Resilience: research evidence and conceptual considerations for posttraumatic stress disorder

Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders

OBJECTIVE

Research suggests that resilience is associated with favorable treatment outcome in patients with depression and/or anxiety disorders. In this regard, the identification of specific characteristics related to resilience that could provide targets for resilience-enhancement interventions is needed. Since the type of cognitive coping strategies is a possible marker of resilience, we investigated adaptive and maladaptive cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders.

METHODS

A total of 230 outpatients with depression and anxiety disorders were consecutively recruited and completed the Cognitive Emotion Regulation Questionnaire, the Connor-Davidson Resilience Scale, the Beck Depression Inventory, and the State Anxiety Inventory. A linear regression model was used to determine which cognitive emotion regulation strategies predicted resilience after controlling for relevant covariates. Additionally, this model of resilience was compared with those of depression and anxiety symptoms.

RESULTS

Adaptive strategies were more strongly correlated with resilience than maladaptive strategies. In the regression model, more use of refocus on planning and positive reappraisal as well as less use of rumination predicted high resilience after controlling for age, gender, marital status, depression, and anxiety. Among these strategies, refocus on planning was the common strategy contributing to resilience and depression.

CONCLUSION

These results suggested that the cognitive emotion regulation strategies of refocus on planning, positive reappraisal, and less rumination contribute to resilience in patients with depression and anxiety disorders. It might provide potential targets for psychotherapeutic intervention to improve resilience in these patients.

Divergent pathways to influence: Cognition and behavior differentially mediate the effects of optimism on physical and mental quality of life in Chinese university students

Previous research has indicated that both cognitive and behavioral variables mediate the positive effect of optimism on quality of life; yet few attempts have been made to accommodate these constructs into a single explanatory framework. Adopting Fredrickson's broaden-and-build perspective, we examined the relationships between optimism, self-rated health, resilience, exercise, and quality of life in 365 Chinese university students using path analysis. For physical quality of life, a two-stage model, in which the effects of optimism were sequentially mediated by cognitive and behavioral variables, provided the best fit. A one-stage model, with full mediation by cognitive variables, provided the best fit for mental quality of life. This suggests that optimism influences physical and mental quality of life via different pathways.

Social reactions to disclosure of sexual victimization and adjustment among survivors of sexual assault

How a support provider responds to disclosure of sexual victimization has important implications for the process of recovery. The present study examines the associations between various positive and negative social reactions to sexual assault disclosure and psychological distress, coping behavior, social support, and self-esteem in a sample of college women (N = 374). Social reactions to assault disclosure that attempted to control the survivor's decisions were associated with increased symptoms of posttraumatic stress, depression, and anxiety and lower perceptions of reassurance of worth from others. Blaming social reactions were associated with less self-esteem and engagement in coping via problem solving. Social reactions that provided emotional support to the survivor were associated with increased coping by seeking emotional support. Contrary to expectations, social reactions that treated the survivor differently were associated with higher self-esteem. Implications are discussed.

Coping and PTSD symptoms in Pakistani earthquake survivors: purpose in life, religious coping and social support

BACKGROUND

High rates of posttraumatic stress disorder (PTSD) and depressive symptoms have been observed in earthquake survivors from less developed areas of the world. This study, conducted three years after the 2005 Pakistan earthquake, aimed to identify potentially protective psychosocial factors associated with lower PTSD and depressive symptom levels.

METHODS

Adult earthquake survivors (N=200) were recruited from affected areas in Northwestern Pakistan and completed self-report questionnaires measuring PTSD and depressive symptoms, positive and negative affect, and four psychosocial variables (purpose in life, positive and negative religious coping, and social support).

RESULTS

Sixty five percent of participants met criteria for probable PTSD. Purpose in life was associated with lower symptom levels and higher positive emotions. A form of negative religious coping (feeling punished by God for one's sins or lack of spirituality) was associated with higher symptom levels and negative emotions. Higher perceived social support was associated with higher positive emotions. Other significant relationships were also identified.

LIMITATIONS

Limitations include the recruitment of a sample of convenience, a modest sample size, and the cross-sectional nature of the study.

CONCLUSIONS

Findings suggest that some psychosocial factors may be protective across cultures, and that the use of negative religious coping is associated with poorer mental health outcomes in earthquake survivors. This study can inform preventive and treatment interventions for earthquake survivors in Pakistan and other less industrialized countries as they develop mental health care services.

Psychological resilience contributes to low emotional distress in cancer patients

PURPOSE

Although a considerable number of cancer patients suffer from emotional distress which may have an impact on their quality of life, it still remains poorly understood which psychosocial factors contribute to individual vulnerabilities to emotional distress of cancer patients. Recently, resilience has been suggested as the capacity to cope with adversities like cancer. In this study, we investigated the relationships between resilience and emotional distress in cancer patients.

METHODS

One hundred fifty-two cancer patients who were consecutively hospitalized for their scheduled treatments at the Seoul St. Mary's Hospital were enrolled and completed the Connor-Davidson Resilience Scale and Hospital Anxiety Depression Scale to measure resilience and emotional distress. The relationships between the levels of psychological resilience and emotional distress were evaluated using univariate and multivariate logistic regression analyses.

RESULTS

Psychological resilience levels were negatively associated with emotional distress after controlling for relevant covariates. The highest quartile of resilience level was associated with a 90% (adjusted odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.03-0.34, P < 0.001) reduction in the risk for emotional distress compared to the lowest quartile. Among metastatic cancer patients, resilience was also found to be a significant protective factor for emotional distress (adjusted OR = 0.14, 95% CI = 0.02-0.79, P = 0.02).

CONCLUSION

The present study suggests that psychological resilience may independently contribute to low emotional distress in cancer patients. The relationship between resilience and emotional distress was also significant in the subgroup of metastatic cancer patients. Psychosocial interventions to enhance resilience might provide useful approaches to overcome cancer-related emotional distress.

The influences of perinatal challenge persist into the adolescent period in socially housed bonnet macaques (Macaca radiata)

Social challenges during the perinatal period influence the mother-infant relationship in nonhuman primates and may affect the offspring's response to later social challenge(s). Relocation of a breeding colony of monkeys (Macaca radiata) created two groups of infants: one group experienced social group relocation to a new housing facility during the perinatal period (ATYPICAL) and the second group developed within a constant environment (TYPICAL). At a mean age of 25 months, all animals were removed from their natal group and placed in same sex adolescent social groups. Behavioral observations were collected after group formation or introduction to a new group. ATYPICAL subjects showed increased aggression and reduced affiliation compared to TYPICAL subjects. Hair cortisol in male subjects collected 6 months after introduction was elevated in the ATYPICAL subjects compared to TYPICAL subjects. These findings demonstrate that early life challenges affect behavior as well as stress hormone responses to social challenge in adolescence.

Culturally sensitive and universal measure of resilience for Japanese populations: Tachikawa Resilience Scale in comparison with Resilience Scale 14-item version

AIM

Although scales specific to resilience are available and widely used, qualities of resilience could be culturally sensitive. This study aimed to develop a concise scale of resilience for Japanese populations, and compare its validity to that of the Resilience Scale 14-item version (RS-14), one of the most widely used scales for measuring resilience.

METHODS

The Tachikawa Resilience Scale (TRS) was developed on the basis of data obtained from unstructured interviews with Japanese motor vehicle accident survivors without psychiatric disorder. The reliability and validity of the TRS and RS-14 were then examined in cross-sectional studies performed with 523 company workers and 140 psychiatric outpatients.

RESULTS

The TRS and RS-14 were negatively correlated with depressive symptoms in company workers and psychiatric outpatients and with anxiety in psychiatric outpatients, and were positively correlated with social support in company workers. Internal consistency and test-retest reliability of the TRS were high. Construct validity of the TRS was equivalent to that of the RS-14 in company workers, and higher than that of the RS-14 in psychiatric outpatients.

CONCLUSION

The reliability and validity of the TRS and RS-14 in Japanese company workers and patients with psychiatric disorders were acceptable. The validity of the TRS was equivalent to or better than that of the RS-14. Although the TRS cannot be regarded as an established scale due to a lack of theoretical rationale, the results of this study suggest that scales measuring resilience that cover cultural aspects might be more relevant in given populations.

Annual Research Review: The experience of youth with political conflict--challenging notions of resilience and encouraging research refinement

AIMS AND METHOD

Drawing on empirical studies and literature reviews, this paper aims to clarify and qualify the relevance of resilience to youth experiencing political conflict. It focuses on the discordance between expectations of widespread dysfunction among conflict-affected youth and a body of empirical evidence that does not confirm these expectations.

FINDINGS

The expectation for widespread dysfunction appears exaggerated, relying as it does on low correlations and on presumptions of universal response to adversity. Such a position ignores cultural differences in understanding and responding to adversity, and in the specific case of political conflict, it does not account for the critical role of ideologies and meaning systems that underlie the political conflict and shape a young people's interpretation of the conflict, and their exposure, participation, and processing of experiences. With respect to empirical evidence, the findings must be viewed as tentative given the primitive nature of research designs: namely, concentration on violence exposure as the primary risk factor, at the expense of recognizing war's impact on the broader ecology of youth's lives, including disruptions to key economic, social, and political resources; priority given to psychopathology in the assessment of youth functioning, rather than holistic assessments that would include social and institutional functioning and fit with cultural and normative expectations and transitions; and heavy reliance on cross-sectional, rather than longitudinal, studies.

CONCLUSIONS

Researchers and practitioners interested in employing resilience as a guiding construct will face such questions: Is resilience predicated on evidence of competent functioning across the breadth of risks associated with political conflict, across most or all domains of functioning, and/or across time? In reality, youth resilience amidst political conflict is likely a complex package of better and poorer functioning that varies over time and in direct relationship to social, economic, and political opportunities. Addressing this complexity will complicate the definition of resilience, but it confronts the ambiguities and limitations of work in cross-cultural contexts.

Resilience as a protective factor against the development of psychopathology among refugees

Refugee research, to date, has predominantly focused on factors that make refugees more vulnerable for developing posttraumatic stress disorder (PTSD) and/or psychological distress. Few articles have studied potential protective factors such as resilience. A targeted nonrandom sample of Iraqi refugees (n = 75) and a control group of non-Iraqi Arab immigrants (n = 53) were recruited from a number of Iraqi/Arab community institutions in Michigan to complete a questionnaire that included measures for psychological distress, PTSD symptoms, exposure to trauma, and resilience. The refugees reported significantly more PTSD symptoms (t-test, p < 0.01) and psychological distress (p < 0.05) compared with the immigrants. There was no difference in resilience between the two groups. In linear regression, premigration exposure to violence was a significant predictor of psychological distress (p < 0.01) and PTSD symptoms (p < 0.01). After controlling for migrant status and violence exposure, resilience was a significant inverse predictor of psychological distress (p < 0.001) but not of PTSD. Resilience is associated with less trauma-related psychological distress and should be considered in assessing risk and protective factors among victims of war-related violence.

Understanding resilience

Resilience is the ability to adapt successfully in the face of stress and adversity. Stressful life events, trauma, and chronic adversity can have a substantial impact on brain function and structure, and can result in the development of posttraumatic stress disorder (PTSD), depression and other psychiatric disorders. However, most individuals do not develop such illnesses after experiencing stressful life events, and are thus thought to be resilient. Resilience as successful adaptation relies on effective responses to environmental challenges and ultimate resistance to the deleterious effects of stress, therefore a greater understanding of the factors that promote such effects is of great relevance. This review focuses on recent findings regarding genetic, epigenetic, developmental, psychosocial, and neurochemical factors that are considered essential contributors to the development of resilience. Neural circuits and pathways involved in mediating resilience are also discussed. The growing understanding of resilience factors will hopefully lead to the development of new pharmacological and psychological interventions for enhancing resilience and mitigating the untoward consequences.

Predictors of posttraumatic growth among parents of children undergoing inpatient corrective surgery for congenital disease

BACKGROUND/PURPOSE

Posttraumatic growth (PTG) is a positive psychological change, or benefit, as a result of a major life trauma and/or loss. The role of emotional intelligence (EI), social support, self-efficacy, posttraumatic stress symptoms (PTSS), and resilience in PTG was evaluated in parents of children undergoing a surgical procedure for congenital disease.

METHODS

A questionnaire survey was conducted in 208 parents of children undergoing inpatient surgery for correction of congenital disease at the Departments of Pediatric Surgery, Qilu and Shandong Province Hospital, China, between May and September. Posttraumatic growth was measured using the Posttraumatic Growth Inventory. The study variables were measured using the Emotional Intelligence Scale, Perceived Social Support Scale, General Self-Efficacy Scale, Posttraumatic Stress Disorder Checklist-Civilian Version, and the 10-item Connor-Davidson Resilience Scale, respectively. Hierarchical multiple regression analyses were used to identify the significant predictors.

RESULTS

Posttraumatic growth was reported in 54.3% (113) of parents. Posttraumatic growth was positively associated with EI, self-efficacy, resilience, and PTSS (total P < .05). Social support was positively associated with the domain of relating to others in the Posttraumatic Growth Inventory (r = .208, P < .01). Hierarchical multiple regression analyses indicated EI was the main predictor of posttraumatic growth, whereas resilience and PTSS were the mediators of personal resources (EI and self-efficacy), perceived social support, and the growth.

CONCLUSIONS

The relationship between PTG and other variables have been examined at only one point in time. Longitudinal studies in exploring the impact of EI and other variables affecting PTG can be used to reduce the impact of bidirectionality that may have impact on the conclusions drawn. Emotional management programs should focus on the use of EI as a proactive measure for enhancing emotional well-being and promoting positive emotions.

Resilience and Stereotyping

Purpose: The lived experiences of Native American elders regarding the effects of stereotypes on resilience were examined. Method: This qualitative study emphasized culturally compatible methods of traditional storytelling and featured interpretive analysis. Results: Themes revealed were the following: (a) having the ability to successfully bridge cultures fostered resilience and inspired self-confidence, (b) a strong sense of identity was a core element of resilience, (c) being responsible and accountable inspired a sense of pride, (d) educational attainment and employment fostered resilience, and (e) cultural resilience was a key component when confronting stereotypes. Although stereotyping has had profound effects, these first Americans have taken the best of both worlds and successfully integrated them to live successful, well-adjusted lives. Discussion: These findings suggest that disparities in mental and physical health could be addressed by building on the unique foundation of cultural resilience embodied by these Native elders.

Low trait anxiety, high resilience, and their interaction as possible predictors for treatment response in patients with depression

BACKGROUND

Although many demographic and clinical characteristics have been suggested to predict treatment outcome of depression, they provide only a weak prediction for clinical response. Based on the predictive values of trauma and biological markers involved in stress response, we investigated the roles of baseline trait anxiety and resilience, which were assumed as vulnerability and resilience factors, respectively, in predicting treatment response in naturalistically treated outpatients with depressive disorders.

METHODS

A total of 178 outpatients with depressive disorders were consecutively recruited and completed measures of trauma experiences, psychological symptoms, and resilience at baseline. Response was defined by Clinical Global Impression (CGI)-Improvement score ≤2 at last visit during a 6month-treatment period. Univariate analyses and multiple logistic regression analysis were performed to determine predictors of treatment response.

RESULTS

Among demographic and clinical variables, treatment response was associated with increased age, longer treatment duration, higher resilience, and lower trait anxiety. In logistic regression analysis, resilience, trait anxiety, and their interaction significantly predicted treatment response after adjusting for age and treatment duration. Interaction between resilience and trait anxiety remained significant in the final model. Examining the interaction between the two, patients with low trait anxiety were only significantly affected by the level of resilience in response rate.

CONCLUSIONS

Low trait anxiety, high resilience, and their interaction might contribute to better treatment response in depressed patients. Our result suggested that individual differences in responding to stress might be important in predicting treatment outcome of depression in addition to other demographic and clinical factors.

The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey

OBJECTIVE

ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses.

DESIGN

Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale.

MEASUREMENTS AND MAIN RESULTS

Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p<0.001), and a lower prevalence of burnout syndrome (p<0.001).

CONCLUSIONS

The presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile.

Resilience mitigates the suicide risk associated with childhood trauma

OBJECTIVE

We wished to examine whether resilience might be a protective factor in relation to suicidal behavior.

METHOD

To do this resilience was examined in relation to childhood trauma, a well established risk factor for suicidal behavior, in two samples. In a preliminary sample 20 abstinent substance abuse patients who had attempted suicide were matched for age and their score on the Childhood Trauma Questionnaire (CTQ) with 20 substance abuse patients who had never attempted suicide. The two age and CTQ matched attempter (N=20) and non-attempter (N=20) groups were then compared for their scores on the Connor-Davidson Resilience Scale (CD-RISC). In the second sample 166 prisoners who had attempted suicide were matched for age and their scores on the CTQ with 166 prisoners who had never attempted suicide. These two age and CTQ matched attempter (N=166)and non-attempter (N=166) groups were similarly compared for their CD-RISC resilience scores.

RESULTS

In the preliminary substance abuse sample, patients who had never attempted suicide (N=20) had significantly higher mean CD-RISC resilience scores than the age and CTQ matched patients who had attempted suicide (N=20). Similarly in the prisoner sample, those who had never attempted suicide (N=166) had significantly higher CD-RISC resilience scores than the age and CTQ matched prisoners who had attempted suicide (N=166).

CONCLUSIONS

The results from these two studies suggest that resilience may be a protective factor mitigating the risk of suicidal behavior associated with childhood trauma.

Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma

Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.

Lucid dreaming and resilience in the face of exposure to terrorism

The relationship between resilience and lucid dreams, which involves awareness of the experience of dreaming, was examined in 79 Israeli young adults. Psychological distress and lucid dreams 3 years prior to exposure to terrorism, and exposure levels and psychological distress 1 week following exposure, were assessed. Both indirect exposure through media and perceived stress predicted an increase in distress during the 3-year interval under low, but not high, levels of lucid dreams. Possible mechanisms are discussed.

What is resilience? A review and concept analysis

The complexities of defining what appears to be the relatively simple concept of resilience are widely recognized. This paper analyses the concept of resilience from a range of disciplinary perspectives and clarifies a definition in order to inform research, policy and practice. The work takes a life course approach to resilience, examining evidence derived from research across the lifespan. It incorporates the methods of systematic review, concept analysis and consultation through face-to-face meetings. The synthesis of methodological approaches enables a clear identification of the antecedents, defining attributes and consequences of resilience, validated with stakeholder partners. Through this process, resilience is defined as the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and ‘bouncing back’ in the face of adversity. Across the life course, the experience of resilience will vary. A large proportion of resilience research is routed within the discipline of developmental psychology, and has mainly been developed with children and adolescents. A major contribution to resilience research could be made through more multi-disciplinary studies that examine the dynamics of resilience across the lifespan, its role in healthy ageing and in managing loss, such as changes in cognitive functioning.

Reliability and validity of the Japanese version of the Resilience Scale and its short version

BACKGROUND

The clinical relevance of resilience has received considerable attention in recent years. The aim of this study is to demonstrate the reliability and validity of the Japanese version of the Resilience Scale (RS) and short version of the RS (RS-14).

FINDINGS

The original English version of RS was translated to Japanese and the Japanese version was confirmed by back-translation. Participants were 430 nursing and university psychology students. The RS, Center for Epidemiologic Studies Depression Scale (CES-D), Rosenberg Self-Esteem Scale (RSES), Social Support Questionnaire (SSQ), Perceived Stress Scale (PSS), and Sheehan Disability Scale (SDS) were administered. Internal consistency, convergent validity and factor loadings were assessed at initial assessment. Test-retest reliability was assessed using data collected from 107 students at 3 months after baseline. Mean score on the RS was 111.19. Cronbach's alpha coefficients for the RS and RS-14 were 0.90 and 0.88, respectively. The test-retest correlation coefficients for the RS and RS-14 were 0.83 and 0.84, respectively. Both the RS and RS-14 were negatively correlated with the CES-D and SDS, and positively correlated with the RSES, SSQ and PSS (all p < 0.05), although the correlation between the RS and CES-D was somewhat lower than that in previous studies. Factor analyses indicated a one-factor solution for RS-14, but as for RS, the result was not consistent with previous studies.

CONCLUSIONS

This study demonstrates that the Japanese version of RS has psychometric properties with high degrees of internal consistency, high test-retest reliability, and relatively low concurrent validity. RS-14 was equivalent to the RS in internal consistency, test-retest reliability, and concurrent validity. Low scores on the RS, a positive correlation between the RS and perceived stress, and a relatively low correlation between the RS and depressive symptoms in this study suggest that validity of the Japanese version of the RS might be relatively low compared with the original English version.

Psychometric properties of the 10-item Connor-Davidson Resilience Scale in Chinese earthquake victims

AIM

Resilience refers to positive adaption in the face of stress or trauma. Assessing resilience is crucial in trauma-related research and practice. The 10-item Connor-Davidson Resilience Scale (CD-RISC) has been demonstrated to be a valid and reliable tool to achieve this goal. This study was designed to examine the psychometric properties of the 10-item CD-RISC in a sample of Chinese earthquake victims.

METHODS

A total of 341 participants (185 women, 156 men) aged 20-63 years were recruited from a psychological relief program supported by the Institute of Psychology, Chinese Academy of Sciences following the 'Wenchuan' earthquake. The participants were given the 10-item CD-RISC and the 17-item post-traumatic stress disorder (PTSD) subscale of the Los Angeles Symptom Checklist (LASC) 4 months after the earthquake.

RESULTS

The results of exploratory factor analysis indicated that a single-factor model consistent with the original design of the 10-item CD-RISC was support. The scale was also demonstrated to have good internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (r = 0.90 for a two-week interval). Scores on the scale could reflect different levels of resilience in populations that are thought to be differentiated (probable PTSD vs healthy controls, t(339) = -7.60, P < 0.01, Cohen's d = 0.84). Moreover, the total resilience scores were significantly negatively correlated with scores on total PTSD scale and its three subscales for all participants.

CONCLUSION

The Chinese version of the 10-item CD-RISC has excellent psychometric properties, and is applicable for Chinese people.

Dutch politicians' coping with terrorist threat

The psychosocial effects of terrorist threat and close protection have never been studied systematically in political leaders. We conducted a study among 12 Dutch politicians and their partners who were living under terrorist threat and close protection in the aftermath of two political murders. Interviews revealed that their coping with the situation varied and consisted of emotion-focused, defensive, palliative and instrumental coping strategies. Symptoms of post-traumatic stress disorder occurred in some individuals, and tendencies to express milder or stronger opinions on sensitive issues were reported. Psychosocial knowledge can be useful in helping to cope with the situation in the best possible way.

Posttraumatic stress disorder in war veterans: a discussion of the Neuroevolutionary Time-depth Principle

INTRODUCTION

Trauma is a universal phenomenon. Violence is a type of trauma and war is one of the ways in which violence is expressed. The "Neuroevolutionary Time-depth Principle" of innate fears, based on prevalence data, suggests that high rates of posttraumatic stress disorder (PTSD) after combat exposure can be due to the fact that this fear-stress response appeared as a reaction to inter-group male-to-male and intra-group killings after the rising of population densities in the Neolithic period.

MATERIAL AND METHODS

Studies of PTSD prevalence available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts and Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed.

RESULTS

Prevalence data of PTSD deeply vary from one country to another, even in groups exposed to similar stressors. Moreover, war is not a uniform and unchanged phenomenon and not all war stressors are similar because some of them are known to lead to PTSD more than others.

DISCUSSION

We argue that psychosocial narratives deeply influence our biological response to trauma and violence, shaping the genotypical response to trauma. Great differences in prevalence may be in part due to this fact. We also suggest that personal preconceptions and socio-cultural interests may also be playing a critical role in the theories developed to explain the nature of our response to violence.

CONCLUSION

A comprehensive model for war-related PTSD should integrate both genotypical and phenotypical findings.

Profiles of Personal Resiliency in Child and Adolescent Psychiatric Inpatients

To ascertain whether children and adolescents whose ages ranged from 9 to 17 years described distinct profiles of personal resiliency, the Resiliency Scales for Children and Adolescents (RSCA) were administered to 100 youth who were admitted to an inpatient psychiatric unit and were diagnosed with various DSM-IV-TR disorders along with the Beck Youth Inventories of Emotional and Social Impairment (BYI-II). Four profiles based on the RSCA Sense of Self-Mastery, Sense of Relatedness, and Emotional Reactivity scales were identified by a k-means nonhierarchical cluster analysis. The profiles were not differentiated with respect to sex, age, being Caucasian, or diagnoses, but were discriminated with respect to different levels of self-reported symptoms as measured by the BYI-II scales. The results were discussed as suggesting that different profiles of personal resiliency should be considered when treating psychiatric inpatients.

Resilience and crime victimization

What do we know about resilience in crime victimization? In this article, the authors discuss resilience defined as protective factors (e.g., personality characteristics, biological characteristics, social and cultural factors, and community characteristics); as a process of adaptation (e.g., self-enhancement, positive cognitive appraisals, coping styles, and spirituality), including an iterative perspective on resilience as a cascade of protective processes; and as positive outcomes (e.g., lack of symptoms) following exposure to adverse events. Within each of these definitional frameworks, they consider general conceptual issues pertaining to resilience and then the small body of research that has focused specifically on resilience and some type of crime victimization. Research and clinical implications are discussed.

Resilience and mental health

The relationship between disease and good health has received relatively little attention in mental health. Resilience can be viewed as a defence mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment and prophylaxis. Though resilience is a widely-used concept, studies vary substantially in their definition, and measurement. Above all, there is no common underlying theoretical construct to this very heterogeneous research which makes the evaluation and comparison of findings extremely difficult. Furthermore, the varying multi-disciplinary approaches preclude meta-analysis, so that clarification of research in this area must proceed firstly by conceptual unification. We attempt to collate and classify the available research around a multi-level biopsychosocial model, theoretically and semiotically comparable to that used in describing the complex chain of events related to host resistance in infectious disease. Using this underlying construct we attempt to reorganize current knowledge around a unitary concept in order to clarify and indicate potential intervention points for increasing resilience and positive mental health.

Bouncing back - trauma and the HPA-axis in healthy adults

BACKGROUND

Dysregulation of the hypothalamic-pituitary-adrenal (HPA)-axis is thought to underlie stress-related psychiatric disorders such as posttraumatic stress disorder (PTSD). Some studies have reported HPA-axis dysregulation in trauma-exposed (TE) adults in the absence of psychiatric morbidity. In this dissertation we set out to unravel part of the mechanism that underlies the complex relations between trauma exposure, stress regulation, and psychopathology.

METHOD

Mentally healthy TE subjects were compared with non-trauma-exposed (NE) healthy controls. To distinguish between the potential effects of childhood trauma and adulthood trauma, we included women exposed to childhood trauma as well as men who were exposed to trauma during adulthood. Basal HPA-axis functioning was assessed with salivary cortisol samples. HPA-axis reactivity was assessed with the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test.

RESULTS

The results show that childhood trauma exposure is associated with an attenuated cortisol response after the Dex/CRH challenge test in women. In contrast, trauma exposure during adulthood was not associated with alterations in HPA-axis regulation after the Dex/CRH test. Neither childhood trauma nor adulthood trauma were associated with basal HPA-axis functioning.

CONCLUSION

Childhood trauma rather than adulthood trauma may chronically affect HPA-axis functioning. Since the association between adulthood trauma and resilience to psychopathology cannot be explained by HPA-axis functioning alone, other factors must play a role.

Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom

BACKGROUND

A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population.

METHODS

A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support.

RESULTS

Resilience scores in the full sample were comparable to those observed in civilian outpatient primary-care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure.

CONCLUSIONS

These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans.

Forever changed: posttraumatic stress disorder in female military veterans, a case report

PURPOSE. This paper examines the experience of posttraumatic stress disorder (PTSD) in a female veteran of Operation Iraqi Freedom, including the barriers to treatment she encountered in an outpatient psychiatry clinic. DESIGN AND METHODS. Case report data were obtained through review of records and interviews with a veteran combat nurse diagnosed with chronic PTSD. CONCLUSIONS. Sex differences in PTSD are controversial, but PTSD in female military veterans is a significant problem. Gender may complicate diagnosis and treatment. This case report discusses these issues and invites further research. PRACTICE IMPLICATIONS. Advanced practice psychiatric nurses increasingly will see female veterans with PTSD in their practices.

Imipramine treatment and resiliency exhibit similar chromatin regulation in the mouse nucleus accumbens in depression models

Although it is a widely studied psychiatric syndrome, major depressive disorder remains a poorly understood illness, especially with regard to the disconnect between treatment initiation and the delayed onset of clinical improvement. We have recently validated chronic social defeat stress in mice as a model in which a depression-like phenotype is reversed by chronic, but not acute, antidepressant administration. Here, we use chromatin immunoprecipitation (ChIP)-chip assays--ChIP followed by genome wide promoter array analyses--to study the effects of chronic defeat stress on chromatin regulation in the mouse nucleus accumbens (NAc), a key brain reward region implicated in depression. Our results demonstrate that chronic defeat stress causes widespread and long-lasting changes in gene regulation, including alterations in repressive histone methylation and in phospho-CREB (cAMP response element-binding protein) binding, in the NAc. We then show similarities and differences in this regulation to that observed in another mouse model of depression, prolonged adult social isolation. In the social defeat model, we observed further that many of the stress-induced changes in gene expression are reversed by chronic imipramine treatment, and that resilient mice-those resistant to the deleterious effects of defeat stress-show patterns of chromatin regulation in the NAc that overlap dramatically with those seen with imipramine treatment. These findings provide new insight into the molecular basis of depression-like symptoms and the mechanisms by which antidepressants exert their delayed clinical efficacy. They also raise the novel idea that certain individuals resistant to stress may naturally mount antidepressant-like adaptations in response to chronic stress.

Effects of venlafaxine extended release on resilience in posttraumatic stress disorder: an item analysis of the Connor-Davidson Resilience Scale

The aim was to evaluate the efficacy of venlafaxine extended release (ER) on characteristics of resilience, measured by the Connor-Davidson Resilience Scale, in patients with posttraumatic stress disorder (PTSD). Data were evaluated from a randomized, 6-month, international, multicenter study of adult outpatients with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD for >or=6 months, and 17-item Clinician-Administered PTSD Scale score >or=60. Patients were assigned randomly to treatment with flexible-dose venlafaxine ER (37.5-300 mg/day) or placebo. Changes from baseline scores and effect sizes of response to treatment with venlafaxine ER compared with placebo were computed for each item, as well as for the newly developed 2-item and 10-item subscales. Effect sizes across items ranged from 0.41 (moderate) to 0.08 (very weak). The effect size for the Resilience Scale-2 (2-item subscale) was 0.32, which was comparable to the effect sizes of 0.35 for the 25-item full scale and 0.34 for the 10-item subscale. Venlafaxine ER improved resilience on individual Connor-Davidson Resilience Scale items that reflect four factors (hardiness, persistence/tenacity, social support, and faith in a benevolent or meaningful world), to varying degrees in patients with PTSD. The findings suggest that assessment of treatment response might be enhanced by routine evaluation of resilience.

Personal resiliency: serious diagnosis and prognosis with unexpected quality outcomes

In this grounded theory study we set out to identify what was common in stories of people with serious disease who had less than a 10% chance of survival, and who had a good quality of life at the time of first interview. A core category of personal resiliency was the organizing theme. This was a way of being and acting in the world that had the person strongly connected to life through relationships and a quality-of-life experience that made their illness secondary to their living. Whereas individual participants might not have had this sense of resiliency at the beginning of their illness, they developed it during the time they were ill, both prior to and during their recovery. Resiliency has five dimensions: Connectedness to their social environment, to family, to their physical environment, to their sense of inner wisdom (experiential spirituality), and a personal psychology with a supportive mindset and way of living which supported their values.

Molecular adaptations underlying susceptibility and resistance to social defeat in brain reward regions

While stressful life events are an important cause of psychopathology, most individuals exposed to adversity maintain normal psychological functioning. The molecular mechanisms underlying such resilience are poorly understood. Here, we demonstrate that an inbred population of mice subjected to social defeat can be separated into susceptible and unsusceptible subpopulations that differ along several behavioral and physiological domains. By a combination of molecular and electrophysiological techniques, we identify signature adaptations within the mesolimbic dopamine circuit that are uniquely associated with vulnerability or insusceptibility. We show that molecular recapitulations of three prototypical adaptations associated with the unsusceptible phenotype are each sufficient to promote resistant behavior. Our results validate a multidisciplinary approach to examine the neurobiological mechanisms of variations in stress resistance, and illustrate the importance of plasticity within the brain's reward circuits in actively maintaining an emotional homeostasis.