Psychological processes of posttraumatic growth among caregivers of children with autism: a qualitative-dominant study informed by the stress-reactive rumination model

Introduction Caregivers of children with autism face prolonged care responsibilities and uncertainty about future support. Although rumination has been associated with posttraumatic growth (PTG), less is known about how caregivers describe recurring thoughts and perceived growth in the context of long-term caregiving. Guided by the stress-reactive rumination model, this qualitative-dominant study explored caregivers' accounts of perceived PTG and the psychological processes they described during long-term caregiving. Methods Fifteen primary caregivers, recruited from two rehabilitation-related institutions in southeastern China, participated in semi-structured interviews. Interviews were analyzed using an iterative, theory-informed, codebook-oriented thematic analysis. Two researchers independently coded the transcripts, developed and refined a codebook, and resolved coding discrepancies through discussion with a third researcher. PTGI dimension scores were summarized descriptively to contextualize the qualitative findings, with the stress-reactive rumination model serving as a sensitizing framework during interpretation. Results Three interrelated themes were developed: (1) diagnostic shock and negative attribution, involving self-blame and catastrophic interpretations; (2) being trapped by the future, involving concerns about future independence, continuity of care, and perceived lack of support; and (3) moving from distress to active coping, involving active learning, self-regulation, acceptance, and meaning reconstruction. PTGI dimension means were highest for personal strength (4.38) and appreciation of life (4.22). The findings suggest that caregivers' accounts of growth were not a simple transition from distress to recovery. Rather, many caregivers reported ongoing future-oriented worries while concurrently describing practical coping strategies, enhanced personal strength, and renewed meaning in caregiving. The stress-reactive rumination model helped interpret these accounts by highlighting a possible shift in rumination direction—from self-blame and future-oriented fear toward actionable concerns and meaning reconstruction. Conclusion The study contributes to existing caregiver resilience research by integrating PTGI descriptive data with qualitative themes in a Chinese caregiving context. The study illustrates that caregiver growth is not a straightforward transition from distress to recovery, but an uneven experience shaped by both individual coping and the challenges of long-term caregiving.