Psychometric Characteristics of the Russian-Language Version of the Posttraumatic Growth and Depreciation Inventory – Expanded Version (PTGDI-X)

Shishkova, A.M. V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, Saint-Petersburg, Russia

Bocharov, V.V. V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, Saint-Petersburg, Russia Saint Petersburg State University, Russia Saint Petersburg State Pediatric Medical University, Russia

Valieva, T.V. Ural Federal University named after the first President of Russia B.N.Yeltsin, Ekaterinburg, Russia

Tedeschi, R. Boulder Crest Institute for Posttraumatic Growth, Virginia, USA

Introduction 

In recent decades, the problems and experiences of relatives caring for the chronically ill have increasingly attracted the attention of the scientific community. In particular, this is related to the growing population of individuals suffering from chronic non-communicable diseases and in need of constant care (Ansah & Chiu, 2023; Antonova et al., 2021; Hacker, 2024). 

The term “informal caregiver” (IC) is most commonly used in the literature to refer to those who are involved in taking care of chronically or seriously ill persons. Based on a publications analysis, we developed the following definition: “an IC is someone who has a social relationship (such as a spouse, parent, child, another relative, neighbor, friend, etc.) with the care recipient (a dependent person in need of care due to various circumstances) and provides unpaid care on a permanent basis or when a necessity arises” (Shishkova & Bocharov, 2021, p. 19). ICs of individuals with severe or chronic illnesses make a substantial contribution to the development of non-hospital forms of care for this patient population; however, their role within the healthcare system is often underestimated (Barello et al., 2019; Shishkova & Bocharov, 2021)

It is crucial to highlight the lack of a system for psychological assessment for ICs of chronically ill patients within the domestic healthcare model, particularly within the framework of specialized public institutions. At the same time, evaluating the psychological well-being of family members, providing care for individuals with severe or chronic somatic and/or mental disorders, appears to be critically important, given the considerable amount of empirical data gathered to date demonstrating that such care is often associated with exposure to acute and/or long lasting (chronic) psychological trauma and stress (Cejalvo et al., 2025; Choi et al., 2024; Shishkova & Bocharov, 2021). 

Psychological trauma is an experience that feels very painful or distressing, leading to short- or long-term mental and physical limitations or an inability to function (Feriante & Sharma, 2023). Traumatic events usually involve threatened death or severe injury, either to the individuals themselves or to a loved one (Cureton, 2014). Acute trauma arises from a single traumatic incident, whereas chronic trauma develops from repeated or prolonged exposure to ongoing traumatic experiences (Feriante & Sharma, 2023). The diagnosis of a life-threatening illness in a close relative may itself constitute a psychotraumatic event for the patient’s family members, potentially resulting in serious emotional distress and difficulties in mental functioning (Choudry et al., 2024). Empirical evidence suggests that family members and close associates of individuals with impaired health conditions (e.g., those affected by COVID-19) may experience higher levels of posttraumatic stress than the patients themselves (Moreta-Herrera et al., 2025). Exploring the mechanisms and moderators underlying this phenomenon could provide important insights into theoretical models of trauma transmission and clinical interventions aimed at supporting affected families.

Financial burdens, disruption of or forced curtailment of hobbies and social contacts, feelings of loss concerning premorbid relationships with a person close to one, as well as concerns about his/her health, safety, and future are often experienced by ICs of people with chronic illnesses. Negative consequences of exposure to caregivers’ stress encompass various emotional disorders, deteriorating health and well-being (Alves et al., 2019; Barello et al., 2019). Depressive disorders, severe anxiety and sleep disturbances are frequently seen in ICs (Alves et al., 2019; Choi et al., 2024; Shishkova & Bocharov, 2021); even posttraumatic stress reactions are possible (Lim et al., 2024). Additionally, studies include negative consequences of the care of chronically ill patients that can be described as burnout, and may appear as the form of a feeling of chronic fatigue and inability to continue care, a distant or cynical attitude towards the patient, and a sense of worthlessness regarding one’s efforts to overcome the disease (Ci Soh et al., 2025; Shishkova & Bocharov, 2021).

Thus, the stress-oriented approach focuses primarily on the negative consequences of care. This may naturally, to some extent, determine the direction of development of the psycho-diagnostic tools used in the assessment of the psychological consequences experienced by ICs. For example, various tools have been developed to assess distress, family burden and burnout of ICs of chronically ill patients (Shishkova et al., 2021; Tamarana et al., 2023; Zhong et al., 2024).

At the same time, researchers have focused mainly on the negative effects of traumatic events, while the possible positive outcomes of traumatic experiences were largely overlooked and their study remained has limited for many years, partly due to the lack of suitable psychodiagnostic tools.  

The Model of Posttraumatic Growth and Posttraumatic Depreciation

In connection with the changes of scientific paradigm toward the framework of positive psychology, one of the most promising areas of research recently is the study not only of the negative consequences, but also of positive outcomes, which can arise in an individual in stressful or psychotraumatic situations. ICs may perceive a loved one’s illness as an opportunity to be stronger and acquire new skills or as an event that gives a sense of purpose in life and spiritual growth, etc. (Palacio & Limonero, 2020; Sergienko, 2019).

The functional-descriptive model of posttraumatic growth (PTG), proposed by Tedeschi and Calhoun (2004), seems to be the crucial theoretical framework that has made it possible to conceptualize the observed phenomena. According to this model, posttraumatic growth (PTG) is the product of an individual’s efforts under conditions in which adaptation to the situation may seem impossible, and where the unavoidability of change necessitates the transformation of fundamental worldviews, beliefs, and personal goals. The construct has so far been confirmed in empirical studies on different populations, including ICs of patients with oncological illnesses, children with disabilities, and others (Palacio & Limonero, 2020; Sergienko, 2019; Taku et al., 2021).

The Posttraumatic Growth Inventory (PTGI) (Tedeschi & Calhoun, 1996), developed by those authors within the functional-descriptive model, was for a long time the most widely used tool for assessing positive changes appears in an individual’s values, beliefs, and meanings arising from ordeals. The PTGI consists of 21 statements and has a five-factor structure that has been confirmed in different cultural groups, showing only minor variations (Exenberger et al., 2019; Weiss & Berger, 2010). The PTGI includes five dimensions, which can be defined as follows: Personal Strength – an increased sense of resilience and self-reliance; New Possibilities – greater openness to new opportunities and life paths; Relating to Others – deeper compassion and closer relationships; Appreciation of Life – increased gratitude and re-evaluation of priorities; and Spiritual Change – greater spiritual or existential awareness. These factors constitute the corresponding scales of the questionnaire and represent different areas of personal growth.   

Further development of the concept suggested by Tedeschi and Calhoun is evident in the formation of the concept of posttraumatic depreciation, which reflects negative changes resulting from an individual’s exposure to stressful or traumatic situations. These changes, according to the authors, take place in the same areas of personal functioning mentioned above (Baker et. al, 2008; Cann et.al., 2010). 

The expansion of the theoretical construct through the notion of posttraumatic depreciation necessitated corresponding transformations of the measurement tool. For this reason, the PTGI was supplemented with negatively formulated statements and renamed the PTGI-42: Growth and Depreciation (Baker et. al, 2008). This was developed in response to criticism that the PTGI was biased toward agreement with positive experiences. Studies have indicated that PTG is associated with positive experiences, whereas PTD is linked to negative ones (Barrington & Shakespeare-Finch, 2013). The emerging possibility of simultaneously examining multidirectional transformations occurring in the personal axiological field under the influence of a psychological trauma has significantly expanded the diagnostic potential of the assessment tool while simultaneously providing an opportunity for a deeper understanding of the mechanisms involved in response to stress—in particular, the relationship between negative and positive personal transformations. The emergence of these new possibilities has generated considerable interest among researchers, as reflected in numerous studies aimed at investigation of the interrelation of the constructs between PTG and PTD (Cann et.al., 2010; Barrington & Shakespeare-Finch, 2013; Kunz et.al., 2019). Thus, the comprehensive understanding of the mechanisms of personal responses to psychologically traumatic situations is impossible without providing respondents with the opportunity to simultaneously assess both positive and negative changes resulting from stress.

As it currently stands, Tedeschi and co-authors have proposed an expanded version of the inventory: Posttraumatic Growth and Posttraumatic Depreciation Inventory - Expanded version PTGDI-X (Taku et. al., 2020). The PTGDI-X is based on the PTGI-X, which was developed to improve the assessment of Spiritual and Existential Change (Tedeschi, et al., 2017). The PTGDI-X was then used in ten countries of varying cultural backgrounds in order to determine the broad applicability of the PTG and PTD concepts. The factor structure and conceptual relationships of the PTGDI-X has been examined in several countries in addition to the ten-country sample on which it was originally based. These countries include Japan (Oshiro, et al., 2019), Italy (Romeo, et al., 2023), Germany (Platte et al., 2023), and Sierra Leone (Steidl, et al., 2024). The five-factor structure failed to replicate in Sierra Leone as it did in other countries, leaving the open the possibility that varying cultures may conceptualize growth and depreciation in different ways.  Therefore, when used with a Russian population, it is useful to determine whether the proposed factor structure applies, especially since Russia was not one of the ten countries on which the measure was based.  In addition to testing the factor structure, the relationship between PTG and PTD is an important theoretical and clinical issue to address. PTG and PTD appear to be separate dimensions of post-trauma experience (Manis, et al., 2025; Taku, et al., 2021), rather than opposing poles of a unidimensional construct. Again, cultural factors could potentially be involved in this relationship.

The Present Study

For Russian-speaking respondents, only an older version of the PTGI (Magomed-Eminov, 2008) is currently available, which lacks the additional items involved in the PTGI-X. Therefore, the authors of this article conducted a cross-cultural adaptation and primary approbation of the PTGDI-X on a sample of ICs of patients with cerebral pathology (Shishkova et.al., 2024).

The aim of this work was to verify the factor structure and assess the psychometric characteristics of the Russian-language version of the PTGDI-X on a sample of ICs of patients with severe and/or chronic mental, neurological, and somatic diseases. Differences in the clinical presentation and progression of the patient’s illness impact the type and severity of psychotraumatic and stressful impacts experienced by family caregivers. In other words, caregiving can affect several aspects of life and relationships, including anticipating the loss of a loved one, changes in social status, and the necessity to adjust life goals, all of which can lead to significant stress. Consequently, this sample is appropriate for studying the effects of exposure to stressful and traumatic events. In our opinion, ICs can be considered one of the most important models for studying posttraumatic and stress-related responses due to their exposure to both long-term and acute psychological stress. Therefore, using the PTGDI-X model with informal caregivers will also help assess whether the instrument is applicable not only to those caring for chronically ill persons, but also to other groups exposed to psychological trauma or ongoing stress.

Methods

The study applied a quantitative approach with a non-experimental, cross-sectional design and an instrumental scope (Slater & Hasson, 2025).

Participants

The study included 404 ICs of patients suffering from various mental, neurological, and somatic disorders. Among those examined were 55 ICs of patients with schizophrenia spectrum disorders (F20, F21, F25), 45 ICs of patients with affective disorders (F31, F32, F34), 53 with anxiety, depressive and somatoform neurotic disorders (F41.0, F41.1, F41.2, F45.0), 45 with epilepsy (G40.0 - 40.4), 13 with multiple sclerosis (G35.0), 40 with Parkinsonism (G20), 52 ICs of patients with consequences of acute cerebrovascular event (I69), 52 ICs of patients with primary/secondary malignant or benign neoplasms of the brain and/or spinal cord (C71.1- C71.8; D32.1; D33.4), 49 ICs of patients with head and spinal cord injuries (S06; T91.3; T90.5). Patients were diagnosed based on the ICD-10.

The requirement for selecting these respondent groups was their involvement in taking care of patients with severe and/or chronic disease (psychiatric, neurological, or physical). ICs had to be over 18 years, able to provide informed consent, and willing to follow the study procedures. Participants were excluded if they had a medical condition severe enough to prevent them from providing informed consent or understanding the study procedure.

Sampling of respondents was based on the requirement of achieving representation of families having members who were living in circumstances related to different care models. In the present article, a care model is considered as the combination of psychological, physical, material, and other forms of support provided by a relative to an ill loved one in order to maintain the latter's well‑being. The extent of help provided is dependent on the level of dysfunction exhibited by the patient, both physically and psychologically. Patient care could be characterized by attributes like the level of somato-neurological dysfunction and the inability of the patient to interact with the caregiver. Thus, in the case of pronounced somatic or neurological impairments, caregiver stress was associated more with caregiving tasks such as hygienic procedures. When dealing with psychiatric disorders, caregiver stress can be associated with stigma and self stigma, communication problems, and family conflict. In our current sample, there were caregivers who dealt with the threat of death of their relatives, while others dealt with challenging behaviors and associated conflicts. At the same time, all caregivers can be assigned to one category, since their patients’ diseases entailed a great danger of disability and caused stress among family members who gave them care. ICs might encounter many challenges when dealing with various kinds of diseases and even when dealing with the same disorder, informal caregivers can go through heterogeneous challenges and emotional reactions, including the fear of losing someone close to them, which is possible not only in oncology but also in multiple sclerosis and depression.

The inclusion of ICs of patients with depressive and anxiety neurotic disorders, despite their psychogenic and functional nature, was determined by the severity of the clinical picture in patients, characterized by pronounced disturbances in the emotional-volitional sphere, difficulties in daily life and self-care, and the presence of somatic correlates of anxiety and depression.

A comparative analysis of respondent groups based on the nosology of the care recipient was not an aim of this study and will be examined by us in future publications. The process of validation of the instrument was done without segregating the subjects into groups. The core concept of the article is to validate, through the use of a caregiver model, the PTGDI-X as an instrument for studying PTG and PTD. 

The sociodemographic and clinical characteristics of ICs and patients care by them are shown in Table 1.

Table 1

Demographic and Clinical Characteristics of the Sample

Sociodemographic and clinical characteristics	n (%):
Relatives’ gender Male  Female	89 (22%) 315 (78%)
Relatives’ age / mean (M±SD)	48.95 ± 13.3
Relationship to patient Father Mother Husband Wife Son Daughter Sister Brother	19 (4.6%) 176 (43.5%) 52 (12.7%) 81 (20.5%) 15 (3.7%) 51 (12.6%) 7 (1.7%) 3 (.7%)
Employment status Not working Working	115 (28,5%) 289 (71.5%)
Patients’ age / mean (M±SD)	40.57 ± 18.8
Patients’ gender Male  Female	204 (50.5%) 200 (49.5%)
Age of the patients’ disease onset / mean (M±SD)	33.82 ± 20.3
Duration of the disease / mean (M±SD)	6.68 ± 7.9
Living with patient Together Separate	274 (67.8%) 130 (32,2%)

The mean age of the ICs was 48.95 (SD = 13.3) years. Most of the ICs were women — 78% (n = 315). By relation, the respondents were predominantly mothers — 43.5% (n = 176), fathers were 4.6% (n = 19), wives — 20.5% (n = 81), husbands — 12.7% (n = 52), daughters — 12.6% (n = 51), sons — 3.7% (n = 15), sisters — 1.7% (n = 7), brothers — .7% (n = 3). Most of the surveyed relatives had higher education — 69.8% (n = 282), and were employed — 71.5% (n  = 289). At the time of conducting psychodiagnostics most of the relatives lived with the cared-for patients — 67.8% (n = 274). The median age of the cared-for patients was 40.57 (SD = 18.8) years. Among them 50.5% (n = 204) were men and 49.5% (n = 200) women. The average age of onset of the patient’s illness was 33.82 (SD = 20.3) years, the duration of the illness was 6.68 (SD = 7.9) years.

Procedure

The cross-cultural adaptation of the PTGDI-X inventory was conducted according to all the necessary stages of the procedure (Beaton et al., 2000; Epstein et al., 2015) and was described in a previous publication (Shishkova et al., 2024). The patients cared for by ICs were treated in V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology and Saint Petersburg clinical scientific and practical center for specialized types of medical care (oncological). All participants provided voluntary informed consent prior to the study. During a face-to-face meeting, a psychologist explained the study procedures and provided relevant information to each relative before obtaining their informed consent. Participants did not receive any payment for participating and were assured that their responses would be kept confidential and that all data would be anonymized prior to analysis. Recruitment and data collection took place between April 2023 and November 2025.

The diagnostic procedure for ICs consisted of: (1) a semi-structured interview during which we sought to establish the most trusting atmosphere possible while discussing the respondents’ current life situation and collecting socio-demographic and clinical characteristics of the ICs and their care recipients, (2) psychological assessment using quantitative methods, and (3) a “feedback” procedure.

Questionnaires

The original PTGDI-X is a 50-item self-report questionnaire designed to assess both PTG and PTD dimensions (Taku et al., 2020). Each item is evaluated on a 6-point Likert-type scale ranging from 0 to 5, where higher scores reflect greater levels of either growth or depreciation. Beyond the composite scores for each dimension, the instrument allows for the calculation of scores across five corresponding subscales for PTG and PTD: Relating to Others, New Possibilities, Personal Strength, Spiritual and Existential Change, and Appreciation of Life.

To study convergent and discriminant validity, the following instruments were used: The World Assumption Scale (WAS) by Janoff-Bulman adapted by Padun and Kotelnikova (2008); the Symptom Checklist SCL-90-Revised adapted by Tarabrina (2001), and the Level of Relatives' Emotional Burnout Questionnaire (LREB) (Shishkova et al., 2021). The World Assumption Scale (WAS), originally developed by Janoff-Bulman (1989), measures core beliefs regarding the benevolence of the world, the meaning of events, and self-worth. The Russian adaptation by Padun and Kotelnikova retains the original multidimensional structure and assesses five key assumptions: Benevolence of the World, Justice, Self-Worth, Luck, and Perceived Control. The adapted version shows good reliability, with Cronbach's α coefficients ranging from .70 to .85 across the subscales.

The Symptom Checklist-90-Revised (SCL-90-R), originally developed by Derogatis (1973), is a self-report measure designed to assesses current psychological symptoms in clinical and non-clinical populations. The Russian adaptation, validated by Tarabrina (2001), retains the original 90-item structure and evaluates nine symptom dimensions: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism, along with three global distress indices (GSI, PSDI, PST). The adapted version demonstrates satisfactory psychometric properties, with Cronbach's α coefficients ranging from .73 to .88.

The Level of Relatives’ Emotional Burnout Questionnaire (LREB), developed by Shishkova et al. (2021), is a self-report measure assessing emotional burnout among relatives caring for chronically ill patients. In addition to the core burnout components—exhaustion, depersonalization, and reduced personal accomplishment—the instrument assesses personal resources related to caregiving, including dedication and self-efficacy. The questionnaire comprises eight scales: Vigor, Dedication, Resource, Self-Efficacy, Exhaustion, Depersonalization, Destruction, and Inefficacy. The subscales showed satisfactory internal consistency, with Cronbach’s α coefficients ranging from .70 to .86.

Data Analysis

The statistical analysis was conducted in several sequential phases. First, confirmatory factor analysis (CFA) was performed to assess the fit of the proposed factor structure to the observed data using an appropriately justified estimation method. Second, internal consistency was assessed using Cronbach’s alpha and McDonald’s omega and internal construct validity was evaluated using Spearman’s rank correlations among the PTGDI-X subscales. The relationship between the overall PTG and PTD scores was examined using nonlinear regression analysis. In the final phase, external construct validity was assessed by examining Spearman’s correlations between the PTGDI-X scales and the WAS, SCL-90-R, and LREB scales. Descriptive statistical methods were calculated. All analyses were conducted using the R statistical programming environment, version 4.6.0 (R Core Team, 2026). Confirmatory factor analysis was performed using the lavaan package, version .6-12 (Rosseel, 2012). The PTG and PTD factor structures were visualized using yEd Graph Editor, version 3.23.2 (yWorks GmbH, 2023).

Results

Descriptive Statistics 

The descriptive statistics are presented in Table 2. 

Table 2

Descriptive Statistics 

Scales	Descriptive Statistics
	Mean	Median	SD	Skewness	Kurtosis
PTG/Relating to Others	12.96	12.0	9.19	.289	-.887
PTG/New Possibilities	7.72	6.0	6.47	.707	-.511
PTG/Personal Strength	7.31	7.0	5.70	.357	-.988
PTG/Spiritual and Existential Change	8.75	8.0	7.88	.671	-.484
PTG/Appreciation of Life	6.65	6.0	4.60	.121	-1.139
PTG/Total	43.40	42.0	30.51	.409	-.727
PTD/Relating to Others	5.79	4.0	6.34	1.205	.933
PTD/New Possibilities	5.86	4.5	5.83	.733	-.564
PTD/Personal Strength	3.78	2.0	4.37	1.233	.963
PTD/Spiritual and Existential Change	4.83	3.0	5.80	1.351	1.253
PTD/Appreciation of Life	2.25	1.0	3.03	1.538	1.990
PTD/Total	22.52	15.0	22.44	1.062	.458

Note. Standard error of skewness  =  .121; standard error of kurtosis  =  .242; SD - standard deviation

The revealed positive skewness across all scales, negative kurtosis for the PTG scales and predominantly positive kurtosis for the PTD scales, as well as large values of standard deviation, necessitate the application of robust methods in subsequent data processing.

Factor Structure

The factor structure of the inventory was examined using confirmatory factor analysis (CFA) with the Weighted Least Squares Mean and Variance adjusted (WLSMV) estimator, which is appropriate for ordinal data. This method was selected for two reasons. First, the use of the Likert scale may be treated as interval data as long as the collected data represent composite scores from several items (Tanujaya et al., 2022). In the context of the present study, the overall PTG and PTD scales scores were treated as interval data, whereas individual item responses were treated as ordinal. Although the questionnaire used a six-point Likert scale, allowing us to initially consider treating the data as continuous (Rhemtulla et al., 2012), the application of Mardia’s test revealed that the PTG and PTD variables deviated substantially from multivariate normality (Table 3), including an asymmetric joint distribution and clustering of extreme values on both scales, indicating that continuous-data estimation methods were unsuitable.

Table 3

Results of Mardia’s Test for Multivariate Normality

Statistics		PTG	PTD
Multivariate skewness	Multivariate skewness coefficient, b1p	101.73	230.07
	Chi-square statistic, χ2	6849.84	15491.46
	P-value	<.001	<.001
Multivariate kurtosis	Observed value of the multivariate kurtosis coefficient, b2p*	879.11	1181.06
	Z-statistic	55.83	138.42
	P-value	<.001	<.001

Note. *Expected value under normality = 675

Given that contemporary empirical data contribute to the conceptualization of PTG and PTD as relatively distinct phenomena (Cann et al., 2010), we examined the factor structure of the PTGDI-X separately for each corresponding dimension. The final a posteriori CFA model with standardized regression coefficients for the PTG scale and the PTD scale are presented in Figure 1. The obtained model fit indices for the empirical data are presented in Table 4.

Figure 1. Final a posteriori CFA models for the PTG scale and the PTD scale.

Notes. To improve the clarity of the factor structure, the residual variances of the observed variables and first-order factors are excluded from the figure. PG 1 - Posttraumatic Growth/Relating to Others; PD 1 - Posttraumatic Depreciation/Relating to Others; PG 2 - Posttraumatic Growth/New Possibilities, PD 2 - Posttraumatic Depreciation/New Possibilities, PG 3 - Posttraumatic Growth/Personal Strength, PD 3 - Posttraumatic Depreciation/Personal Strength, PG 4 - Posttraumatic Growth/Spiritual and Existential Change, PD 4 - Posttraumatic Depreciation/Spiritual and Existential Change, PG 5 - Posttraumatic Growth/Appreciation of Life, PD 5 - Posttraumatic Depreciation/Appreciation of Life, PTG - Posttraumatic Growth, PTD - Posttraumatic Depreciation.

Table 4

Conformity Indices of Confirmatory Models

Model	CMIN	CMIN/df	NFI	TLI	CFI	RMSEA	SRMR
PTG	647.141*	2.397	.991	.994	.995	.059	.054
PTD	753.150*	2.789	.985	989	.990	.067	.072

Notes. *p < .001; CMIN – chi-square criterion; p – significance level of chi-square; CMIN/df – chi-square divided by degrees of freedom; NFI – normed fit index, TLI – Tucker-Lewis index, CFI – comparative fit index, RMSEA – root mean square error of approximation, SRMR – standardized root mean square residual

The regression coefficients show that the items are illustrative indicators of the questionnaire’s subscales, which are also significant indicators of the total scales. The regression coefficients showed that the items loaded strongly onto their respective subscales, which were significant indicators of the overall PTG and PTD total scales. Overall, the fit indices supported the adequacy of the constructed models for both the PTG and PTD scales. The CMIN/df ratio for both models were below 3, indicating good model fit. The incremental fit indices (NFI, TLI, and CFI) values exceeded the recommended threshold of .90, indicating satisfactory model fit. The RMSEA and SRMR values were within acceptable limits, not exceeding .08. This allows us to conclude that the factor structure of the methodology scales, identified as a result of CFA, confirms their construct validity.

PTGDI-X Scales Consistency

Given that the data deviated from a normal distribution, robust estimators of Cronbach’s alpha and McDonald’s omega were employed to evaluate the internal consistency of the scales (Zhang & Yuan, 2016).

Both Cronbach’s alpha (PTG-total = .956; PTD-total = .942) and McDonald’s omega (PTG-total = .964; PTD-total = .952) coefficients were found to be high. Likewise, the coefficients for the separate subscales indicated satisfactory internal consistency, ranging from .774 to .897, except for the Appreciation of Life subscale of the PTD, which yielded somewhat lower values, approximating .70. The obtained values generally revealed high internal consistency of the questionnaire items and demonstrated sufficient reliability of the Russian-language version of the PTGDI-X (see Table 5).

Table 5

The PTGDI-X Scales Internal Consistency

PTG scales	Cronbach’s alpha	McDonald’s omega		PTD scales	Cronbach’s alpha	McDonald’s omega
PTG /Relating to Others	.896	.897		PTD /Relating to Others	.825	.827
PTG /New Possibilities	.831	.838		PTD /New Possibilities	.837	.867
PTG /Personal Strength	.839	.843		PTD /Personal Strength	.825	.830
PTG /Spiritual and Existential Change	.869	.873		PTD /Spiritual and Existential Change	.802	.808
PTG /Appreciation of Life	.774	.785		PTD /Appreciation of Life	.693	.708
PTG / Total	.956	.964		PTD / Total	.942	.952

Notes. PTG - Posttraumatic Growth; PTD - Posttraumatic Depreciation.

PTGDI-X Internal Construct Validity

The results of the correlation analysis of the PTGDI-X scales are presented in the Table 6.

Table 6 

The PTGDI-X Subscales Intercorrelations

Scales

PG 1

PD 1

PG 2

PD 2

PG 3

PD 3

PG 4

PD 4

PG 5

PD 5

PGT

PDT

PG 1

1

PD 1

.26**

1

PG 2

.74**

.35**

1

PD 2

.23**

.70**

.16**

1

PG 3

.74**

.25**

.77**

.12*

1

PD 3

.22**

.77**

.22**

.77**

-

1

PG 4

.80**

.31**

.78**

.16**

.75**

.18**

1

PD 4

.28**

.77**

.24**

.76**

.16**

.76**

.21**

1

PG 5

.80**

.34**

.71**

.28**

.70**

.25**

.79**

.28**

1

PD 5

.26**

.62**

.25**

.60**

.17**

.63**

.23**

.71**

.24**

1

PGT

.93**

.33**

.88**

.21**

.88**

.21**

.92**

.26**

.88**

.26**

1

PDT

.31**

.89**

.30**

.90**

.20**

.88**

.27**

.90**

.34**

.76**

.32**

1

Notes. * р<.05; ** p<.01; PG 1 - Posttraumatic Growth/Relating to Others; PD 1 - Posttraumatic Depreciation/Relating to Others; PG 2 - Posttraumatic Growth/New Possibilities, PD 2 - Posttraumatic Depreciation/New Possibilities, PG 3 - Posttraumatic Growth/Personal Strength, PD 3 - Posttraumatic Depreciation/Personal Strength, PG 4 - Posttraumatic Growth/Spiritual and Existential Change, PD 4 - Posttraumatic Depreciation/Spiritual and Existential Change, PG 5 - Posttraumatic Growth/Appreciation of Life, PD 5 – Posttraumatic Depreciation/Appreciation of Life, PGT - Posttraumatic Growth/Total, PDT - Posttraumatic Depreciation /Total. 

PTG scales indicate multiple strong and moderate positive connections with each other. A similar structure of correlational relationships is observed across the scales of PTD dimension. Weak to moderate positive correlations were found between PTG and PTD. This indicates that the variability in one variable is accounted for only to a small extent by the variability in the other. This limits the practical significance of the association and indicates that PTG and PTD may occur together while remaining largely separate and weakly related phenomena. The structure of intercorrelations disclosed through the correlation analysis corroborates the theoretical constructs underlying the validated measure.

Nonlinear Dependence of PTG and PTD Scales

To clarify the correlation between the phenomena of the PTG and PTD scales, we used a nonlinear regression analysis. The result showed a significant inverted U-shape quadratic dependence between the total PTG scale scores and the total PTD scale scores: F = 27.121, p < .001, ∆R2 = .079, R2 = .119 (see Figure 2).

Figure 2. Dependence of the PTD level on the PTG level 

The results showed that the analyzed indicators have a nonlinear dependence, i.e., an increase in the total PTG indicator has a significant moderate correlation with an increase in the total PTD indicator up to a certain level; a further increase in PTG indicators is associated with a decrease in PTD indicators.

Splitting the sample into two parts based on the PTG median (Md  =  42) and calculating the Spearman's correlation coefficient *r* in the obtained parts showed that in the first half, the correlation is significantly moderate positive r~s~ = .467 at p < .001, while in the second half, the correlation is significantly weak negative r~s~ = -.147 at p = .04, which also indicates the presence of a nonlinear dependency between PTG and PTD indicators.

PTGDI-X External Construct Validity

Convergent and discriminant validity were evaluated by analyzing the correlations between the scales of the PTGDI-X and those of the WAS, SCL-90-R, and LREB. The findings are shown in Table 7.

Table 7 

Intercorrelations Between the PTGDI-X and WAS, SCL-90-R, and LREB Variables

PTGDI-X

PG 1

PD 1

PG 2

PD 2

PG 3

PD 3

PG 4

PD 4

PG 5

PD 5

PGT

PDT

WAS

Benevolence of the Impersonal World

.11*

-.27**

-

-.12*

-

-.16**

-

-.14**

-

-.10*

-

-.18**

Justice

.19**

-.20**

.12*

-.18**

.19**

-.21**

.24**

-.17**

.15**

-

.20**

-.19**

Self-Worth

-

-.23**

.11*

-.29**

.16**

-.27**

-

-.29**

-

-.20**

-

-.29**

Luck

.18**

-.28**

.18**

-.35**

.26**

-.33**

.16**

-.30**

.10*

-.18**

.19**

-.32**

Self-controllability

.12*

-.19**

.22**

-.31**

.23**

-.28**

.12*

-.24**

-

-.19**

.16**

-.27**

SCL-90-R

Somatization

.30**

.40**

.22**

.39**

.18**

.45**

.27**

.39**

.27**

.33**

.29**

.46**

Obsessive-Compulsive

.28**

.41**

.26**

.43**

.20**

.45**

.27**

.44**

.29**

.35**

.30**

.49**

Interpersonal Sensitivity

.23**

.40**

.26**

.35**

.18**

.42**

.25**

.39**

.26**

.37**

.27**

.45**

Depression

.23**

.49**

.26**

.51**

.14**

.53**

.23**

.50**

.29**

.42**

.26**

.57**

Anxiety

.24**

.41**

.25**

.40**

.14**

.45**

.25**

.43**

.27**

.35**

.26**

.48**

Hostility

.17**

.32**

.22**

.30**

.16**

.37**

.20**

.31**

.22**

.31**

.21**

.38**

Phobic Anxiety

.17**

.32**

.16**

.32**

.11*

.34**

.21**

.36**

.17**

.31**

.19**

.38**

Paranoid Ideation

.20**

.41**

.24**

.36**

.19**

.40**

.23**

.34**

.27**

.31**

.25**

.42**

Psychoticism

.25**

.45**

.25**

.42**

.17**

.47**

.27**

.42**

.27**

.36**

.27**

.50**

Global Severity Index

.30**

.48**

.29**

.48**

.20**

.52**

.30**

.49**

.33**

.42**

.32**

.56**

Symptom Distress Index

.29**

.47**

.30**

.45**

.21**

.51**

.30**

.47**

.32**

.40**

.32**

.54**

Positive Symptom Total

.18**

.39**

.17**

.43**

.11*

.44**

.16**

.42**

.20**

.38**

.19**

.49**

Notes. * р<.05; ** p<.01; PG 1 - Posttraumatic Growth/Relating to Others; PD 1 - Posttraumatic Depreciation/Relating to Others; PG 2 - Posttraumatic Growth/New Possibilities, PD 2 - Posttraumatic Depreciation/New Possibilities, PG 3 - Posttraumatic Growth/Personal Strength, PD 3 - Posttraumatic Depreciation/Personal Strength, PG 4 - Posttraumatic Growth/Spiritual and Existential Change, PD 4 - Posttraumatic Depreciation/Spiritual and Existential Change, PG 5 - Posttraumatic Growth/Appreciation of Life, PD 5 – Posttraumatic Depreciation/Appreciation of Life, PGT - Posttraumatic Growth/Total, PDT - Posttraumatic Depreciation /Total.

Table 8

Intercorrelations Between the PTGDI-X and WAS, SCL-90-R, and LREB Variables

PTGDI-X

PG 1

PD 1

PG 2

PD 2

PG 3

PD 3

PG 4

PD 4

PG 5

PD 5

PGT

PDT

LREB

Vigor

.10*

-.19**

.10*

-.21**

.20**

-.26**

.13**

-.22**

-

-.14**

.14**

-.17**

Dedication

.20**

-

.24**

-.13*

.27**

-.16**

.29**

-.11*

.21**

-

.27**

-.11*

Resource

.18**

-.13**

.20**

-.17**

.26**

-.22**

.25**

-.16**

.17**

-.10*

.24**

-.17**

Self-efficacy

.26**

-.14**

.25**

-.12*

.31**

-.18**

.25**

-.14**

.21**

-

.29**

-.14**

Exhaustion

-

.29**

-

.47**

-

.39**

-

.36**

.17**

.31**

-

.42**

Depersonalization

-

.31**

-

.38**

-

.33*

-

.33**

-

.31**

-

.39**

Destruction

.17**

.29**

.15**

.43**

-

.38**

.18**

.40**

.24**

.32**

.17**

.42**

Inefficacy

-

.27**

-.15**

.37**

-.15**

.29**

-

.30**

-

.28**

-.10*

.34**

Notes. * р<.05; ** p<.01; PG 1 - Posttraumatic Growth/Relating to Others; PD 1 - Posttraumatic Depreciation/Relating to Others; PG 2 - Posttraumatic Growth/New Possibilities, PD 2 - Posttraumatic Depreciation/New Possibilities, PG 3 - Posttraumatic Growth/Personal Strength, PD 3 - Posttraumatic Depreciation/Personal Strength, PG 4 - Posttraumatic Growth/Spiritual and Existential Change, PD 4 - Posttraumatic Depreciation/Spiritual and Existential Change, PG 5 - Posttraumatic Growth/Appreciation of Life, PD 5 – Posttraumatic Depreciation/Appreciation of Life, PGT - Posttraumatic Growth/Total, PDT - Posttraumatic Depreciation /Total. 

As expected, we found significant positive correlations between the WAS subscales with the subscales of the PTG dimension, and negative correlations with the subscales of the PTD dimension. It is quite natural that beliefs in the controllability of the surrounding world, its justice, and one’s own luck in life are associated with PTG in various areas. At the same time, in individuals experiencing pronounced stress and psychological traumatization, the process of depreciation is closely associated with the loss of basic trust in the world as safe, just, benevolent, and controllable. 

As shown in Table 7, the PTGDI-X and the SCL-90-R subscales show a significant number of positive interrelations of subjectively noted symptoms of mental distress with PTG and PTD across all studied dimensions. Thus, depression and anxiety symptoms, as well as other manifestations of psychological distress, accompany both of PTG and PTD phenomena. More weak connections found between indicators of psychopathological symptomatology and PTG, compared to indicators of PTD, may reveal a nonlinear dependence between growth and stress symptomatology. The more pronounced strength of correlation coefficients is revealed between the overall indicator of posttraumatic depreciation (Posttraumatic Depreciation /Total, PTGDI-X), depressive symptoms, and the severity indicators of psychological distress (Depression; Global Severity Index and Symptom Distress Index, SCL-90-R).

The correlations between the scales of the LREB and PTGDI-X proved to be predictable and supported the construct validity of the questionnaire. Thus, feelings of exhaustion, cynicism, detachment, or negative attitudes toward the care recipient, as well as a sense of personal ineffectiveness in the process of caring for a seriously ill loved one, were found to be associated with the process of depreciation within ICs’ value-meaning sphere. The more pronounced the devaluation, the greater the extent to which ICs are prone to destructive tension discharge, manifested in the somatization of emotional distress and addictive behaviors. The PTG scales of PTGDI-X are, as expected, positively associated with resource scales of LREB, such as Vigor, Dedication, Resources, and Self-Efficacy. Thus, the higher the level of a relative's engagement in the caregiving process, and their feelings of meaningfulness and effectiveness of their actions in overcoming the disease, the more pronounced the positive changes that occur in the relative’s value system as a result of confronting a loved one’s illness. It should be noted that destructive tension discharge (the Destruction scale of LREB) can accompany positive personal transformations in almost all domains of PTG. 

Discussion

The aim of this study was to verify the factor structure and psychometric characteristics of the Russian-language version of the PTGDI-X. The validation procedures were carried out on a non-clinical sample of ICs caring for patients with diverse somatic, neurological, and mental disorders. The sample of ICs varied in terms of age, gender, and caregivers’ family role. Most ICs were women, primarily mothers and wives, while most male caregivers were husbands. Therefore, the sample shows that those individuals are more similar to typical ICs rather than the population as a whole. As standardization of the PTGDI-X was not the primary objective of this study, greater gender and role balance in the sample wasn’t our priority; this task will be addressed in our future work.

Verification of the factor structure of the analyzed version of the questionnaire, conducted through CFA, showed sufficient adequacy of the constructed models for both the PTG and PTD scales. Our findings are consistent with the results of the majority of studies (Ho et al., 2022; Ramos et al., 2016; Taku et al., 2021) and support the cross-cultural invariance of the five-factor structure of the PTGDI-X in both PTG and PTD dimensions. 

It should be noted that the literature contains studies in which the five-factor model was not confirmed (Bocharov et al., 2024; Romeo et al., 2023). For example, in a study conducted on a sample of 601 Italian-speaking adults with traumatic experiences, the five-factor structure of the PTD dimension was not confirmed (Romeo et al., 2023). Moreover, deeper examinations of previous validations (e.g., Baker et al., 2008; Cann et al., 2010) have consistently shown that PTD is psychometrically less stable than PTG, possibly because participants tend to respond in ways that reduce discomfort or present themselves more positively. The factor structure of PTD remains debated, with some studies supporting a unidimensional model rather than five distinct domains (Cann et al., 2010; Romeo et al., 2022). Thus, the poor fit of the PTD model in the Italian validation study is not an isolated finding, but rather a recurring challenge that warrants further investigation.  The sample location and characteristics should be also considered. The Italian validation sample consisted predominantly of young, female, and highly educated participants, most of whom reported interpersonal losses (e.g., the death of a relative) rather than direct life-threatening events. This sociodemographic and trauma-related profile may limit the generalizability of the findings and partly explain the weaker factor structure observed for PTD. Conversely, in our sample, the model obtained for the PTD scales is not inferior to the model obtained for PTG in terms of fit indices.

The results of the psychometric evaluation indicate a good level of reliability of the adapted tool. Cronbach’s alpha and McDonald’s omega coefficients were high for both the PTG-total and PTD-total scales, exceeding .90. For the separate subscales, Cronbach’s alpha and McDonald’s omega also demonstrated good reliability, ranging from .774 to .897, with the exception of the Appreciation of Life subscale of the PTD, where the values were slightly lower, at approximately .70. The data are consistent with the results identified during the cross-cultural adaptation of the PTGDI-X in other populations, and demonstrated the lowest consistency of statements for both the PTG and the PTD dimensions (Romeo et al., 2023).

Assessing the internal construct validity of the PTGDI-X, we assessed intercorrelations between the scale scores of PTG and PTD. These findings confirm that the phenomena of growth and depreciation can coexist in individuals following trauma (Cann et al., 2010; Pieta & Rzeszutek, 2023; Romeo et al., 2022). This, in turn, underscores the necessity of providing respondents with the opportunity to assess the degree of severity of both positive and negative consequences resulting from their exposure to psychotraumatic events.

It is important to emphasize that the nonlinear regression analysis indicates the presence of a nonlinear relationship between PTG and PTD indicators. In other words, an increase in the PTG-total scale has a significant moderate correlation with an increase in the PTD-total scale up to a certain level; a further increase in PTG indicators is associated with a decrease in PTD indicators. The data are consistent with the results obtained during the adaptation of the PTGDI-X on a Chinese sample, where a significant quadratic relationship was also found (Ho et al., 2022).

The results of the analysis of cross-convergent and discriminant validity also confirm the correspondence of the analyzed Russian-language version of the PTGDI-X to the underlying theoretical constructs. The study of correlational relationships between the PTGDI-X and WAS scales revealed that, as expected, the PTG scales show positive correlations with the scales reflecting basic trust in the world and in oneself. The results of our study are consistent with previous findings and demonstrate that belief in justice, the controllability of the surrounding world, and one’s own luck in life are associated with PTG in various areas (Bayer et al., 2007; Dekel et al., 2011; Szcześniak et al., 2022). Furthermore, the present study demonstrates that the PTD scales (PTGDI-X) are negatively correlated with the scales of basic beliefs (WAS). Thus, the identified relationships indicate a close association between the processes of cognitive appraisal of the situation and the direction of personal changes in stressful or psychotraumatic circumstances (Calhoun et al., 2000). Assumptions about justice and luck, controllability of the current life situation, as well as perceived social support, act as predictors of PTG. A negative appraisal of oneself and the surrounding reality is associated with destructive consequences manifested in the form of PTD. 

Our data are consistent with the results of studies reporting associations between depressive, anxiety and other psychopathological distress symptoms and the processes of PTD and PTG (Ho et al., 2022; Michélsen et al., 2017; Romeo et al., 2023). The positive link between PTG and psychopathological symptoms may reflect a facilitative role of stress symptoms in the emergence of growth, whereby initial distress triggers the cognitive processing necessary for positive transformation. Since evidence suggests that depressive and stress symptoms exhibit nonlinear relationships with PTG (Shakespeare-Finch & Lurie-Beck, 2014), the obtained data require additional clarification within the target population and may be considered a potential direction for further research.

The data obtained regarding the relationship between PTD and burnout in the process of caring for a chronically ill loved one demonstrated that under the conditions of traumatic stress, these two detrimental processes become closely entwined and mutually perpetuating, which is consistent with the results of other studies (Semeijn et al., 2019). PTG is positively interrelated with engagement, which suggests that the sense of meaning and the feeling of rightness regarding one’s own patient care actions should be considered as a resource potential for ICs in the process of caring for a chronically ill.

Conclusion

The Russian-language version of the PTGDI-X demonstrated good psychometric characteristics. The analysis of the factor structure, conducted using CFA, indicates a sufficient correspondence of the model to the empirical data and confirms the construct validity. Evaluation of internal construct and cross validity also confirmed the theoretical constructs underlying the questionnaire.

The Russian-language version of the PTGDI-X, validated on a group of relatives providing assistance and care for seriously and/or chronically ill patients, can be used to study the phenomena of PTG and PTD that arise in a person in various stressful and psycho-traumatic situations. Employing this instrument will help consolidate information on PTG and PTD and help address current methodological and instrumental gaps in cross‑cultural studies of these phenomena.

The range of the tool’s application is wide, as the PTGDI-X can be used both in individual work and in clinical research. Its application will help to have a better understanding of theoretical ideas about the mechanisms of an individual’s mental response to the impact of stressful or psycho-traumatic events, as well as expand clinical perspectives, allowing assessment of the individual resource potential and identification of “targets” for tailored psychotherapy.

Limitations

It should be noted that the sample is specific, which defines the essence of the stress-related burden that emerges within the context of family relationships characterized by high personal significance. This stress load is predominantly prolonged (chronic) in its course; however, it may vary significantly depending on the type of disease. The specificity of PTG/PTD may vary depending on the type and how severe and deeply felt is the experience of traumatic stress. In other words, the way traumatic stress is experienced can be influenced by the nature of the event and may differ between ICs of severely or chronically ill patients and individuals exposed to combat and natural disasters. Future research should focus on how PTG and PTD differ depending on the type of psychological stressor/traumatic impact. Future validations should include more diverse samples in term of age, gender, trauma type, and educational background to ensure the reliability of the results. 

In relation to relatives of chronically ill patients, future studies will focus more on analyzing various factors, such as disease type and severity, caregivers’ family role (parent, spouse, child, sibling), and their attitudes toward the patient. An additional promising area for future research is the investigation of the relationship between PTG and PTD in caregiving relatives compared with patients themselves, which may provide insight into different coping trajectories within the same stressful context.

Ethics Statement

The study was approved by the local Ethics Committee of the V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology (approval No: 10/21 and No. 11/23). All participants provided written informed consent.

Author Contributions

A.Sh. and V.B. conceptualized and designed the study; T.V. analyzed the data, A.Sh. drafted the manuscript; V.B. and R.T. reviewed and edited the manuscript. All authors contributed to the final manuscript.

Conflict of Interest

The authors declare no conflict of interest.

Funding

Part of this research was supported by the Russian Science Foundation (Project No. 23-25-00090).

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