Impact of Direct and Indirect Trauma Exposure: Moderating Role of Coping Self-Efficacy and Perceived Social Support

The present study was conducted to understand the impact of direct and indirect exposure to war trauma on active security officials of police who participated in the war on terror. The study also investigated the role of perceived social support and coping self-efficacy and their interaction on enhancing or impending PTG among the population. The study was cross-sectional in design. The sample comprised 400 active-duty police officials who participated in the war on terror and were directly and indirectly exposed to trauma exposure. Hypothesis based on existing literature grounded the path analysis assessing the role of coping self-efficacy and perceived social support and their relationship with war trauma and post-traumatic growth. Non-probability purposive sampling technique was used. Post-Traumatic Stress Diagnostic Scale (Foa et al.,2016), Post Traumatic Growth Inventory (Tedeschi & Calhoun, 1996), Comprehensive Trauma Inventory (Hollifield, 2002), Coping Self-Efficacy Scale (Chesney et al., 2006) and Multi-Dimensional Scale of Perceived Social Support (Zimat et al.,1988) were used in the study. All scales were used in Urdu to understand better and avoid cultural biases. The results revealed that perceived social support and coping self-efficacy moderated the relationship between exposure to trauma and post-traumatic growth. Findings have concluded that direct exposure to war trauma was more intense than indirect exposure, and the population with direct exposure scored high on stress and post-traumatic growth. So, findings of the study confirmed that stress and post-traumatic growth could be experienced together, and variables like coping self-efficacy and perceived social support moderate the relation between war trauma and post-traumatic growth.

Keywords. Trauma, post-traumatic growth, perceived social support, coping self-efficacy

Important events which are traumatic in nature can produce long-lasting effects on the exposed population are war, personal (violent) assault (e.g., sexual assault and physical attack), being hostage or kidnapped, being in prison, torture, being a victim of terrorist attack, exposure to sever car accidents and natural disasters (Angel, 2016). Law enforcement officials tend to be exposed to a high frequency of potentially traumatic incidents during the war. The dichotomous distinction among these events involves witnessing threat or harm to others and experiencing threat or harm directly to oneself. Previous research suggests that different types of trauma exposure can develop varying levels of negative post-traumatic responses, including post-traumatic stress and disorder related to stress (PTSD) symptoms and positive outcomes such as post-traumatic growth (Park et al., 2022). With the goal of better-assisting officers experiencing post-traumatic stress, enhanced knowledge regarding this psychological response to the development of PTG is necessary. Post-traumatic stress disorder (PTSD) and many other mental problems are common in the population exposed to tragic events, especially war. Previous studies have found that individuals with higher and direct exposure to trauma experience higher levels of distress than indirect and low levels of trauma exposure. Studies have confirmed that unexpected, sudden, and extreme tragedies may cause the exposed population to post-traumatic stress disorder and anxiety (Gori et al., 2021). The severity of the distress can be measured by the symptoms like feelings of chronic sadness, worthlessness, and loss of interest in interaction with other people (Montalvo-Ortiz et al., 2022).

Trauma exposure can be a precondition for severe psychological reactions like post-traumatic stress, but not all individuals who face trauma suffer from severe psychological disorders. In recent years the identification of positive changes after trauma exposure has attracted scientific exploration, especially with regard to direct trauma exposure (Tedeschi et al., 2017). Studies have found that some people maintain psychological stability when they face trauma, whereas others bounce back or thrive and experience meaningful complete positive change, which includes many positive consequences like a positive change in social interaction, improved relationships with others, improvement in personal strength and self-assurance and an increased sense of appreciation of life and change in priorities of life. There are many studies that have reported post-traumatic growth in survivors of trauma (Shuwiekh et al., 2018). Tedeschi and Calhoun’s (1996) model of post-traumatic growth is a comprehensive approach to this area of study, and the model explains the co-existence of post-traumatic growth and stress in survivors of trauma. The model also explains that many factors can contribute to and predict either one or both consequences. There are factors that can be positively associated with one out of two outcomes but negatively with the other (Calhoun & Tedeschi, 2014).

Perceived social support plays an important role in the aftermath of trauma and can save an individual from adversities, and their presence can produce positive changes (Chasson et al., 2022). Perceived social support is the person’s belief that they are loved and cared for, 

Esteemed and a part of communal obligations. Research has proved that supportive interactions among people are protective factors against the negative consequences on health because of life stressors. Coping self-efficacy is the belief that reflects control of personal actions and a personal and future view that is more optimistic. Coping self-efficacy also plays a protective role and leads to growth after trauma (Tedeschi et al., 2018; Taku et al., 2021). 

Research has begun to identify variables that affect the relationship between trauma exposure, post-traumatic stress, and post-traumatic growth. These variables may be conceptualized as social and personal strength factors. Studies on social factors suggest that veterans who have a strong perception of being supported suffer less from stress and other mental adversities like PTSD after trauma. Personal strength factors like coping self-efficacy also play an important role in diffusing the effects of war trauma and preventing PTSD (Acquaye et al., 2018). The process adopted in the face of adversity can affect the development and intensity of stress. The use of avoidant coping shows a link with increased PTS symptoms following trauma, but on the other hand use of active coping relations plays an important role in the development of PTG (Hokes & Adams, 2022). A significant part of the studies about the impacts of direct and indirect war trauma exposure and factors that play an important role in positive change after trauma exposure has been done in countries of the west, but very little work has been done in Pakistan. The present study is unique as it is the first study in Pakistan conducted on the impact of direct and indirect exposure to war trauma among police officials who played an important role in the war against terror. The study has investigated the lying relationship between war trauma, stress, and post-traumatic growth and the role of contributing factors of growth like coping self-efficacy and perceived social support.



The sample included 400 active-duty police officials. The age range of the sample was from 21 to 56. To be eligible for participation in this study, the criteria were having direct or indirect exposure to trauma during the war on terror and from 1 year on post-deployment in peaceful areas.


Post-Traumatic Stress Diagnostic Scale (PDS-5). PDS-5 is a 22-item 5-point Likert-type scale which was developed by Foa et al. (2016). The Urdu version was unavailable, so the scale was translated into Urdu and adapted culturally. The alpha reliability of the scale for the sample was (.93).

Post Traumatic Growth Inventory (PTGI-SF). PTGI-SF was developed by Tedeschi and Calhoun (1996); translated Urdu was available. The inventory was used as a measure of post-traumatic growth. A score of the alpha reliability of the current scale for the sample was .91. The scale has 10 items. Participants rated their responses on a 6-point Likert-type scale.

Comprehensive Trauma Inventory (CTI-104). CTI-104 was developed by Hollifield (2002) and has been used to measure war-related trauma. The Urdu version was unavailable, so the inventory was translated into the Urdu language and culturally adapted. Participants rated their responses on a 5-point Likert-type scale. The scale's alpha reliability score for the sample is .91.

Coping Self-Efficacy Scale (CSE). The CSE scale (developed by Chesney et al., 2006) was used to measure self-efficacy. The available Urdu version was used. The scale has 26 items with 3 subscales. Participants rated their responses on 0 to 10 rating scale. The scale showed (.93) reliability for the sample.

Multi-Dimensional Scale of Perceived Social Support (MSPSS). The MSPSS was first developed by Zimet et al. (1988), Urdu version was available. It is a 7- point Likert-type scale consisting of 12 items questioning the source and the level of social support. 


A cross-sectional study was conducted. Approval was taken from the ethical committee of NIP (National institute of Psychology). Data was collected after receiving permission from concerned authorities, and informed consent from the participants was taken. All

participations were given information about the purpose of the study; personal identity information was not taken. Assurance about the confidentiality of the data was provided, and it was clarified that data would be used for research purposes only. Participants were asked to respond to the items by selecting an option resembling their situation, feelings, or behaviors more closely. There were no right or wrong answers. 


AMOS and SPSS 21 version (Statistical Package for the Social Science) was used for the analysis. The response rate of the study was 97%. A structured questionnaire collected demographic information. In table 1 difference between direct and indirect exposed individuals has been described.

Table 1

Note. CI = Confidence interval, LL = Lower limit; UL = Upper limit.

Differences between Direct and Indirect Trauma Exposed Population on Intensity of War Trauma, Post Traumatic Stress, Post Traumatic Growth (N= 400) 

Table 1 shows differences between respondents with indirect and direct trauma-exposed populations. Individuals with direct trauma exposure showed high scores on war trauma intensity, post-traumatic stress and post-traumatic growth compared to individuals with indirect trauma exposure. 

Table 2
Correlation between Study Variables (N = 400)

Table 2 shows the descriptive statistics and Pearson correlation of the variables. The results showed that the correlation between trauma related to war, post-traumatic stress and growth is positive. Coping self-efficacy and Perceived social support showed a significant positive relationship with post-traumatic growth. Perceived social support and coping self-efficacy were marginally positively correlated with PTS. War trauma and PTS were positively correlated, and PTS and PTG also showed a positive relationship. In Tables 3 and 4, results of moderation between study variables are provided.

Table 3
Moderating Role of Perceived Coping Social Support in Contributing Post-Traumatic Growth After Trauma (N=400)

*p < .05; **p < .01; ***p < .001.

Table 3 shows an analysis of moderating effects of perceived social support on war trauma and post-traumatic growth. Moderation is found satisfactory for perceived social support. Findings suggested a significant increase in post-traumatic growth aftermath of exposure to trauma in the presence of perceived social support.

Table 4
Moderating Role of Coping Self-Efficacy in Contributing Post Traumatic Growth after Trauma (N = 400)


This article aimed to investigate the relationship between war trauma, post-traumatic growth and post-traumatic stress and confirm the moderating role of perceived social support and coping efficacy with growth. The present study is the first one to investigate the impact of direct and indirect trauma exposure on police officials who participated in the war on terror. Additionally, studies have investigated the underlying pathway from stress to growth and highlighted the role of contributing factors of growth, like perceived social support and coping self-efficacy. Results are consistent with the findings of the studies in the literature. A literature review concluded that different factors play an important role in promoting growth (Henson et al., 2021). Overall, findings suggest that direct trauma exposure affects officials’ well-being more than indirect trauma exposure. Conversely, the presence of perceived social support (social factor) and coping self-efficacy (personal strength factor) during the coping process can bring positive changes like growth. Findings are inconsistent with previous literature, as previous studies have inferred that the relationship between stress and growth in the aftermath of trauma can be affected by factors like perceived social support and coping self-efficacy (Cox, 2017; Finstad et al., 2021).  

The findings also confirmed that stress and PTG are positively correlated. The confirmation of the association between stress and growth is in line with the previous studies. Previous research has confirmed this association in different cultures (Yaun et al., 2021). Present findings have confirmed that a higher level of stress is associated with a higher level of growth and have confirmed the co-existence of stress symptoms and growth is possible, which is in line with previous research on adolescent survivors of the Wenchuan (China) earthquake (Zhou et al.,2015). More ever, the negative effects of trauma, like stress after trauma, may buffer positive effects like growth in the aftermath of trauma. The study has confirmed that using positive factors like perceived social support and coping self-efficacy is a shield against the negative consequences of a traumatic event like war. And especially war against terror was not a traditional war. The active-duty officials of police who had direct exposure to trauma in this war showed high levels of post-traumatic growth and scored high in stress as well. The result proves the fact that what does not kill u gives you strength. And belief in self (coping self-efficacy) and perception of being helped results in positive change like growth. Findings are persistent with previous research (Taku et al., 2021). 

The study findings concluded that trauma exposure results in stress which can end in PTSD or growth. The moderating role of perceived social support and coping self-efficacy positively predicted growth in a population exposed to war trauma. The use of positive factors to cope with trauma leads individuals to think positively about the trauma and produce feelings of personal strength which turn into post-traumatic growth and reduces the chances of PTSD after math of war trauma exposure. The findings are consistent with the previous findings in the area (Zhou, 2018).

Limitations & Implications 

The study's cross-sectional nature of the study and utilization of the self-report measures, and use of the purposive technique for sample selection are the study's limitations. The use of random sampling and longitudinal study design provides better qualification for the generalization of the findings, but due to time limitations and complex samples, it was not possible to conduct the longitudinal study. Findings have implications for soldier fitness programs, psychological intervention planning and health care programs for the active-duty officials of police who had faced tragedies during the war on terror.


Despite the mentioned limitations, the study's contribution is new knowledge to previous theoretical and empirical knowledge related to direct and indirect trauma exposure, PTS and Post-traumatic growth, and the underlying mechanism and role of perceived social support and coping self-efficacy. The results have demonstrated that more consideration is required to be given to enhance the role of the contributing factors of growth, like perceived social support and coping self-efficacy. These factors may foster post-traumatic growth in individuals, target stress, and reduce the chances of PTSD. The study highlights the implication of increased clinical efforts to improve coping self-efficacy and perceived social support, which moderates the relationship between growth and stress. Additionally, helping the war trauma survivors and helping them to buffer and achieve more positive attitudes towards traumatic events.


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