The Kumpfer’s resilience framework believes that individuals who encountered the traumatic event would gather their own resources to cope with the stress based on their cultural context. The more risk factors (such as childhood exposure to domestic violence) or the fewer protective factors in the cultural context there are, the higher probability individuals perform maladaptively, and vice versa. Hence, the stress would be alleviated or strengthened by the cultural context. Then, interactions between individuals and the environment would happen to handle stress, which may lead to the changes of the internal resources and traits associated with resilience. Consequently, the process of resilience influenced by such traits would bring about the adaption or maladaptation which may reduce the possibility of developing PTG and PTSD[10].

Self-compassion is the ability to treat oneself with the same kindness and compassion as one would treat others in the same situation[11] , which was regarded as a trait associated with resilience. Existing literature indicated that self-compassion is an important predictor of resilience and promoting self-compassion may facilitate individual resilience[12-14]. This suggests that individuals with high self-compassion can exhibit a higher level of resilience and better adapt and recover when facing stress or difficulties. In contrast, individuals with a low level of self-compassion are inclined to criticize or reject themselves, which often form negative self-beliefs and low self-esteem, and feel unworthy of love[15]. These eventually lead to a low level of resilience.

Based on the Kumpfer’s resilience framework and empirical evidence, the present study hypothesized that the effect of childhood exposure to domestic violence on PTG and PTSD is significantly mediated by self-compassion (hypothesis 1) and resilience (hypothesis 2), respectively (1-step indirect path). It was also hypothesized that childhood exposure to domestic violence may affect PTG and PTSD via self-compassion to resilience (hypothesis 3) (2-step indirect path). Specifically, suffering from the trauma of COVID-19, children and adolescents who were exposed to domestic violence regarded as a risk factor may show a lower level of self-compassion compared with those who were not. It would lead to a lower level of resilience, increased risk of PTSD, and decreased likelihood of PTG.

Between February 12 and 17, 2020, college students who have been or have not been exposed to domestic violence from more than 180 universities in China were recruited to participate in this study. Prior to filling out several self-reported questionnaires, all volunteers signed an online consent form which was opaque about the aim of the study to control the hawthorn effect. Overall, 2500 students from 29 provinces and cities of China were invited on the basis of the following inclusion criteria: Being at least 18 years of age and fluent in Chinese; however, only 2126 students completed the questionnaire (85.04% response rate). Of these 2126 students, 88 were excluded due to missing or incomplete responses. Finally, data of the remaining 2038 students (755 males and 1283 females, mean age: 20.56 ± 1.90) was analyzed. To ensure the adequate power, we calculated the sample size using the sampling formula {N = [(Z²)p(1-p)]/d²}[16], which determined that at α = 0.05, P = 0.3, and d = 0.03, the sample size needed was approximately 896 individuals. The sample size of 2038 in the present study should be sufficient.

In an attempt to control the pandemic, the government had imposed a nationwide lockdown. Hence, this cross-sectional survey was conducted online, which was also safer and convenient. For 6 d, students were invited to participate in the survey via Tencent’s QQ, WeChat, Weibo, and college-related websites, such as university association websites and bulletin board system forums. Participants who clicked the survey link would be automatically directed to the questionnaire website page. It would not be proceeded to the next page unless participants completed all the items on the current page so that there was no missing data for those who completed the questionnaire. Participants received 10 RMB via online payment (equivalent to USD 1.5 at the time) on completion of the survey, which took approximately 20 min. Recruitment and data collection procedures were approved by the Human Research Ethics Committee (No: 2020005) of Shenzhen University.

Dependent variables: The independent variables were PTSD and PTG. PTSD symptoms were assessed using the abbreviated PTSD Checklist-Civilian version (PCL-C)[17,18]. It consists of six items that correspond to six different symptoms. The respondents rated the frequencies of symptoms over the past 1 mo on a 5-point Likert scale that ranges from 1 (not at all) to 5 (extremely). To assess participants’ PTSD related to the COVID-19 pandemic, we revised “stressful experience” in this scale to “COVID-19 pandemic” (e.g., “Feeling very upset when something reminded you of COVID-19 pandemic from the past”). Higher total scores indicate more severe PTSD symptoms. The PCL-C possesses good psychometric with a sensitivity of 0.78 and specificity of 0.71[17]. In the present study, the results indicated a good internal reliability (Cronbach’s α = 0.81) of this scale.

PTG was assessed using the 21-item Posttraumatic Growth Inventory (PTGI)[19]. It includes five dimensions: Relating to others (seven items), new possibilities (five items), personal strength (four items), spiritual change (two items), and appreciation of life (three items). Previous studies conducted by two different research groups indicated that few persons, including Chinese college students, expressed religious beliefs and spiritual change (two items); therefore, these items were deemed not applicable to the local culture and were finally excluded from this study[20,21]. All items were rated on a 6-point scale ranging from 0 (no change) to 5 (complete change). Sum scores were obtained, ranging from 0 to 95, with higher scores representing higher levels of PTG. The inventory in prior studies was found to have good psychometric properties in the Chinese context with an internal reliability of 0.88[22-24]. In this study, the internal reliability of the inventory was 0.95 and the internal reliabilities for the 4 subscales were 0.88, 0.86, 0.81, and 0.82, respectively.

Independent variable: The independent variable was childhood exposure to domestic violence, which was selected from the Chinese version of the revised Adverse Childhood Experiences Question. More specifically, this scale was used to measure domestic violence experienced in the first 18 years of life[25,26]. It contains 4 items and each item was rated on a 5-point scale ranging from 1 to 5 (1 = never, 2 = once or twice, 3 = sometimes, 4 = often, and 5 = very often). The total scores were used, with higher scores representing a higher frequency of exposure to domestic violence. The Chinese version of the revised Adverse Childhood Experiences Question possesses good psychometric properties with an internal reliability of 0.83[26]. In this study, the internal reliability of the scale was good (Cronbach’s α = 0.84).

Mediation variables: The mediation variables were self-compassion and resilience. Self-compassion was assessed using the Self-compassion Scale, which has 26 items on 6 dimensions: Self-kindness (5 items), self-judgment (5 items), common humanity (4 items), isolation (4 items), mindfulness (4 items), and over-identification (4 items). All items were rated on a 5-point scale ranging from 1 (almost never) to 5 (almost always). Self-judgment, isolation, and over-identification should be scored in reverse, then a grand mean was computed based on the mean of all six subscales, with higher scores reflecting a greater level of self-compassion. This scale was adapted in Chinese, with good reliability (Cronbach’s α = 0.96) and validity reported among Chinese adolescents and college students[27-29]. In this study, the internal reliability of the scale was good (Cronbach’s α = 0.87), and the internal reliabilities for the 6 subscales were 0.81, 0.65, 0.68, 0.75, 0.81, and 0.66, respectively, indicating an acceptable reliability.

Resilience was assessed using a short version of the Connor–Davidson Resilience Scale (CD-RISC). It reflects the ability to tolerate experiences, such as change, personal problems, illness, pressure, failure, and painful feeling[30]. Participants responded to 10 items on a 5-point Likert scale (0 = not true at all to 4 = true nearly all of the time), with total scores ranging from 0 to 40 (higher points indicate greater resilience capacity). This original scale in Chinese was adapted and reported with good reliability (Cronbach’s α = 0.88) and validity[31,32]. In this study, the results indicated an excellent internal consistency (Cronbach’s α = 0.92).

First, the mean ± SD or distribution was calculated for all variables. Second, partial correlations were performed to examine the association between domestic violence and PTG, PTSD, self-compassion, and resilience while controlling the age, gender, subjective social economic status, and family structure. Third, to examine the mediating role of self-compassion and resilience in the relationship between domestic violence and PTG and PTSD, a series of structural equation models were built. First, we established a direct model from domestic violence to PTG and PTSD and relational paths among PTG and PTSD were then added. Second, based on the direct model, an indirect model with the mediators (self-compassion and resilience) inserted between domestic violence and PTG and PTSD was built. In this indirect model, the predictive paths from self-compassion to resilience were added. The specific mediation pathways were presented as below: domestic violence → self-compassion → resilience → PTG/PTSD; domestic violence → resilience → PTG/PTSD; domestic violence → self-compassion → PTG/PTSD. Finally, a parsimonious model constraining non-significant paths to zero was built to further identify the indirect effect of domestic violence and PTG/PTSD via self-compassion and resilience. In the process of path analysis, all aforementioned variables were treated as observed variables in terms of their total scores, with controlling the cofounders as above. For all pathways, standardized direct, specific indirect, total indirect, and total effects were estimated. Standardized values were reported for all estimations. The goodness of fit was assessed using the following fit indices: Comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). Thresholds used were as follows: For CFI and TLI, excellent fit > 0.95 and moderate fit > 0.90; for RMSEA and SRMR, excellent fit < 0.05 and moderate fit < 0.08.

The descriptions of cofounders are as follows: Gender, 755 males and 1286 females; age, 20.56 (SD = 1.90) years; subjective social economic status, 4.85 (SD = 1.38); family structure, 1859 intact families and 179 non-intact families. Table 1 shows the mean ± SD for all variables, as well as results from partial correlation analyses between every two variables (domestic violence, self-compassion, resilience, PTG, and PTSD). The mean variable values were as follows: PTG, 60.97 (SD = 16.95); PTSD, 11.79 (SD = 4.25); resilience, 35.45 (SD = 6.62); self-compassion, 84.75 (SD = 11.88); and domestic violence, 4.76 (SD = 1.72). Further, the results of partial correlations while controlling the age, gender, subjective social economic status, and family structure, showed that PTG was significantly positively correlated with self-compassion and resilience (P < 0.001), but significantly negatively correlated with domestic violence (P < 0.001). Moreover, PTSD had a positive association with domestic violence (P < 0.001), but negatively correlated with resilience and self-compassion (P < 0.001). Similarly, resilience was significantly positively correlated with self-compassion (P < 0.001), whereas resilience and self-compassion were negatively correlated with domestic violence (P < 0.001).

First, the results indicated that domestic violence had a direct effect on PTG and PTSD. This model fits the data better (χ² = 424.026, df = 49, P = 0.000, CFI = 0.966, TLI = 0.951; RMSEA = 0.061, 90%CI (0.056, 0.067), SRMR = 0.024), while controlling the age, gender, subjective social economic status, and family structure. Results from the path analysis showed that domestic violence was negatively associated with PTG (β = -0.100, 95%CI: 0.147 to -0.052, P < 0.001) and positively associated with PTSD (β = 0.083, 95%CI: 0.033 to 0.135, P < 0.005). This indicated that domestic violence was a common factor in PTG and PTSD.

Based on the results of the direct effect model, an indirect effect model was established controlling the cofounders as above. The results indicated a complete model with fit indices as follows: χ² = 891.522, df = 128, P < 0.001, CFI = 0.960, TLI = 0.943; RMSEA = 0.054, 90%CI (0.051-0.057), SRMR = 0.045. The path analysis showed that the paths between domestic violence and resilience were non-significant, and the remaining paths were statistically significant. Next, we removed the non-significant path above; constraining these paths to zero caused no degradation in fit. Using these procedures, a parsimonious model was built (Figure 1) controlling the cofounders as above. The result also indicated a good model with the following fit indices: χ²= 891.564, df = 129, P = 0.000, CFI = 0.960, TLI = 0.943; RMSEA = 0.054, 90%CI (0.051 to 0.057), SRMR = 0.045. The path analysis showed that domestic violence was significantly negatively related to PTG via a 1-step indirect path of self-compassion (β = -0.023, 95%CI: -0.044 to -0.007, P < 0.01) and by one 2-step indirect path of self-compassion to resilience (β = -0.008, 95%CI: -0.018 to -0.002, P < 0.05). Domestic violence was significantly positively related to PTSD via a 1-step indirect path of self-compassion (β = 0.008, 95%CI: 0.002 to 0.021, P < 0.07) and by one 2-step indirect path of self-compassion to resilience (β = 0.013, 95%CI: 0.004 to 0.024, P < 0.01). The detailed information is listed in Table 2. These findings suggest that self-compassion to resilience mediates the relationship between domestic violence and PTG and PTSD and that the mechanisms underlying the association between domestic violence and PTG and PTSD are similar.

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Figure 1 Multiple indirect effects model after controlling age, gender, subjective social economic status, and family structure. ^aP < 0.05, ^bP < 0.01, ^cP < 0.001. PTG: Posttraumatic growth; PTSD: Posttraumatic stress disorder.

It was reported that domestic violence had a 30 percent incidence, which always happened in front of children or adolescents, causing an increased risk of psychological problems such as posttraumatic stress disorder (PTSD) symptoms. But some people who are exposed to domestic violence perform positive changes in psychology such as posttraumatic growth (PTG). It is unclear whether PTG and PTSD share a common underlying mechanism. The present study is exploratory to reveal it during the coronavirus disease 2019 (COVID-19).

Based on the shattered world assumption theory, the PTG model, and conservation of resources theory, this study hypothesized that the self-compassion and resilience are the common factors for PTG and PTSD. The present study addressed the mediator roles of self-compassion and resilience. It may inform future mental health interventions for certain individuals.

The present study aimed to explore the common mechanism of PTG and PTSD, revealing the mediating role of self-compassion and resilience between exposure to domestic violence and PTG/PTSD.

A nationwide cross-sectional online survey was conducted in China during the COVID-19 pandemic. The data was collected using the Chinese version of revised Adverse Childhood Experiences Question, Self-compassion Scale, Connor-Davidson Resilience Scale, PT Growth Inventory, and the Abbreviated PTSD Checklist-Civilian version. A structural equation model was conducted to analyze the data.

The path analysis indicated that exposure to domestic violence was significantly correlated with PTG and PTSD via a 1-step indirect path of self-compassion and via a 2-step indirect path from self-compassion to resilience. The 1-step indirect path of resilience did not reach significance.

PTG and PTSD share a common mechanism for those who were exposed to domestic violence. Those who perform a lower level of self-compassion would tend to difficultly bounce back to normal, causing an increased risk of PTSD and decreased possibility of PTG, and vice versa.

From a clinical perspective, the intervention study could be considered in investigating the roles of self-compassion and resilience for vulnerable individuals.