Exposure to trauma not only contributes to harmful mental health impact, but may also be associated with continued normal functioning or even induce positive changes [1]. The latter outcomes may be attributable to positive dynamic psychological processes, such as post-traumatic growth and resilience [2, 3]. Resilience refers to a personal trait that enables bouncing back and adapting in an efficient way after stress and adversity [4], which does not exclude the presence of psychopathology [5]. Posttraumatic growth (PTG) is a distinct but complementary concept related to resilience, defined as personal growth and positive emotional experiences that actively develop while struggling to heal after traumatic and stressful events [6]. The presence of resilience and PTG is associated with positive indicators of mental health (e.g., self-esteem [7, 8], perceived social support [7, 9], positive affect [10, 11], sleep quality [12–14]), and are manifested in greater well-being [15]; whereas when lacking, they are related to a range of mental health and behavioral problems [16–18]. Interestingly, resilience and PTG have proven to be modifiable through interventions [19]. A critical step in assessing the efficiency of such interventions is the use of measurement instruments. Therefore, to prevent negative outcomes and promote mental health and wellbeing after exposure to traumatic or stressful life events, valid and reliable assessment measures are needed.
To this end, Connor and Davidson developed a 25-item five-factor measure, the Connor-Davidson Resilience Scale (CD-RISC), which assesses resilience through self-report [4]. Despite being one of the best three resilience scales in terms of psychometric quality [20] and the most widely used worldwide, this original English version of the CD-RISC has demonstrated unstable psychometric properties across societies and cultures (i.e., inconsistent number of items [21–23] and/or factors [24–27]). This motivated many researchers to develop shorter and more psychometrically sound versions (10 and 2 items) [28], from which the most stable and most reliable at capturing the resilience construct is the 10-item version (CD-RISC-10) [29]. The CD-RISC-10 has been translated into different languages, including French [30], Spanish [31, 32], Finnish [33], South African [34], Persian [35], and Chinese [36]; it has also been tested in different specific populations, i.e., students [34, 36, 37], community young adults [31, 32, 38], older adults [33, 39, 40], and adults on the autism spectrum [41]. However, an Arabic shortened version of the CD-RISC has not been developed so far to the best of our knowledge.
On the other hand, the gold standard for the assessment of PTG is the Post-Traumatic Growth Inventory (PTGI), a six-point 21-item scale that has been developed by Tedeschi and Calhoun [42]. The PTGI measures positive changes following trauma. Since this original version published in 1996, there has been a few attempts to develop shortened versions of the PTGI including a 10-item five-factor structure version by Cann et al. (Posttraumatic Growth Inventory-Short Form; PTGI-SF) [43], an 8-item four-factor structure version by GarridoHernansaiz et al. [44], and a 5-item one-factor structure version by Gómez-Acosta et al. [45]. The PTGI has been largely used to thoroughly investigate PTG in various populations and cultures [46]. In the present work, we are interested in the 10-item and 8-item PTGI-SF, which have been translated in several languages including Spanish [44, 47], Portuguese [48], French [49], Italian [50], Urdu [51], Malay [52], and Persian [53]. The 10-item PTGI-SF has been validated in the Arabic language in a sample of Palestinian professional helpers [54]; however, Palestinians represent a specific and particularly vulnerable population due to their prolonged exposure to political violence, war experiences, and mental healthcare shortages [55]; and might not be representative of the broader Arabic-speaking population. This suggests that its validation in another Arab context is needed to confirm its cross-cultural validity.
The Arab context
During the last decades, Arab countries have undergone a series of conflicts, wars and terrorist attacks [56]; and faced, like all other countries, increasing disaster and climate-related threats [57, 58]. Nevertheless, most of the research literature emerging from the Arab world have focused on the negative psychological effects of experiencing these crises (e.g., [59–64]); while only very few studies addressed resilience and PTG [65–68]. This highlights the importance of investigating and deepening the understanding of positive human responses to trauma and stress in the specific Arab context. Indeed, given their clinical significance and impact on stress response and their potential malleability, resilience and PTG should receive greater attention as relevant constructs in clinical and research practice in the Arab context. As such, there is a strong need to provide clinicians and researchers with standardized methods and valid, reliable scales in the Arabic language to evaluate these constructs.
The present study
Validating the short forms of the CD-RISC and the PTGI for Arabic-speaking people is valuable for more than one reason. First, resilience and PTGI are culturally-dependent constructs [69, 70], and may be subject to change according to personal contexts and circumstances [4]. As such, developing brief, easy-to-use measures in the Arabic language can help promote research on these constructs in the under-researched Arab-speaking populations, and therefore enhance our knowledge of how resilience and PTGI models differ across cultures, contexts and groups [69]. Second, the target population of these scales (i.e., CD-RISC and PTGI) are generally survivors of major life crises (e.g., cancer, natural disasters, wars, terrorism), who are likely to lack time and energy when responding to the questionnaire [43]. Third, administering a reduced number of items implies lower costs of data gathering, which is of high interest economically in the low-middle income Arab countries. Fourth, the available CD-RISC and PTGI adaptations are not completely homologous to each other across countries, cultures and settings. Given that there is no Arabic version of the CD-RISC-10 and the 8-item PTGI-SF, and the fact that PTGI-SF has only been validated in a narrow context and a particular population (i.e., Palestinian health providers); the need for an Arabic translation of these instruments in an Arabic-speaking population with extended sociodemographic and cultural characteristics is evident.
We aimed through the present study to test the reliability and validity of Arabic translations of the CD-RISC-10, the 10-item and the 8-item PTGI-SF in Lebanese adults from the general population, with the approval of the original developers. We expect that the three scales will show a one-factor structure, good internal consistency, measurement invariance across gender; and that their total scores will be positively correlated with emotion regulation, which corresponds to the way how individuals shape, experience and express their emotions [71].