Research Proposal (Apendi Martha Amelia)

Traumatic exposure, Post traumatic stress disorder and Post traumatic growth/resilience among
Refugees in Uganda
Apendi Martha Amelia
2022/HDO3/2802U
A research proposal in partial fulfillment for the Master's degree in Clinical psychology
January 2023
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Table of contents
Chapter one......................................................................................................................................3
Background..................................................................................................................................3
Statement of the problem.............................................................................................................2
Purpose of the study.....................................................................................................................3
Objective......................................................................................................................................3
Significance..................................................................................................................................3
Scope of the study........................................................................................................................4
Conceptual Framework................................................................................................................5
Theoretical framework.................................................................................................................5
Chapter two......................................................................................................................................7
Traumatic exposure......................................................................................................................7
Posttraumatic stress disorder........................................................................................................8
Post traumatic growth/Resilience.................................................................................................8
Traumatic exposure and Post traumatic growth...........................................................................9
Traumatic exposure and Post traumatic stress disorder.............................................................10
Post-traumatic stress disorder and Post traumatic growth/resilience.........................................11
Hypothesis..................................................................................................................................11
Chapter Three................................................................................................................................12
Methods.........................................................................................................................................12
Study design...............................................................................................................................12
Sample design/Sampling technique...........................................................................................12
Instruments and measures..........................................................................................................12
Post traumatic diagnostic scale (PDS – 5).................................................................................13
Post-Traumatic Growth Inventory (PTGI)/ Connor-Davidson Resilience Scale -10 (CD-RISC -

10)..............................................................................................................................................13
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Procedure and ethical considerations.........................................................................................14
Institutional Review Board (IRB)..............................................................................................14
Consent forms............................................................................................................................14
Confidentiality...........................................................................................................................14
Standard Operating Procedures (SOPs) for COVID 19 and Ebola............................................15
Data management.......................................................................................................................15
Post traumatic diagnostic scale (PDS – 5).................................................................................15
Post Traumatic Growth Inventory (PTGI)/ Connor Davidson Resilience Scale (CD-RISC-10)
....................................................................................................................................................15
Data analysis..............................................................................................................................16
References......................................................................................................................................17
Appendix........................................................................................................................................21
Work plan/time schedule...........................................................................................................21
Budget........................................................................................................................................21
Instruments.................................................................................................................................21
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Chapter one
Background
A rising number of refugees are residing in Uganda. Uganda hosts the largest refugee
population in Africa and gets the third-highest number of refugees worldwide, behind Turkey
and Pakistan (Bohnet & Schmitz-Pranghe, 2019). Beginning in 2022, Uganda was the biggest
nation on the continent of Africa and one of the most well-known countries that hosted refugees,
housing roughly 1.5 million refugees. (Uganda Population Statistics Dashboard - November,
n.d.) with many of them fleeing from their countries of origin such as Congo, South Sudan,
Somalia due to war, violence and other unforeseeable difficult experiences. Evidence from a
2009 study by Onyut et al. among the Democratic republic of Congo (DRC) refugees in the
Nakivale Refugee Settlement in Uganda supports the claim that many of the refugees from the
DRC experience or witness various traumatic events. They discovered that 73 % of their
respondents said they had seen dead or dismembered bodies, 69.3% had seen bomb or shelling
attacks, 67.7 % had seen someone get hurt using a weapon, 60.3% had seen crossfire or sniper
attacks, and 60.2% had seen burning houses all these events were extremely distressing and had
a profound impact on a their wellbeing (Ainamani et al., 2016). Posttraumatic stress disorder
(PTSD) is a significant contributor to the global disease burden, affecting nearly 4% of the
world's population. (Ng et al., 2020). These PTSD rates ranged between 13% and 25%, which is
roughly comparable to the World Health Organization's estimate of 20% for the median
prevalence of mental disorder in societies exposed to humanitarian emergencies (Steel et al.,
2020). With a lot of research being documented on the negative impacts of the traumatic
experiences little is still known on Post traumatic growth (PTG). PTG develops after a traumatic
experience and during the struggle to find a new normal, while resilience involves the capacity to
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deal with negative emotions that come from a stressful experience and function at or near normal
levels (maintain a stable equilibrium) (Greup et al., 2018). Resilience and PTG can both be
thought of as processes and results, but the terms shouldn't be used interchangeably. Adversity
and positive adaptation are two crucial concepts that often result in resilience (Yuan et al., 2018).
Thus where resilience involves a specific construct of one’s ability to cope and adjust in difficult
situations, PTG involves a general and broader sense of well-being. In the trauma field, the
realization that not everyone exposed to potentially traumatic events developed psychopathology
prompted a paradigm shift to focus on the various positive and negative pathways in the
aftermath of trauma (Ssenyonga et al., 2013). Empirical research demonstrates that after a
traumatic event, an individual may as well experience positive changes, including a greater
appreciation of life, the strengthening of close relationships, the recognition and elaboration of
one's own strengths, the recognition of new opportunities, and spiritual growth (Măirean, 2016).
Statement of the problem
Due to the unique challenges that refugees confront that other groups do not, the
available research does not fully depict the specific PTG/resilience profile of refugees. (Chan et
al., 2016). Even though distressing or traumatic experiences can leave survivors with lasting
psychological symptoms of PTSD, many of them may only go through minor setbacks or even
come out stronger. After a traumatic exposure, they may report a new and healthier lifestyle, an
increase in spiritual interest, increased maturity and improved social relationships, which are
indicators of PTG/resilience (Kılıç et al., 2016). By understanding the factors that can influence
an individuals' response to trauma, it is possible to develop more effective interventions and
support systems for those who are at risk of developing negative outcomes following a traumatic
event.
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Purpose of the study
The purpose of the study is to determine the relationship between traumatic exposure,
post traumatic stress disorder and post traumatic growth/resilience among refugees in Uganda.
Objective
To find out the relationship between traumatic exposure and post traumatic
growth/resilience among refugees
To identify the relationship between traumatic exposure and post traumatic stress
disorder among refugees.
To examine the relationship between post traumatic stress disorder and post traumatic
growth/resilience.
To establish the mediating/moderating role of resilience in the relationship between
traumatic exposure and post traumatic growth/PTSD
Significance
The study may help Non-Government Organizations (NGOs) and Community Based
Organizations (CBOs) to identify the factors underlying Post Traumatic Growth hence develop
programs to prevent the negative aftermaths faced by refugees after being exposed to traumatic
events.
This study may help the government address the concerns of refugees and give priority to
their mental health after resettlement with the help of the findings from this research.
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Since a copy of this research may be kept in the university library and other academic
reading sites this study may be used as a reference manual by students and academicians
interested in the study.
This study may help respondents gain more information and understanding of the
traumatic experiences and the influence on their lives especially during their participation.
Scope of the study
This study will focus on rural refugees who are adult males and females (18– 35 years)
living in Kyaka refugee settlement in Kyegegwa district. It’s one of the refugee settlements with
the highest number of refugees in Uganda, hosts refugees from Democratic republic of Congo
(DRC) with recent conflicts in the nearby countries increasing new arrivals per day.
Traumatic exposure refers to the experience of a traumatic event which is defined as
exposure to “actual or threatened death, serious injury or sexual violence” which can happen
directly to a person, indirectly through witnessing or learning about a loved one experiencing a
traumatic event, or repeatedly being exposed to traumatic events that have happened to others
(Degenhardt et al., 2022). PTSD is a mental illness that may arise from exposure to exceptionally
terrifying or threatening events; it can happen as a result of a single traumatic event or from
repeated trauma exposure (Bisson et al., 2015). PTG is defined as the experience of positive
psychological change as a result of the struggle with highly challenging life circumstances
(Tedeschi & Calhoun, 2004). It should be noted that PTG isn’t just the absence of negative
emotion or difficulties but the presence of positive psychological change in spite of those
challenges. Resilience is the ability to withstand or tolerate adversity without experiencing
lasting negative effects (Tedeschi et al., 2018).
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Conceptual Framework
Resilience
Social support PTG /PTSD
Facing failure Appreciation of life
Traumatic Increased Sense of personal
exposure Meaning in life
growth
War related Meaningful relationships
exposure
Violence
exposure Social support
(physical and Flash backs
sexual) Nightmares
Uncontrollable thoughts
Figure 1
A conceptual framework showing the relationship between Traumatic exposure, Resilience
and Post traumatic growth/Post traumatic stress disorder among Refugees.
This conceptual frame work suggest that Traumatic exposure can lead to the development
of PTSD in some individuals but it can also lead to positive psychological changes and growth
which is PTG/Resilience in others, however it also explains that some refugees can develop
PTSD and still adapt and grow through their negative experiences. It is important to note that
note all refugees who experience a traumatic event will develop PTSD and not all refugees who
experience a traumatic event will develop PTG/resilience.
Theoretical framework: Cognitive adaptation theory
Humans deal with hazards in their life, according to the Theory of Cognitive Adaptation,
by creating a sequence of optimistic illusions that protect their psychological health (Taylor,
1983). Positively tilted cognitions are not considered delusory or erroneous, but rather a sign of
mental health because they allow for hope, personal growth, and adaptability.
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Based on the cognitive adaptation theory, traumatic events challenge people's ideas about
the self and the environment. The adjustment process, it is said, revolves around three themes: a
search for meaning in the experience, an endeavor to reclaim power over the event in particular
and over life in general, and an attempt to restore self-esteem through self-enhancing
appraisals(Czajkowska, 2017). Therefore, according to cognitive adaptation theory, resilient
people are those who can maintain strong self-esteem, personal control, and optimism in the
midst of adversity and trauma.
Furthermore the cognitive adaptation theory asserts that when components of the
cognitive adaptable index, such as optimism, mastery, and self-esteem, are increased, both global
and particular PTSD symptoms are reduced (Schwabish, 2011).
However, the cognitive adaptation theory has been challenged for focusing on illusions
about the good nature of the event or effects, rather than what happens when the illusions are
incorrect. Because people can achieve a goal or hold a belief in various ways, the idea is said to
have less impact than intended. (Taylor, 1983).
Chapter two
This section discusses the review of different literature on the relationship between
traumatic exposure, post traumatic stress disorder and post traumatic growth among/resilience
refugees. It majorly has six sections namely; traumatic exposure, post traumatic stress disorder,
post traumatic growth/resilience, traumatic exposure and post traumatic growth/resilience,
traumatic exposure and post-traumatic stress disorder and post traumatic stress disorder and post
traumatic growth/resilience.
Traumatic exposure
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Almost 80 million people are currently forcibly displaced worldwide, including 26
million refugees. These forcibly displaced individuals fled to various nations in search of safety.
Their journey has been influenced by numerous factors. Particularly, due to persecution, war,
and/or violence, refugees and asylum seekers flee their country, and many of them experience
torture and trauma (Ziersch et al., 2020). During their journey from their home to their new
country of residence, refugees are frequently exposed to violence at various points, which can
cause physical or mental health issues that negatively impact their psychosocial adjustment.
(Scoglio & Salhi, 2021). Approximately 28 to 90 percent of people in developed countries,
according to studies of the general population, report having experienced at least one Traumatic
event in their lifetime. The most common occurrences are unexpected loss of a loved one, auto
accidents, and muggings. Unsurprisingly, the authors discovered that men and women report
different types of events; men report more injuries, accidents, and physical assault, while women
report more sexual assault (Benjet et al., 2016). While war and armed conflict cases are on the
rise, contributing to the high disease burden we see today. People who live in conflict zones
however endure ongoing violence as well as poverty, limited access to healthcare, and food
insecurity (Mesa-Vieira et al., 2022). These experiences are not only encountered during pre-
migration that is during their flight but refugees share experiencing them even after resettlement.
Posttraumatic stress disorder
According to research, psychological disorders are more common in refugee populations
than in the general population. Studies show that refugees not only frequently encounter a wide
variety of potentially traumatic experiences in their home countries and during displacement, but
that these experiences are also frequently repeated and have a lasting impact (Li et al., 2016).
These experiences can include physical and sexual violence, loss of loved ones, forced
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displacement and exposure to war and conflict. Approximately 3% of adult population suffers
from PTSD at any given time. Lifetime prevalence ranges from 1.9 percent to 8.8 percent, but in
areas affected by conflict, this rate doubles and rises to more than 50 percent among rape
survivors.(Bisson et al., 2015) . This demonstrates that the prevalence of PTSD can vary
depending on a range of variables, such as the kind of trauma experienced and the population
being studied. Thus these studies show that many people who experience trauma are able to not
only cope with the challenges they face, but also use those challenges as an opportunity for
personal growth and development.
Post traumatic growth/Resilience
Although a lot of research has concentrated on the negative effects of trauma and on
coping mechanisms for stressful life events like loss or suffering, since the 1990s, there has been
a lot of attention paid to the potential for experiencing positive psychological changes after
exposure to extremely difficult life circumstances (Shamia et al., 2015). The psychological
upheaval that follows a trauma leads to post-traumatic growth. Following an experience, the
mind goes through a cognitive process that produces useful processing, which in turn results in
growth. Each person experiences severely stressful events differently afterward (Naik & Khan,
2019). Although some people show negative decline and others report no change, many people
report positive growth following adversity (Naik & Khan, 2019) . Despite being comparable
since they are both regarded to be outcome processes, post-traumatic growth and resilience are
also highly dissimilar. In contrast to PTG, which prevents a return to baseline functioning,
resilience is the ability to withstand or tolerate adversity without experiencing lasting negative
effects (Tedeschi et al., 2018). Resilience may be understood as a personal trait. The more
resilient a person is, the less likely someone is expected to experience cognitive struggle, so he or
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she may be less likely to experience profound transformational changes such as PTG (Tedeschi
et al., 2018). Furthermore, the available research indicates that resilience to violent and life-
threatening situations is rather widespread and that more than three-quarters of people who
experience trauma are resilient (Lee et al., 2020). This realization then proves the need for this
research to rule out the similarity and difference of resilience and Post traumatic growth among
the refugee population to also rule out the meaning of Post traumatic growth among the refugee
population in Uganda.
Traumatic exposure and Post traumatic growth
Findings reveal that shared traumas that target a community or group of individuals lead
to more PTG than man-made traumas that target an individual. .(Abraham et al., 2018). This may
be because individual who experience shared traumatic experiences may feel a sense of
belonging and support from their community which can aid in the healing process and facilitate
growth. However, it’s important to note that there can be other factors that can facilitate an
individual’s ability to develop PTG and its possible for an individual to develop PTG from
individual traumatic experiences as well. Recent research suggests that many survivors of
traumatic events, in addition to experiencing the symptoms of posttraumatic stress, report
positive changes in their lives as a result of facing trauma (Hussain & Bhushan, 2013). These
positive psychological changes which include a greater appreciation of life, improved
relationships a sense of personal strength and a greater spiritual understanding have been related
to PTG. However, it’s important to note that PTG is a complex phenomenon not everyone
exposed to traumatic events will experience PTG and that traumatic events can have different
impacts on people hence making it personal event.
Traumatic exposure and Post traumatic stress disorder
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In terms of deaths, injuries, and long-term effects, war, armed conflict, political unrest, and other
forms of organized violence account for a sizable portion of the global burden of disease (Mesa-
Vieira et al., 2022) with different mental health problems such as anxiety depression and PTSD
as the most common conditions. Research has been done on the refugee population resettled in
the Ugandan refugee settlements in Africa who have been exposed to traumatic experiences
which show that in northern Uganda, PTSD was discovered in 46% of Sudanese refugees and
18% of Ugandan citizens. Among Somali community refugees, it was also discovered that 32%
of adults suffer from PTSD (Bapolisi et al., 2020), according to two previous studies in the
Nakivale refugee settlement, In the first study, PTSD prevalence was found to be 61% among
Congolese, and in the second, it was found to be 32 and 48.1% among Rwandan and Somali
refugees (Ssenyonga et al., 2013). Although there is still a lot of material on PTSD as a result of
traumatic exposure, it should also be taken into consideration that the body of knowledge on
posttraumatic growth (PTG) is expanding, and a focus of attention is shifting to the contradictory
findings in the literature on the symptoms of posttraumatic stress disorder (PTSD) and PTG (Liu
et al., 2017).
Post-traumatic stress disorder and Post traumatic growth/resilience
The connection between PTG and PTSD is a subject of debate. According to studies, the
degree of the traumatic experience is correlated with PTG, and veterans and former prisoners of
war with PTSD reported higher levels of PTG than those without PTSD (Cengiz et al., 2018).
Furthermore, Increased exposure to traumatic events and the amount of time that passed after the
traumatic events affected the level of PTG, according to the findings of a study among
psychiatric outpatients with immigrant backgrounds, while PTG is not linked to PTSD, a
different study found that the two coexist (Cengiz et al., 2018). Refugees are significantly more
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likely to experience psychological distress due to their exposure to traumatic life experiences that
occurred prior to, during, and after their flight. However, not everyone who experiences
traumatic life events exhibits psychological anguish, PTSD, or other symptoms due to protective
factors such as resilience, social support and mean making in life the authors argued that resilient
people experience temporarily elevated distress when an adverse event happens but their distress
declines over time reflecting their normal variation in mood, distress, and functioning (Tekie,
2018).
Hypothesis
The aims to test the following hypothesis;
There is a significant relationship between traumatic exposure and post traumatic
growth/resilience
There is a significant relationship between traumatic exposure and post traumatic stress
disorder
There is a significant relationship between post traumatic stress disorder and post
traumatic growth/resilience
Post traumatic stress disorder significantly mediates the relationship between traumatic
exposure and post traumatic growth/resilience.
Chapter Three
Methods
This chapter focuses on the methodological aspects which include the study design, study
population and setting, sample size and sampling techniques, instruments and measures,
procedure and ethical considerations, data management and data analysis.
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Study design
The research will be quantitative in nature, use a cross sectional study and implore a
correlation study design to ascertain the relationship between traumatic exposure, post-traumatic
stress disorder, and post-traumatic growth/resilience. Studies that examine relationships between
variables and the outcome of interest are known as correlational studies. Furthermore, those
conducted all at once or over a brief period of time are cross sectional studies (Levin, 2006).
Study population and setting
The study sample will comprise of adults in Kyaka refugee settlement in Kyegegwa district.
Sample size and sampling techniques
A total sample size of 566 refugees will be targeted using G power with Correlation ρ
H1: .143, α err prob: .01, Power (1 – β err prob): .8, Correlation ρ H0: 0. The respondents to
participate in the study will be obtained using the purposive sampling which rests on the theory
that sometimes researchers must pre-select subgroups from an entire population to create a case
study or shape a grounded theory.
Inclusion and exclusion criteria
Refugees both male and female between the age of 18-35 years residing in Kyaka ii
refugee settlement will be eligible. Participants not able to travel to and from the place of the
assessment will be excluded.
Instruments and measures
Structured interviews will be used with section A will include Biodata (Background
information), section B will measure Traumatic exposure using the Trauma history screen,
section C will measure PTSD using Post traumatic diagnostic scale, section D using measure
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PTG/ Resilience using Post traumatic growth inventory and Connor Davidson resilience scale
respectively.
Trauma history screen (THS)
Carlson et al. (2011) created the THS in California. The Trauma History Screen (THS) is an
easy-to-use, 14-item self-report questionnaire that asks about 13 different event categories as
well as "other" occurrences. Respondents are questioned about whether each event happened for
each occurrence ("yes" or "no"). The number of times the endorsed occurrences occurred is then
asked for by the respondents to mark. The next question asks respondents to provide specifics
regarding incidents "that really hurt you emotionally." Age at the time of the occurrence, actual
or imminent danger of death or harm, helplessness, dissociation, a four-point scale for distress
length ("not at all" to "a month or more"), and a five-point scale for distress intensity are all
evaluated ("not at all" to "very much") (Carlson et al., 2011). The THS has shown excellent
temporal stability with test–retest correlations of 0.93 for High Magnitude Stressors (HMS) and
0.73 for Post traumatic distress (PPD) events in a subset of this sample of homeless veterans, and
construct validity was supported by strong convergent validity with a longer measure of trauma
exposure (0.77) and correlations between PTSD symptoms and HMS (0.41) and PPD scores
(0.25) (Carlson et al., 2013).
Post traumatic diagnostic scale (PDS – 5)
PDS – 5 was developed by Enda B. Foa 1995. The PDS-5 is a 24-item self-report
measure that assesses PTSD symptom severity in the last month according to DSM-5 criteria.
Symptom items are rated on a 5-point scale of frequency and severity ranging from 0 (Not at all)
to 4 (6 or more times a week / severe. Because the items on the Post-Traumatic Stress Diagnostic
Scale (PDS) accurately capture a person's experience with PTSD and have good internal
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consistency, the PDS has a high face validity (alpha coefficient of 0.92). Ages 18 to 65 people
were used to validate this scale (Foa et al., 2016) The PDS's alpha coefficients indicate that the
scale's overall score (.89) and its subscale scores (.80 for the Re-experiencing subscale,.71 for the
Avoidance subscale,.78 for the Hyper-arousal subscale, and.86 for the items evaluating
functional impairment) have extremely strong internal consistency.
Post-Traumatic Growth Inventory (PTGI)/ Connor-Davidson Resilience Scale -10 (CD-
RISC - 10)
The Post-Traumatic Growth Inventory (PTGI), created by Tedeschi and Calhoun in 1996
at the University of Carolina, measures a person's post-trauma growth and self-improvement.
This inventory, a 21-item scale based on the five-factor (Relating to Others, New Possibilities,
Personal Strength, Spiritual Enhancement, Appreciation). model of Tedeschi, is one of the most
valid and dependable tools for assessing human development following a stressful experience.
The PTGI measure factors' psychometric qualities have been reported: Internal consistency
(α=0.90) was determined to be strong, and test-retest reliability (r=0.71) was good. Scores on the
measure were found to be relatively regularly distributed across people reporting a variety of life
difficulties (Keidar, 2013). Davidson, created the Connor-Davidson Resilience Scale (CD-
RISC). CD-RISC-10. The 10-item scale is made up of ten of the original 25 CD-RISC-10 scale
items. Drs. Campbell-Sills and Stein of the University of California, San Diego created this 10-
item scale, based on factor analysis. The CD-RISC-10 items version's (Spanish version)
Cronbach's alpha was .88 (Broche-Pérez et al., 2022).
Ethical considerations and procedures
The researcher will obtain an ethical clearance from the Institutional Review Board
(IRB). Furthermore, the researcher will obtain a letter of introduction from the Department of
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Mental health, School of Psychology Makerere University which will be delivered to the Office
of the Prime minister (OPM) requesting authorization to collect data from the specified refugee
settlement. Simple language, clear and understandable questions will be used to enable easy data
collection. Consent will be obtained from the respondents to participate in the study and ensure
that they participate voluntarily. The respondents will sign the Consent forms. They will be
assured of confidentiality and the researcher will ensure no leakage of personal data through
coding the data collected.
Data management
Trauma history screen (THS)
13 event categories as well as "other" events Respondents are questioned about whether each
event happened for each occurrence ("yes" or "no"). four-point scale for distress length ("not at
all" to "a month or more"), and a five-point scale for distress intensity are all evaluated ("not at
all" to "very much"). THS is meant as a preliminary assessment of HMS and PPD exposure, as
well as people' subjective experiences. As a result, THS lacks a specific cut-off scoring
procedure (admin, 2018).
Post traumatic diagnostic scale (PDS – 5)
PTSD symptoms on a 5-point scale in accordance with DSM-5 criteria. 0 = Not at all, 1 =
Once per week or less / a little, 2 = 2 to 3 times per week / somewhat, 3 = 4 to 5 times per week /
a lot, 4 = 6 or more times a week / severe. PTSD severity is determined by totaling the 20 PDS-5
symptom ratings (items 1-20). Scores range from 0-80. With 0-10 minimal symptoms, 11-23
mild symptoms, 24-42 moderate symptoms, 43-59 severe symptoms, 60-80 very severe
symptoms.
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Post Traumatic Growth Inventory (PTGI)/ Connor Davidson Resilience Scale (CD-RISC-
10)
On a 6-point scale, participants indicate their scores as follows: 0 - implies that I did not
have this experience as a result of my crisis, 1 - implies that I experienced this change to a very
minor degree as a result of my crisis, 2 - implies that I experienced this change to a minor degree
as a result of my crisis,. 3 - denotes that I experienced this change to a moderate degree as a
result of my crisis, 4 - denotes that I experienced this change to a great extent as a result of my
crisis, and 5 - denotes that I experienced this change to a very great extent as a result of my
crisis. The 21-item scale yields a total score with a potential range of 0-105 with a higher score
indicating stronger posttraumatic growth. For the CD-RISC, the total score of a respondent can
range from a minimum 0 to 40 maximum with the highest scores indicating higher levels of
resilience and lower levels the vice versa. The possible responses range from 0 – Not true at all,
1 - Rarely true, 2 - Occasionally true, 3 - Frequently true, 4 - Almost always true.
Data analysis
IBM Statistical package for social sciences (SPSS) version 22 is the software program
that will be used to analyze and test the relationship between the variables mentioned in this
research study. The statistical analysis that will be used after collecting the data will be a
Correlation analysis. Pearson’s correlation co efficient will be used to assess the significance of
the relationship between the hypothesis 1,2, 3 and 4 and the descriptive statistics tabulated into
frequencies and percentages.
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Appendix
Work plan/time schedule
Year 2023
Month
1 2 3 4 5 6 7 8 9 10 11 12
No Activity Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
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1 Proposal writing
2 Departmental and
school clearance
3 Ethical clearance :
IRB
4 Data collection
5 Data cleaning and
entry
6 Data analysis
7 Thesis writing
8 Handing in thesis
for marking
Budget
Activity Amount
IRB 150,000shs
Printing out proposal 100,000shs
Compensation for participants 700,000shs
Transport for every activity 250,000shs
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Printing out of questionnaires 150,000shs
Total 1,350,000shs
Instruments
Section A: Demographic information/Bio data
1. How old are you? _______________
2. What is your nationality? ___________________________
3. What is your marital status (tick one)
Married Single Divorced/Separated
4. Do you stay with your spouse? __________
5. What is your education level?
Did not go to School Primary Secondary
Tertiary/University
6. What is your occupation? ______________________
7. How many children do you have? ______________________
Section B: Trauma History Screen
The events below may or may not have happened to you. Circle “YES” if that kind of thing has
happened to you or circle “NO” if that kind of thing has not happened to you. If you circle
“YES” for any events: put a number in the blank next to it to show how many times something
like that happened.
Circle Circle “NO” Number
“YES” if if that kind of times
that kind of something
Event of thing has thing has not like this has
happened to happened to happened
you you
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A.A really bad car, boat, train, or airplane accident YES NO _____ times
B.A really bad accident at work or home YES NO _____ times
C.A hurricane, flood, earthquake, tornado, or fire YES NO _____ times
D. Hit or kicked hard enough to injure - as a child YES NO _____ times
E.Hit or kicked hard enough to injure - as an adult YES NO _____ times
F.Forced or made to have sexual contact - as a child YES NO _____ times
G. Forced or made to have sexual contact - as an adult YES NO _____ times
H. Attack with a gun, knife, or weapon YES NO _____ times

I. During military service - seeing something horrible or
YES NO _____ times
being badly scared
J. Sudden death of close family or friend YES NO _____ times
K. Seeing someone die suddenly or get badly hurt or
YES NO _____ times
killed
L. Some other sudden event that made you feel very
YES NO _____ times
scared, helpless, or horrified
M. Sudden move or loss of home and possessions YES NO _____ times
N. Suddenly abandoned by spouse, partner, parent, or
YES NO _____ times
family
Did any of these things really bother you emotionally? NO YES
If you answered “YES”, fill out one or more of the boxes on the next pages to tell about
EVERY event that really bothered you.
Letter from above for the type of event: ______ Your age when this happened: ______
Describe what happened:
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When this happened, did anyone get hurt or killed? NO YES

When this happened, were you afraid that you or someone else might get hurt or killed? NO
YES
When this happened, did you feel very afraid, helpless, or horrified? NO YES
When this happened, did you feel unreal, spaced out, disoriented, or strange? NO
YES
After this happened, how long were you bothered by it? not at all / 1 week / 2-3 weeks / a
month or more
How much did it bother you emotionally? not at all / a little / somewhat / much / very
much

YES
YES
month or more
much
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xxix

YES
YES
month or more
much
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xxx
YES
YES
month or more
much
Letter from above for the type of event: ______ Your age when this
happened: ______ Describe what happened:

YES
YES
month or more
much
Letter from above for the type of event: ______ Your age when this
happened: ______ Describe what happened:
xxx
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YES
YES
month or more How much did it bother you emotionally? not at all / a little /
somewhat / much / very much
Section C: Post trauma diagnostic scale (PDS)
Subject ID________
Date__________
TRAUMA SCREEN
Have you ever experienced, witnessed, or been repeatedly confronted with any of the following:
(Check all that apply)?
attacked with a weapon, severe injuries from a fight, held at gunpoint, etc.)
years
older than you, etc.)
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):
_____________________________________________________________________________
_____________
_____________________________________________________________________________
_____________
_____________________________________________________________________________
_____________
*** If NONE, please STOP and return this questionnaire ***
If you marked any of the above items, which single traumatic experience is on your mind and
currently bothers you the most:
(Check only one)
lt (attacked with a weapon, severe injuries from a fight, held at gunpoint, etc.)
ne 5 years
older than you, etc.)
):
_____________________________________________________________________________
_____________
_____________________________________________________________________________
_____________
_____________________________________________________________________________
_____________
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Page 1
©2013 Edna B. Foa
All rights reserved. Reproduction or redistribution, in whole or in part, in any manner, without
the prior written consent of the copyright holder, is a violation of copyright law.
Mental health researchers and clinicians may make copies of the measure for their own clinical
and research use. Any other use is prohibited.
Instructions: Below is a list of problems that people sometimes have after experiencing a
traumatic event. Write down the most distressing traumatic event that you checked on the last
page:
Please read each statement carefully and circle the number that best describes how often that
problem has been happening and how much it upset you over THE LAST MONTH. Rate each
problem with respect to the traumatic event that you wrote above.
For example, if you’ve talked to a friend about the trauma one time in the past month, you
would respond like this: (because one time in the past month is less than once a week)
Talking to other people about the trauma
0 1 2 3 4
Not at all Once a week or 2 to 3 times a 4 to 5 times a 6 or more
times a less/a little week/somewhat week/very
much week/severe
1. Unwanted upsetting memories about the trauma
0 1 2 3 4
much week/severe
2. Bad dreams or nightmares related to the trauma
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0 1 2 3 4
much week/severe
3. Reliving the traumatic event or feeling as if it were actually happening again
0 1 2 3 4
much week/severe
4. Feeling very EMOTIONALLY upset when reminded of the trauma
0 1 2 3 4
much week/severe
5. Having PHYSICAL reactions when reminded of the trauma (for example, sweating,
heart racing)
0 1 2 3 4
much week/severe
6. Trying to avoid thoughts or feelings related to the trauma
0 1 2 3 4
much week/severe
7. Trying to avoid activities, situations, or places that remind you of the trauma or that
feel more dangerous since the trauma
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0 1 2 3 4
much week/severe
8. Not being able to remember important parts of the trauma
0 1 2 3 4
much week/severe
9. Seeing yourself, others, or the world in a more negative way (for example ”I can’t trust
people,” “I’m a weak person”)
0 1 2 3 4
much week/severe
10. Blaming yourself or others (besides the person who hurt you) for what happened
0 1 2 3 4
much week/severe
11. Having intense negative feelings like fear, horror, anger, guilt or shame
0 1 2 3 4
Not at all Once a week or 2 to 3 times a 4 to 5 times a6 or more times
less/a little week/somewhat week/very much a week/severe
12. Losing interest or not participating in activities you used to

do
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0 1 2 3 4
13. Feeling distant or cut off from others

0 1 2 3 4
14. Having difficulty experiencing positive feelings

0 1 2 3 4
15. Acting more irritable or aggressive with others

0 1 2 3 4
16. Taking more risks or doing things that might cause you or others harm (for example,
driving recklessly, taking drugs, having unprotected sex)
0 1 2 3 4
much week/severe
17. Being overly alert or on-guard (for example, checking to see who is around you, being
uncomfortable with your back to a door)
0 1 2 3 4
much week/severe
18. Being jumpy or more easily startled (for example when someone walks up behind you)
0 1 2 3 4
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much week/severe
19. Having trouble concentrating
0 1 2 3 4
much week/severe
20. Having trouble falling or staying asleep
0 1 2 3 4
much week/severe
DISTRESS AND INTERFERENCE
21. How much have these difficulties been bothering you?

0 1 2 3 4
much week/severe
22. How much have these difficulties been interfering with your everyday life (for example
relationships, work, or other important activities)?
0 1 2 3 4
much week/severe
SYMPTOM ONSET AND DURATION
23. How long after the trauma did these difficulties begin? [circle one]
a. Less than 6 months
b. More than 6 months
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24. How long have you had these trauma-related difficulties? [circle one]
a. Less than 1 month
b. More than 1 month
Section C: PTGI/CD RISC – 10
Client Name: Today’s Date:
Indicate for each of the statements below the degree to which this change occurred in your life as
a result of the crisis/disaster, using the following scale.
0 = I did not experience this change as a result of my crisis.

1 = I experienced this change to a very small degree as a result of my crisis.
2 = I experienced this change to a small degree as a result of my crisis.
3 = I experienced this change to a moderate degree as a result of my crisis.
4 = I experienced this change to a great degree as a result of my crisis.
5 = I experienced this change to a very great degree as a result of my crisis.
Possible Areas of Growth and Change 0 1 2 3 4 5

1. I changed my priorities about what is important in life.
2. I have a greater appreciation for the value of my own life.
3. I developed new interests.
4. I have a greater feeling of self-reliance.
5. I have a better understanding of spiritual matters.
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xxxix
6. I more clearly see that I can count on people in times of trouble.
7. I established a new path for my life.

8. I have a greater sense of closeness with others.
9. I am more willing to express my emotions.
10. I know better that I can handle difficulties.
11. I am able to do better things with my life.
12. I am better able to accept the way things work out.
13. I can better appreciate each day.
14. New opportunities are available which wouldn't have been
otherwise.
15. I have more compassion for others.
16. I put more effort into my relationships.
17. I am more likely to try to change things which need changing.
18. I have a stronger religious faith.

19. I discovered that I'm stronger than I thought I was.
20. I learned a great deal about how wonderful people are.
21. I better accept needing others.
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Research Proposal (Apendi Martha Amelia)

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Research Proposal (Apendi Martha Amelia)

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Traumatic exposure, Post traumatic stress disorder and Post traumatic growth/resilience among

Apendi Martha Amelia

Statement of the problem.............................................................................................................2

Purpose of the study.....................................................................................................................3

Scope of the study........................................................................................................................4

Posttraumatic stress disorder........................................................................................................8

Post traumatic growth/Resilience.................................................................................................8

Traumatic exposure and Post traumatic growth...........................................................................9

Traumatic exposure and Post traumatic stress disorder.............................................................10

Post-traumatic stress disorder and Post traumatic growth/resilience.........................................11

Sample design/Sampling technique...........................................................................................12

Instruments and measures..........................................................................................................12

Post traumatic diagnostic scale (PDS – 5).................................................................................13

Post-Traumatic Growth Inventory (PTGI)/ Connor-Davidson Resilience Scale -10 (CD-RISC -

Procedure and ethical considerations.........................................................................................14

Institutional Review Board (IRB)..............................................................................................14

Standard Operating Procedures (SOPs) for COVID 19 and Ebola............................................15

Post traumatic diagnostic scale (PDS – 5).................................................................................15

Work plan/time schedule...........................................................................................................21

prevalence of mental disorder in societies exposed to humanitarian emergencies (Steel et al.,

Statement of the problem

an individuals' response to trauma, it is possible to develop more effective interventions and

Purpose of the study

growth/resilience among refugees

disorder among refugees.

To establish the mediating/moderating role of resilience in the relationship between

traumatic exposure and post traumatic growth/PTSD

interested in the study.

Scope of the study

Traumatic exposure refers to the experience of a traumatic event which is defined as

challenges. Resilience is the ability to withstand or tolerate adversity without experiencing

lasting negative effects (Tedeschi et al., 2018).

A conceptual framework showing the relationship between Traumatic exposure, Resilience

and Post traumatic growth/Post traumatic stress disorder among Refugees.

experience a traumatic event will develop PTG/resilience.

Theoretical framework: Cognitive adaptation theory

appraisals(Czajkowska, 2017). Therefore, according to cognitive adaptation theory, resilient

midst of adversity and trauma.

and particular PTSD symptoms are reduced (Schwabish, 2011).

have less impact than intended. (Taylor, 1983).

post traumatic growth/resilience, traumatic exposure and post traumatic growth/resilience,

Almost 80 million people are currently forcibly displaced worldwide, including 26

(Scoglio & Salhi, 2021). Approximately 28 to 90 percent of people in developed countries,

Posttraumatic stress disorder

According to research, psychological disorders are more common in refugee populations

personal growth and development.

Post traumatic growth/Resilience

Traumatic exposure and Post traumatic growth

traumatic events, in addition to experiencing the symptoms of posttraumatic stress, report

positive psychological changes which include a greater appreciation of life, improved

impacts on people hence making it personal event.

Traumatic exposure and Post traumatic stress disorder

Post-traumatic stress disorder and Post traumatic growth/resilience

The aims to test the following hypothesis;

There is a significant relationship between traumatic exposure and post traumatic

exposure and post traumatic growth/resilience.

procedure and ethical considerations, data management and data analysis.

Study population and setting

Sample size and sampling techniques

study or shape a grounded theory.

Inclusion and exclusion criteria

assessment will be excluded.

Instruments and measures

Trauma history screen (THS)