Growth without Relief? Posttraumatic Growth and Daily Functioning Among U.S. Veterans

Background and Purpose: Posttraumatic growth (PTG) is often assumed to reflect post-trauma recovery; however, evidence suggests growth may coexist with ongoing distress. PTG, defined as positive psychological change arising from adversity, is widely studied among trauma-exposed U.S. veterans. Traditional PTG measures rely on retrospective self-reports, possibly reflecting meaning-making processes rather than actual change. By examining domain-specific and non-linear associations, this study addresses key gaps in how growth is operationalized and linked to real-world functioning using a present-oriented PTG measure. We examined whether total PTG and its domains are associated with mental and physical functioning among U.S. veterans.

Methods: We conducted an online cross-sectional survey from December 2022 through June 2023. The analytic sample included 285 U.S. veterans; 242 had sufficient data to compute PTG scores. Participants averaged 34.77 years (SD = 10.78) and reflected diverse identities (65.3% men, 30.2% women, 4.7% other or undisclosed; 79.3% White, 8.1% Black; 39.9% Hispanic/Latino/a/x). The Army (25.0%) and Marine Corps (15.1%) were the most represented branches; 18.7% served in multiple branches.

PTG was assessed using a current functioning version of the 11-item Posttraumatic Growth Inventory–Short Form. Domain scores were computed for Relating to Others, New Possibilities, Personal Strength, Spiritual Change, and Appreciation of Life. Functional outcomes were measured using CDC Healthy Days indicators (past 30 days): poor mental health days, mental health activity limitations, poor physical health days, physical activity limitations, and pain interference. Due to non-normal distributions, Spearman rank-order correlations (ρ) examined associations between total and domain PTG and each outcome. PTG tertiles assessed non-linear patterns.

Results: Veterans reported moderate-to-high PTG (M = 3.83, SD = 0.72) alongside substantial health burden: 8.98 poor mental health days and 10.53 poor physical health days on average. Total PTG was modestly associated with fewer poor mental health days (ρ = -.215, p = .014) but not with any other outcome. Tertile comparisons showed veterans with low PTG reported ~11.5 poor mental health days versus ~7.8 days for moderate and high groups, where differences were driven by low PTG, with no additional functional benefit at higher levels. Domain analyses showed Relating to Others (ρ = -.230, p = .009) and Personal Strength (ρ = -.215, p = .014) were associated with fewer poor mental health days; Relating to Others was also associated with fewer pain interference days (ρ = -.183, p = .045). Spiritual Change and Appreciation of Life were unrelated to all functional outcomes.

Conclusions and Implications: PTG demonstrated modest, domain-specific associations with mental health but not physical health or functional impairment. Findings suggest PTG is not a uniform indicator of recovery. Relational and personal strength domains appear most relevant to daily functioning, whereas spiritual and existential domains may reflect distinct adaptive processes not captured by functional health measures. Interventions for veterans may benefit from prioritizing relational connection and personal efficacy, rather than assuming benefit from broader meaning-making approaches. These findings underscore the importance of integrating functional health outcomes into trauma-informed care and social work interventions, supporting more equitable and effective service delivery for veterans.