Psycho-Spiritual Pathways to Well-Being after Adversity: An Umbrella Review
Abstract
Objective: This umbrella review synthesizes findings from existing systematic, scoping, and narrative reviews on psycho-spiritual processes and interventions that influence well-being following trauma and adversity.
Method: Following umbrella review methodology, we searched major databases (PsycINFO, PubMed, CINAHL, etc.) for reviews published between 2015 and 2025. Methodological quality was assessed using the AMSTAR-2 tool. Only reviews scoring above the predefined threshold of > 8/16 were included. All 18 included reviews scored 14–16 out of 16, indicating high methodological quality. Eighteen reviews met the inclusion criteria, encompassing diverse populations including veterans, cancer survivors, disaster victims, and survivors of abuse.
Results: The synthesis reveals three core psycho-spiritual pathways: 1) The Meaning-Making Pathway, where spirituality facilitates posttraumatic growth (PTG), identity reconstruction, and spiritual well-being (SWB); 2) The Pathway of Spiritual Struggle, where existential conflict, moral injury, and a loss of meaning exacerbate psychological distress; and 3) The intervention Pathway, where psycho-spiritually integrated therapies showed positive effects. However, effect sizes, confidence intervals, and heterogeneity were inconsistently reported across the 18 included reviews, precluding a single pooled estimate. Effect sizes from meta‑analyses ranged from small to moderate: for depression (Cohen’s d = 0.42, 95% CI [0.21, 0.63]), for anxiety (SMD = 0.31–0.58), and for spiritual well‑being (SMD = 0.47, 95% CI [0.29, 0.65]). Heterogeneity was moderate to high (I² = 54–72%). Key facilitators include person-centered, trauma-informed care that validates spiritual concerns, while a primary barrier is the clinician's lack of training in addressing existential and spiritual dimensions.
Conclusion: Psycho-SWB is a pivotal, multifaceted outcome of trauma recovery. Effective support requires a nuanced approach that acknowledges both the potential for growth and the reality of existential pain. Clinical practice must integrate evidence-based psycho-spiritual interventions, while research should prioritize longitudinal designs, diverse populations, and standardized measures of psycho-spiritual constructs.
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| Posttraumatic Growth Psychological Well-Being Spirituality Trauma | ||
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