, and venting. In contrast, all avoidant coping strategies showed no significant correlations with the PTGI-SF score, except for behavioural disengagement and self-blame. In the final model of hierarchical multiple linear regression analysis, problem-focused coping (β = 0.341, p = 0.002), emotion-focused coping (β = 0.234, p = 0.037), and age (β = 0.218, p = 0.005) remained significantly associated with PTG, explaining 36.6% of the variance. Trauma exposure, psychotherapy, and avoidant coping were no longer associated with PTG after adjustment for covariates. CONCLUSION: Among patients with MDD, PTG reflects adaptive cognitive and emotional processing rather than the absence of symptoms. Problem-focused and emotion-focused coping strategies were associated with higher levels of PTG.