Impact of Post Traumatic Stress Disorder on Employee Job Performance: Moderating Role of Spirituality

The aim of this paper was to determine the correlation amid post-traumatic stress disorder (PTSD) and employee job performance with moderating role of spirituality among Police ocials who experienced during the war on terror. Ninety seven personnel from Pakistan Security Forces, hospitalized as result of injuries in war against terror, were selected as study respondents and personally administered with the seventeen items questionnaire to measure PTSD symptoms. All the instruments administered to measure PTSD symptoms, employees’ performance and spiritualty were adopted. Andrew F. Hayes Process model was used to test the hypotheses derived from the study’s conceptual model as it was identical with the Andrew model (Hayes 2013) in which moderation is tested with one moderator that is spirituality. Correlation and Regression analysis were carried out by using SPSS. Moderation analysis checked the moderating effect of spirituality upon the relationship between PTSD and employees performance. The research concluded that PTSD negatively affects the job performance, however, spirituality reduces the negative outcomes of PTSD. The research found that the spirituality contributes positively to the psychological well-being of a person, thereby making one’s self more robust to tremor and harrowing engagement and subsiding the negative impacts of PTSD. Managerial implications and future direction were also discussed.


Introduction
Post-Traumatic Stress Disorder (PTSD) is de ned by Mayo Clinic (2013) as a mental health condition that is generally experienced directly by either observing or undergoing directly any terrifying event(s). Severe anxiety, bad dreams, ashbacks and overpowering thoughts about the event(s) are foremost symptoms of the disorder. Technically, it might be a reaction psychologically occurred after any event(s) which was extremely stressful for instance physical violence, natural disaster or a war combat. . It is a mental condition which affects a person who has had a very shocking or di cult experience such as ghting in a war and it is usually categorized by hopelessness, nervousness, recurring nightmares or recaps of that speci c event (Learner's et al;1980;Adam et al, 2019). The symptoms of PTSD may remain for months even years after the event(s) and usually affect the functioning of the entire body Ever since the primitive era of orthodox warfare till the contemporary globally spread war against terrorism, humans have discovered to live on the bloodshed by developing an aspect of resilience. . Among other injuries, PTSD is very complex to understand, and di cult to tolerate and overcome, and in particular the one which is associated with the conventional war, and no doubt it becomes very hard for the soldiers or members of security forces those are out and exposed to the 'war on terror'.
The "Good stress" is felt when excited and is normally termed as "eustress," by the psychologists. Though pulse hormones ow accelerate during such stress as well, but there is no physical or psychological threat to it. Moderate stress kindles the production of a chemical named interleukins and provides the resisting immune system a speedy enhancement to guard against ailments. Therefore, in contrast to normal assumption, every type of "stress" cannot be termed as totally bad, rather a moderate degree of stress is necessary to reinforces readiness and rallies individual performance on challenging tasks (Ghazali,2004). However, unusually rise in stress inches to erode performance, negatively affecting emotional intelligence, affect decision making ability, spoils work place mood, lowers productivity, and shut down self-regulation (Gates, et.al,2011;Matthewset.al, 2017;Janke et.al, 2018).
Literature on stress and performance unanimously endorses the signi cantly inverse relationship between the Stress disorder and employees as well as organizational overall performance with deteriorating work quality, increasing errors, and absenteeism. The literature also identi es, amongst the suffering employees, the tendency of higher degree of turnover intensions, deteriorating health with ailments like anxiety, emotional disorder; work life imbalance; and psychological state of hopelessness etc.( Ghazali,2004; Singh, Y., & Sharma, 2012;Janke et.al, 2018). Empirical research studies investigating post trauma effects found that a PTSD affected may experience symptoms such as; regrets, cynicism and self-betrayal that hampers timely reclamation of sound health, requiring detailed psychotherapeutic attention (Yager,& Kay, 2020). Ciocca,et.al, (2015) suggest continuous and intimate psychological support for these patients to help them to positively recover from PTSD.
Finding spiritual or religious practice to cope up with stress has been often a commonly adopted stress management strategy. Because, spirituality provides reliably believed alternative to the person that dependence on God helps conceding fears and concerns. Bourne & Watts (2011); and Canda et.al, (2019) note that spiritual performs such as praying, re ecting, meditating, joining a church or mosque sermon or travelling in nature, cultivate positive changes in ones perceptions about life, attitude, and behavior needed to contest sadness, hopelessness, and depression. Kent (2020); and Kent et.al, (2020) contend that prayers of the people having secured perceptions about God, as sincere and earnest loving, are result with optimistic psychological outcomes that cope up stress to a considerable degree. Stress amongst spiritually void people is converted in to Spiritual distress where the subject is unable to nd meaning, amity, relief, strength, or connectivity with life. . Bourne & Watts (2011) and Kent (2020) suggests that Spirituality allows people to overcome stress.
Bodily injuries sustained by the soldiers during combat cause both; physical and psychological burdens.
Besides, the physical wounds of war, the soldiers are exposed to manifold combat experiences such as, seeing friends amongst serious casualties (injured or killed), missing comrades, and charging enemy on the face of relentless re or bearing barrages of enemy re. According to Grieger, et.al, (2006), "interaction across time of wound, battle exposure, discomfort, doubts about physical recovery, and apprehensions over long-term disability or dysfunction, availability of sustained medical care or otherwise, and wanting social supports results in a intricate option of ailment and retrieval". Psychological stress of 'war on terror' is relatively different that of conventional war, because in case of 'war on terror', the enemy is hidden, may be from within and not limited to frontiers with incomprehensible results. Whereas, in conventional war the enemy is visible, operating along de ned borders and the results delivered become source of accomplishment thereby minimizing the extreme effects of PTSD as compared to those traumas of 'war on terror. Since the September 11 th , 2001, paralleled to the role played by NATO forces and US troops in Afghanistan and Iraq, Pakistani forces are also facing the 'war on terror' countrywide for more than a decade now especially in the tribal areas and province of Khyber Pakhtunkhwa.
The veterans and the families of the injured or dead of the Pakistan security including Police, Frontier Corps, and Rangers or military including have been consistently facing the trauma during the war on terror. The negative impact of PTSD has been apparent on one grounds or the other on the job performance. It is therefore area of concern for researchers to nd out the factors which are playing a role to develop Counterproductive behavior of employees. It is also important to nd out factors which are helpful to improve the performance of employees. Post-traumatic stress disorder (PTSD) is understood as a deferred reaction to an abnormal, traumatic life experience like war, terrorism, accident, a natural disaster, or any kind of physical, emotional or psychological abuse (Miller et al, 2012(Miller et al, , 2014. The

Research Question:
Aim of this study is to investigate the effects of PTSD upon employees' performance of Pakistan security forces personals and how does spirituality moderate this relationship. Therefore the study focused on the following objectives: a. To examine 'impact' of PTSD on the employees' performance of the police and personnel other security forces having fought war on terror in KP and around.
b. To nd out the moderation effect of spirituality on the association of PTSD with Perceived Job Performance

Literature Review
Organizational accomplishment is not simply the outcome of an well thought-out organizational strategy, rather, it is a creation of its employees' productivity and performance ( frustrates workplace harmony and a drops in professional passion and eagerness. These all psychological and physical re ections considerably in uence performance towards negative side of the productivity. Stress has been shown to adversely affect organizations wherein staff who report higher levels of stress have lower job satisfaction, increased turnover, increased absenteeism, and lower productivity (Baloch, 2009 . All these gives support in managing combat stress and PTSD compressed environment at workplace thereby maintaining the affected performance of the employees.

PTSD Framework
Stress is sensation of expressive reaction or corporal pressure that is normally de ned as the higher degree of overwhelmed feelings. In medical language stress is body's reaction to physical, mental, or emotional pressure. American Psychology Association de nes stress as any type of change that predicts physical, emotive, or psychosomatic tension or strain. Its body's reaction to everything that entails responsive attention or action. No one is free from stress rather everyone practices stress to some degree on one pretext or the other. Stress roots changes in the body with increase in blood pressure, acceleration in heart rate, and blood sugar levels. Stress may be positive or negative. Positive stress helps energize motivation to accept challenges or meet targets or deadlines. Negative side of the stress represents state of inability in coping with outcome of incontrollable pressures confronted with and marks one feel frustrated, irritated, tense or nervous. Negative stress results in to the development of feelings of frustration, hopelessness, nervousness, anxiety, annoyance, anger, sadness or depression.
PTSD has been de ned as an ailment or disorder that is sequential follow-up of life-threatening event experienced by an individual or serious injury resulting in physical or psychological of incapacitation of function life or hopelessness. PTSD symptoms, vary from person to person and time to time, are generally grouped into unpleasant memories, negativity in mood, emotions and thoughts, and changes in physical and psychological reactions. Posttraumatic stress disorder (PTSD) is a psychiatric disorder that used to be known in the past as "shell shock" or "combat fatigue" during World War era. PTSD not happens to combat veterans and may occur in people of any society, or culture, and gender of any age.
It happened to occur in people who have witnessed or faced a shocking happening that may be a natural tragedy or catastrophe, or manmade such as a fatal accident, a terrorist attack threatened with death or sexual violence.
PTSD is an anxiety disorder that occurs in response to an extreme traumatic event in somebody's life which may include military combat, terrorist attacks, violent personal assaults, natural disasters or serious accidents. People having experienced PTSD have distressing feelings that usually continue harassing for longer duration of time even after the traumatic incident occurred. The feelings re ect state of hopelessness, despondency, anger; and estranged from other people. PTSD, if not properly treated, is questionable to dissolve and results in to enduring pain, prolonged depression, drug addiction sleep loss, hampering a person's ability to work and interact with others.
Outlining the track history of PTSD framework, Parry-Jones et al (1994) discovered that "abnormal stressors have been featured in all the societies from the earliest civilizations". Although stressful events have existed in the history of mankind, but the PTSD is "an enduring condition that was codi ed in the contemporary diagnostic categorization, and depicted by various names like 'shellshock' and 'railway spine' etc. Extreme fear, ineptness, desperateness, and decreased energy levels are hallmarks of the disease and can affect the overall functional aspects of a person's life (Bender, Morey,and Skodol, 2011) and it is very common for other conditions; depression, anxiety, or substance abuse to occur along with PTSD. The symptoms of PTSD immediately after the traumatic event may remain hidden until months or years, having following indications: a. Re-Experiencing Symptoms i.e. Becoming upset when de ed with a traumatic prompt or thinking about the trauma when you are attempting to do something else, b. Avoidance and Numbing Symptoms i.e. detachment from people and places leading to social isolation, and Arousal Symptoms i.e. sleeplessness, hyper-alertness to danger.

Employees Performance
Performance' is a sequence of controlled actions of employees that leads to the achievement of organizational goals, and the actions could be measured on individual level. Murphy (1989); Campbell (1994) and Iqbal et al (2015) de ned 'performance as a set of employees' behaviors that facilitate advancement towards organizational goals and leadership style plays very decisive role in it. High level of motivation, espirit de corps, and true empathy, dedication for martyrdom, divine reward, and strong belief in religion plays a signi cant role in improving the employees' performance against the occurrence of PTSD in combat environment (Wagner, 1994;Newsome, 2003;Silke and Brown, 2016). The eminence of decisions depends on the positive or negative attitude of the front line employees. If the employees have a high level of satisfaction towards their organization, they would exhibit an added role of behavior, and will also try to put a good impression of their organization acting as a role model. Participation in decision making enhances employees' commitment that directly persuade their performance for the overall bene t of the organization. Performance of is optimized by their high level of motivation. Motivation is among the most studied element as it presumes that a satis ed employee displays enhanced performance that bene ts the overall performance of the organization and its growth. Baloch (2007) suggests that satis ed workers are more productive. Organizational performance is directly hinges upon the individual performance. Therefore, employee performance has always been an

Security Forces Personnel Performance Relationship with PTSD
PTSD is found as a common occurrence among military veterans, as more than one million veterans from the Vietnam's war had experienced combat PTSD, almost half of them having the symptoms as of 1990 1990;Weiss,1992). According to "National Co.," morbidity survey of Korean con ict veterans and WW-II, about 58% of the male veterans were diagnosed with trauma which was combat related and was related to the most stressful trauma event (Kessler et al, 1995;Kessler, 2000).). Study conducted by Zatzik et al (1997) indicated that those male veterans, who were identi ed with the symptoms of PTSD, were three times more probable to be out of work as compared to those who were not affected by PTSD. PTSD has been strongly connected with reduced performance at work among veterans of Vietnam. Savoca and Rosenheck (2000) discovered that lifetime effects of PTSD were associated with the fact that current employment probability for affected veterans was 50% reduced. Seal et al (2007)  Veterans effected with PTSD generally face problems at workplace and ethically it is expected that employers shall recognize the challenges faced by the affected employees and cooperate to support affected employees to recover through reasonable adjustments. Employers in each organizations shall acknowledge that war veterans from security forces are an imperative human capital, each one of them hold valuable knowledge, skills, abilities, experience and endurance (Simpson & Sariol, 2018). Hence, a systematic and articulated integration of war veterans, with more emphases on PTSD, in to civilian employment market shall be taken, not only as corporate social responsibility, but also as a most promising linchpin for the job market if judged on the applied side of the "Diversity principles"(MacLean, 2017).
Religious philosophies and observances (spirituality) are acknowledged as traditional means of developing individual beliefs, values that de ne meaning to their life. Even, health professionals are recognizing spirituality as a primary human dimension for psychological balancing besides other social, emotional, physical, and cognitive aspects, as signi cant coping measures from psychological and stress disorder. Spirituality is the inner spring of wisdom that is mirrored in human oriented ethics and performance oriented behaviors. The values of spirituality include sympathy, empathy, kindness, modesty, imagination, and knowledge. According to Paramahansa Yogananda, Indian monk and guru of meditation and Yoga, "Spirituality is the in nite reservoir of wisdom. Each human is a channel through which that divine wisdom is steadily owing" (Guillory, 2000). Workplace spirituality lessens stress level, and provides an all-inclusive umbrella that embraces the totality of work-related activities encompassing diversity, performance, workplace engagement, work life integration, creativity, or imagination. Spirituality constructs positivity amongst individuals and helps cultivate employees into a better humanoid (Houghton et al, 2016). Spirituality when linked with religion gives birth to a strong and better citizen who always believes in helping others, and giving back to society (Kalantari & Khalili, 2018).Furthermore, a higher level of spirituality is correlated with lower level of post-traumatic syndromes, and signi cantly positive association with high degree job satisfaction and contentment that subdue pains, anguish and nervousness, despairs and mental disorders to a considerable extent ( Connor . Hence, organizations gifted with the culture of spirituality support shape a rmative culture, healthy environment, principled and considerate leadership for the workforce marked with PTSD syndrome (Garg, 2020).

Conceptual Frame Work & Development of Hypotheses:
Following conceptual framework derived from the review of related literature and preceding discussion thereof as diagrammatically exhibiting association between security forces related PTSD with the their employees performance: Figure. 1: Conceptual Framework Hypotheses: A set of hypotheses to be tested by this study is given as follows: H1: Post traumatic stress disorder directly negatively affects the Job Performance.
H2: Spirituality moderates the relationship between Post Traumatic Stress Disorder and Job Performance.
H3: Spirituality directly positively affects the Job Performance.
H4: Spirituality directly affects post-traumatic stress order.

Research Methodology
To pursue its research objectives, the study was conducted in two stages. The stage one was prelude to the main study that conducted to check the consistency of the instruments through a pilot study and necessary modi cations were incorporated accordingly. In stage two the main study was undertaken through a survey research.

Discussion And Recommendations
This study was aimed to investigate the impact of Post-Traumatic Stress Disorder -PTSD on the employees' job performance as well as the moderating impact of spirituality on the relationship of PTSD and job performance of the personnel of Pakistan security forces including Police combated the War against terror. Resulst showed that PTSD negatively affected the job performance (β = -.0708 and Grag (2020) support the ndings that religiosity and spirituality lessen the negative impacts of cognitive and psychological disorders i.e. depression, anxiety, frustration, and emotional exhaustion etc. It was hypothesized in the study that spirituality lowers the negative impacts of PTSD on the job performance.
Results of this study con rmed this and thus supported the hypothesis. Milliman, Gatling, and Kim, (2018) conclude that spirituality amongst individual or in organizational culture inculcate motivation for performance and minimize negative perceptions or pains developed during work.
This study gave a brief description of PTSD and its effects on the performance of veterans who have been involved in war zones. PTSD and job performance especially in war zone are strongly linked together. This study can be concluded in way that although PTSD negatively and badly affected the job performance of Security forces personnel having subjected to the effects of War against terror however, their negative outcomes can be lessened by the spirituality. The possible explanation for this fact may be that the spirituality contributes positively to the psychological well-being of a person, thus making one's self more resilient to traumatic absorption.

Study Limitations
The study was limited to the security forces personnel including Police who were either, owing to their PTSD, admitted in hospitals or returned to peace location after recovery from the physical and psychological rigorous of war against terror. In addition, the study also holds following limitations: a. Use of self-reported methods of PTSD and depression, though the instruments used were well validated through number of research studies in the past.
b. Across-sectional study, thus causation cannot be established with accurate conclusion.
c. The low representation of female combat soldiers in Pakistan's security forces, and the exclusion of veterans with severe mental damages limit the research ndings to generalize to other populations. d. De ciency of an objective measure of injury sternness or social supports that might have added to the recovery or deteriorating of symptoms in post hospital's discharge period.
Keeping in mind the above mentioned limitations, the future researchers shall employ more rigorous research design e.g. longitudinal design and sample inclusive of veterans in the process of rehabilitation / integration in the society after getting discharged from hospitals. The data collection may also involve other sources e.g. personal and war diaries, citations and situation reports, interviews, focus group discussion. The link between PTSD and veteran employee performance in war zones for the war on terrorism in Pakistani tribal areas, and Afghanistan have opened up new avenues for future research i.e. extending it to IDPS during their displacement and rehabilitation phases. Furthermore keeping in view the polarization of views of the masses on the causes and effects of the war against terror there is dire need of measuring the socio-cultural effects on nation psyche in post war scenario.

Study Recommendations
Though War on terror is apparently concluded but the sleeper cells of terror groups are still active and news of clandestine attacks on security forces in tribal areas and Balochistan astride Afghanistan border keep appearing with soldiers seriously wounded or killed. Threat of simmering debris of war is looming until successful culmination of Afghanistan peace process is realized. Furthermore, Pakistan is not only exposed to manmade disasters but also exposed to natural disasters which leave extremely affected in the past with lasting impact on our socio-economic and socio-psychic national pro le. e. Religion motivates people and provides a structure that offers a group of people to bond with similar beliefs and values. The religious belief impacts the individual's approach towards the life and shape their mental and socio-psychological leaning. There is plethora of literature that reinforces that religiosity and spirituality helps to disassociate from evils, theft, abusive behavior, atrocities with weeks, controls tendency to suicide, alcoholism and drug use. Therefore, soldiers shall be subjected to the frequent interactive sessions with the religious scholars to strengthen their belief to ght for RIGHT against social menace damaging their society and its socio-economic wellbeing. The enhancement in their degree of spirituality would multiply their resilience to manifold and face the scourges of when trusted upon them or their society. b. The research is not funded by any outside funding agency.
c. There is no con ict of interest to be reported d. We acknowledge the support of military hospitals administration in facilitating our data collection process.
It is certi ed that all ethical requirements were ful lled while investigating the participants and they were briefed about the purpose of research. All of the participants were duly informed and they willingly responded to our questionnaires served to them. Each questionnaire was lled by them that re ects their are informed consent.  Figure 1 Conceptual Framework