2. Purpose of the Study
This study had three main goals: (1) to test the mediating effect of existential anxiety and life satisfaction on the relationship between PTSD stress and post-traumatic growth (PTG); and (2) to examine the moderated mediating effect of severity of trauma symptoms on life satisfaction and existential anxiety and its associations with PTG.
We hypothesized that existential anxiety and life satisfaction would mediate the association between PTSD and PTG, and that these mediators may interact together on this relationship. Furthermore, we hypothesized that the severity of the PTSD stress would moderate the association between existential anxiety and PTG, and between life satisfaction and PTG.
Despite the fact, that the connectedness between existential anxiety, PTSD symptoms, post-traumatic growth, and life satisfaction have been already tested by several researchers there are several uniqueness of our study. First, the unique time of data collection—e.g., the COVID-19 pandemic. The COVID-19 pandemic is a serious cause of distress that may modulate the relationship between abovementioned psychological variables. To our knowledge, none of the prior research have been done during a pandemic, and only a few tested the abovementioned variables all together. What is more, we examined the moderated mediating effect of severity of trauma symptoms on life satisfaction and existential anxiety and its associations with PTGI, that has not been yet tested. Finally, it seems very important, that we tested the associations between past trauma symptoms and actual stress of individuals connected with high death thought accessibility, as COVID-19 is a serious threat to human health and life.
4. Results
The descriptive statistics for each of the four groups divided by severity of PTSD symptoms are presented in
Table 3. According to Kruskal–Wallis Test, significantly higher PTSD symptoms and existential anxiety was found in the group with full PTSD symptoms (group 4). The level of life satisfaction was similar in all groups. The comparisons of PTG results indicated that group 3 had significantly lower post-traumatic growth than group 4 (see
Table 3).
The results of Pearson’s analysis revealed the significant and positive associations between the PTSD symptoms (IES-R) and existential anxiety indicators (Pearson’s correlation coefficient r ranged between 0.21 to 0.36), while life satisfaction negatively correlated with IES-R score (
r = −0.15;
p = 0.039), and PTG was not connected with traumatic symptoms. Life satisfaction was positively correlated with PTG (Pearson’s
r = 0.23,
p = 0.002), and PTG was also significantly and negatively connected only with one existential anxiety indicator e.g., anxiety of fate and death (
r = −0.37,
p < 0.0001) (see
Table 4).
To examine the mediation and moderation effects, we applied macro PROCESS by Hayes (see
Figure 1). In model 1, multiple mediation effect was tested with two mediators (model 6 in the Hayes PROCESS); in model 3, moderation mediation model was examined (model 15 in the Hayes PROCESS).
Table 5 presents the estimated regression coefficients of the direct effects for the examined models and the mediation-moderation effects. We tested one sub-dimension of existential anxiety—Anxiety of fate and death (SNE3)—as a potential mediator, because only this variable significantly correlated with PTSD symptoms (see
Table 4).
According to the results for model 1, individuals with more PTSD symptoms expressed more existential anxiety (β = 0.39;
p < 0.0001; CI95% = 0.41 to 0.87—path a1). Surprisingly, PTSD symptoms were not connected to life satisfaction (β = −0.04, SE = 0.03; CI95% = −0.07 to 0.04—path a2). However, existential anxiety as a mediator, significantly affected both life satisfaction (β = −0.34;
p < 0.0001; CI95% = −0.10 to −0.04), and PTG (β = 0.20;
p = 0.018; CI95% = 0.03 to 0.26—path b1). The indirect effect of PTSD symptoms on PTG via existential anxiety was significant (β = 0.09, SE = 0.04, CI95% = 0.01 to 0.18), and via life satisfaction was insignificant (β = −0.01, SE = 0.02, CI95% = −0.06 to 0.02). Furthermore, the indirect effect of two mediators tested simultaneously (existential anxiety and life satisfaction) was significant (β = −0.04, SE = 0.03, CI95% = −0.08 to −0.01) (see
Table 6,
Figure 1).
In model 2 we confirmed the simple mediation effect of existential anxiety on the relationship between life satisfaction and PTG (β = −0.07, SE = 0.03, CI95% = −0.15 to −0.02). The results of moderation-mediation analysis tested in model 3 revealed that the interactive effect of existential anxiety and severity of traumatic symptoms on PTG was insignificant (β = −0.02, CI 95% = −0.12 to 0.08;
p = 0.765). However, the indirect effect of life satisfaction on PTG through severity of trauma symptoms was significant trauma (β = 0.84; CI95% = 0.31 to 1.37;
p = 0.765) (see
Table 5,
Figure 2). The test revealed that severity of trauma symptoms may impact the experience of life satisfaction and post-traumatic growth. Specifically, the relation between life satisfaction and positive growth in the group with full PTSD symptoms (group 4) is strong and positive, and in low (group 1) and high (group 3) PTSD the symptoms are strong and negative.
5. Discussion
The presented study aimed to test the mediation effects of existential anxiety (SNE), activated by the COVID-19 pandemic and life satisfaction (SWLS), on the post-traumatic stress (PTSD) and post-traumatic growth (PTG) relationship. Secondly, we also examined the mediation effect of existential anxiety and the moderated mediating effect of severity of traumatic symptoms on the association between SWLS and PTG.
Despite the fact that the relationship between PTSD, SWLS, and PTG had already been tested in several studies, to our knowledge the investigation that includes the aforementioned variables combined with severity of trauma and existential anxiety has not yet been conducted. Additionally, such an investigation during the COVID-19 pandemic has created special conditions for analyzing the relationship between these variables because all the participants experienced a real threat to their health and life as it was the time of population-wide crisis [
10]. Additionally, many recently conducted studies have confirmed that COVID-19 pandemic is connected with diminished well-being and escalated chronic symptoms of psychological distress and other mental disorders [
46,
47].
The results indicated that the effect of PTSD on PTG is mediated by existential anxiety and life satisfaction, and that these psychological characteristics simultaneously impacted the relationship between the independent (PTSD) and dependent (PTG) variables. Additionally, the relationship between life satisfaction and post-traumatic growth is moderated by the severity of traumatic symptoms. Our also study confirmed previous findings which indicated that the association between PTSD and PTG may be a curvilinear relationship (a U association) [
26,
36,
37]. However, in our study the U association was not inverse. Tsai et al. [
37] found an inverted U-shaped relationship between PTSD symptoms and PTG among veterans. A meta-analysis conducted by Shakespeare–Finch and Lurie–Beck [
36] revealed a significant linear relationship between PTG and PTSD symptoms, but also a curvilinear relationship that depends on trauma type and age. In our studies U-shaped relationship meant that an intermediate or high level of PTSD level seemed to lead to less PTG, when low and full PTSD stress symptoms strengthened PTG experiences. Some of the past results suggested that trauma reaction, because of its complexity, may be a vehicle for personal growth after a difficult event. For example, in Jin et al.’s [
48] study, higher levels of trauma and post-traumatic distress among earthquake survivors were associated with greater post-traumatic growth. The authors explained this relationship in two ways (1) PTG occurs when the trauma has been upsetting enough for person to promote engagement in a positive outlook about the event, but not too overwhelming for survivors to handle; (2) PTG and PTSD have a shared psychological ‘engine’ that sets them in motion, and PTG reflect a cognitive adaptation process among those who experience post-traumatic stress disorders in response to their disaster (a positive reinterpretation). Our findings may be also the results of factors that were not controlled in our study; however, they may modify the relationship between PTSD and PTG—e.g., personality characteristics and maladaptive coping strategies [
49], resilience [
26], and unsupportive social network [
50], time passing after traumatic event [
51].
Similarly to prior studies conducted by Schubert et al. [
35], we revealed that individuals with more severe post-traumatic symptoms show more PTG than those with low PTSD characteristics. Furthermore, we also found that the severity of trauma experiences may influence the association between life satisfaction and PTG level. In individuals with low PTSD symptoms in the abovementioned relationship, it was negative, and in the group with full PTSD symptoms it was positive. These findings may shed light on the mechanism that underlies the trauma symptoms and its meaning to the individuals. Perhaps the key here is the currently felt life satisfaction resulting from the acceptance of past life experiences of the individual and the current existential fear. Zhang et al. [
47] revealed that the severity of COVID-19 and restriction connected with this pandemic negatively impacted life satisfaction and this effect depended on the chronic medical issues of the individuals In our studies traumatic stress symptoms may be consider as chronic mental disease, and such symptoms strengthened existential fear connected to COVID-19, diminished life satisfaction, and via these mediators reduced PTG. Additionally, Dymecka et al. [
52] found that the relationship between stress felt during pandemic COVID-19 and life satisfaction was mediated by sense of coherence, and the fear of COVID-19 acted as a buffer by weakening the relationship between stress and a sense of coherence. Looking at the results, it is worth noting that the respondents faced new difficult and threatening events during the study, which were probably significant for their satisfaction with life and interpretations of previous difficult events. The significant correlations between PTSD symptoms and existential fear felt during COVID-19 pandemic may suggest that people after trauma must also cope with existential crises that include interventions in the psycho-spiritual aspects of the human psyche, such as fear of fate and death; anxiety of guilt and meaninglessness and fear of emptiness and condemnation. Understanding the interface of the psychological and spiritual dimensions may contribute to a more efficient therapeutic practice. Spirituality relates to quality of life and mental well-being.
The findings should also be interpreted in the light of recently developed Terror Management Health Model for Pandemics by Courtney et al. [
7]. Similarly to TMT theory, from the perspective of TMHM model people engage in different two defensive tactics to cope with the fundamental threat of their mortality and health vulnerability e.g., (1) proximal defenses which are defined as threat-focused attempts to push death/health vulnerability outside of consciousness—denial or avoidance mechanism; and (2) distal defenses which are connected with response to non-conscious death thoughts that are not accessible and derived automatically [
7,
53]. Notwithstanding, it is possible that PTSD symptoms in some way may protect against confrontation with current life-threats and existential crises due to the fact that focusing on past and known difficult events may be easier than dealing with loneliness caused by forced isolation, the possibility of infection, and the death or loss of somebody close because of the SARS-CoV-2 virus. In light of the abovementioned terror management health model, such actual reactions on past trauma during new deadly pandemic may be recognized as a form of proximal defenses—e.g., (1) reducing perceived vulnerability to health or death threat by for example reinforcing the self- belief that a person has already experienced so many difficulties, therefore, is strong enough to deal with COVID-19; (2) denial perceived vulnerability to health or death threat by strong concentration on PTSD symptoms caused by past trauma and ignoring the personal risk of infection of the SARS-CoV-2 virus. Such an interpretation seems to be also in accordance with Li et al.’s [
54] statement that a lack of knowledge about COVID-19 and the treatment methods negatively impact on the mental health issue, as it causes fear, anxiety, and insecurity regarding the future and the meaning of one’s own life. Kar et al. [
21] have provided some guidelines for people with long-term illness during COVID-19 to maintain their mental health. The authors concentrated on avoiding a distressing situation, and an exposure to media, as well as maintaining an online relationship with friends and family, and trying to think positively. The findings of our studies suggest that struggling with past trauma distress symptoms is connected with existential crises indicated by high existential anxiety felt during pandemic COVID-19, and both may diminish life satisfaction and PTG. In order to minimize coronavirus anxiety, Kecmanovic [
55] advises practicing tolerating uncertainty, accepting anxiety as an integral part of human experience, and trying to transcend it by connecting it to one’s own life’s purpose and sources of meaning, sharing negative feelings with others (especially in spirituality relations), trying to increase self-awareness by getting adequate sleep, exercising regularly, and employing relaxation techniques. In accordance with our findings, a proper strategy to cope with COVID-19 distress is also the dynamic-dialectical process of spirituality as described by Yang et al. [
23]. It consists of reflection on the experience of being part of a greater whole and being blessed with a positive sense of life, as well as increasing awareness and accepting the total loss of meaning and trying to (re)discover it in a wholly new form. A person needs to prepare for the moments of discontinuity and be able to discuss with others their own existential dilemma and anxiety.