Annual Research Review: Resilience--clinical implications

Late adolescent & young adult functioning and participation outcomes after prematurity

There has been an increased emphasis on optimizing health, developmental, and behavioral outcomes over the life course after prematurity. An important framework for examining adolescent and young adult outcomes is the International Classification of Functioning Disability and Health Children (ICF) developed by the World Health Organization (WHO) in 2001 and expanded to children and youth (ICF-CY) under age 19 years in 2007. The ICF and the ICF-CY can be used as a statistical tool in population studies, a research tool to measure outcomes, quality of life, and environmental factors, a clinical tool for outcomes of rehabilitation and vocation training, and as a social policy-educational tool to raise awareness and promote social action for equity. In this review we describe how functioning and participation can help inform transitional outcomes at age 17 years and emerging adult independence at 23 years. We highlight outcomes in adolescence and adulthood of former preterm infants using the ICF domains of functioning and participation. We include current standardized adaptive assessments (Vineland Adaptive Behavior Scales-3rd Edition; VABS3) and Adaptive Behavior Assessment Scale-3; ABAS3) that measure self-care daily living skills, applied learning, and social functioning. We also emphasize that participation involves life activities of higher education attainment, completing vocational training, experiencing employment, living independently, and relationship experiences with partners as well as family formation.

What is resilience: an affiliative neuroscience approach

Resilience - a key topic in clinical science and practice - still lacks a clear conceptualization that integrates its evolutionary and human-specific features, refrains from exclusive focus on fear physiology, incorporates a developmental approach, and, most importantly, is not based on the negation (i.e., absence of symptoms following trauma). Building on the initial condition of mammals, whose brain matures in the context of the mother's body and caregiving behavior, we argue that systems and processes that participate in tuning the brain to the social ecology and adapting to its hardships mark the construct of resilience. These include the oxytocin system, the affiliative brain, and biobehavioral synchrony, all characterized by great flexibility across phylogenesis and ontogenesis. Three core features of resilience are outlined: plasticity, sociality and meaning. Mechanisms of sociality by which coordinated action supports diversity, endurance and adaptation are described across animal evolution. Humans' biobehavioral synchrony matures from maternal attuned behavior in the postpartum to adult-adult relationships of empathy, perspective-taking and intimacy, and extends from the mother-child relationship to other affiliative bonds throughout life, charting a fundamental trajectory in the development of resilience. Findings from three high-risk cohorts, each tapping a distinct disruption to maternal-infant bonding (prematurity, maternal depression, and early life stress/trauma), and followed from birth to adolescence/young adulthood, demonstrate how components of the neurobiology of affiliation confer resilience and uniquely shape the social brain.

Predictive model of variables associated with health-related quality of life in patients with advanced chronic kidney disease receiving hemodialysis

PURPOSE

Chronic kidney disease (CKD) affects over 10% of the global population. Health-related quality of life (HRQoL) has been identified as a reliable indicator for assessing the effectiveness of treatment in chronic patients, and resilience as a predictor of low levels of stress and higher QoL. The aim of this research is to identify the relationship between HRQoL, resilience, perceived stress, and the different sociodemographic and clinical routine variables of advanced chronic kidney disease (ACKD).

METHODS

Multicenter, cross-sectional, and correlational study with 155 ACKD patients in the Valencian Community (Spain). The measures for the study included the Kidney Disease Quality of Life 36 (KDQOL-36), the Perceived Stress Scale 10 (PSS10), and the Connors-Davidson Resilience Scale (CD-RISC). To identify the variables with predictive power over the scales and subscales of the KDQOL-36, multiple regression analyses were performed.

RESULTS

Average participants' age was 67.39, 68.4% were male, 29% diabetic, and 83.2% had undergone arteriovenous vascular access placement with a Charlson Comorbidity Index of 6 (SD = 2.09). The regression models identified that age and resilience explained up to 26.8% of the variance of the KDQOL-36 total score. As for the physical component of QoL, comorbidity with other clinical conditions, resilience, and the presence of diabetes explained 32.1% of its variance.

CONCLUSIONS

Resilience was identified as one of the most important predictors of HRQoL. Thus, the development of interventions aiming to improve the level of resilience may have a positive impact over the quality of life of patients with CKD.

Annual Research Review: Rethinking childhood trauma-new research directions for measurement, study design and analytical strategies

Childhood trauma is a key modifiable risk factor for psychopathology. Despite significant scientific advances, traumatised children still have poorer long-term outcomes than nontraumatised children. New research paradigms are, thus, needed. To this end, the review examines three dominant assumptions about measurement, design and analytical strategies. Current research warns against using prospective and retrospective measures of childhood trauma interchangeably; against interpreting cross-sectional differences in putative mediating mechanisms between adults with or without a history of childhood trauma as evidence of longitudinal changes from pre-trauma conditions; and against directly applying explanatory models of resilience or vulnerability to psychopathology in traumatised children to forecast individual risk in unseen cases. The warnings equally apply to research on broader measures of adverse childhood experiences (ACEs). Further research examining these assumptions can generate new insights on how to prevent childhood trauma and its detrimental effects.

Developing an individualized risk calculator for psychopathology among young people victimized during childhood: A population-representative cohort study

BACKGROUND

Victimized children are at greater risk for psychopathology than non-victimized peers. However, not all victimized children develop psychiatric disorders, and accurately identifying which victimized children are at greatest risk for psychopathology is important to provide targeted interventions. This study sought to develop and internally validate individualized risk prediction models for psychopathology among victimized children.

METHODS

Participants were members of the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative British birth cohort of 2,232 twins born in 1994-1995. Victimization exposure was measured prospectively between ages 5 and 12 years, alongside a comprehensive range of individual-, family-, and community-level predictors of psychopathology. Structured psychiatric interviews took place at age-18 assessment. Logistic regression models were estimated with Least Absolute Shrinkage and Selection Operator (LASSO) regularization to avoid over-fitting to the current sample, and internally validated using 10-fold nested cross-validation.

RESULTS

26.5% (n = 591) of E-Risk participants had been exposed to at least one form of severe childhood victimization, and 60.4% (n = 334) of victimized children met diagnostic criteria for any psychiatric disorder at age 18. Separate prediction models for any psychiatric disorder, internalizing disorders, and externalizing disorders selected parsimonious subsets of predictors. The three internally validated models showed adequate discrimination, based on area-under-the-curve estimates (range = =0.66-0.73), and good calibration.

LIMITATIONS

External validation in wholly-independent data is needed before clinical implementation.

CONCLUSIONS

Findings offer proof-of-principle evidence that prediction modeling can be useful in supporting identification of victimized children at greatest risk for psychopathology. This has the potential to inform targeted interventions and rational resource allocation.

Caregiver resilience and patients with severe musculoskeletal traumatic injuries

AIMS

This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries.

METHODS

A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey.

RESULTS

Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden (β = -0.74, p = 0.008) and higher levels of patient physical health and function (β = -0.69, p = 0.003).

CONCLUSIONS

Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes.Implications for rehabilitationAfter 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function.The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden.Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community.Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health.

Modelling resilience in adolescence and adversity: a novel framework to inform research and practice

Recent conceptualisations of resilience have advanced the notion that it is a dynamic and multifaceted construct. However, its adaptive components, especially those forged by adversity, have not been fully realised, and its neurobiological and psychosocial underpinnings are yet to be meaningfully integrated. In part, this is because a developmental perspective is often neglected in the formulation of resilience. In this review, we consider the findings of resilience research, with a specific emphasis on the developmental period of adolescence. To bridge the gaps in our current understanding, we propose a model of resilience that is predicated on experiencing adversity. Specifically, our model provides a sophisticated insight into the components of resilience, which, together with intrinsic features, involves facilitation of, and skill acquisition via strengthening processes we term tempering and fortification. The model also points to the potential trajectories of adversity-driven resilience and forms the basis of a framework that allows for individual variance in resilience, and the identification of both neurobiological and psychosocial targets for prevention and therapeutic interventions.

Developing the universal unified prevention program for diverse disorders for school-aged children

BACKGROUND

Psychological problems during childhood and adolescence are highly prevalent, frequently comorbid, and incur severe social burden. A school-based universal prevention approach is one avenue to address these issues.

OBJECTIVE

The first aim of this study was the development of a novel, transdiagnostic cognitive-behavioral universal prevention program: The Universal Unified Prevention Program for Diverse Disorders (Up2-D2). The second aim of this study was to examine the acceptability and fidelity of the Up2-D2.

METHODS

Classroom teachers who attended a 1-day workshop implemented the Up2-D2 independently as a part of their regular curricula. To assess the acceptability of the Up2-D2, 213 children (111 boys and 102 girls) aged 9-12 years completed questionnaires about their enjoyment, comprehension, attainment, applicability, and self-efficacy after completing Lessons 1-12. For fidelity, research assistants independently evaluated audio files that were randomly selected and assigned (27.3%).

RESULTS

Our preliminary evaluation revealed the program was highly enjoyable, clear, and applicable for students. In addition, self-efficacy demonstrated a trend of gradually increasing over the 12 sessions. The total fidelity observed in the two schools was sufficient (76.2%), given the length of the teacher training.

CONCLUSIONS

The results of this study supported the theory that the Up2-D2 could be feasible in real-world school settings when classroom teachers implement the program. We discussed current research and practical issues of using universal prevention to address mental health problems in school, based on implementation science for user-centered design.

Compensatory strategies below the behavioural surface in autism: a qualitative study

BACKGROUND

Little is known about the compensatory profile in autism; that is, people with autism spectrum disorder who show few symptoms in their behavioural presentation, despite continuing to report autism-related cognitive difficulties or differences. Even less is known about the specific compensatory strategies that these individuals use to disguise autism at the behavioural surface, both in the clinic and everyday life. It is also currently unclear whether individuals without a formal autism diagnosis, but experiencing autistic-like difficulties, use similar compensatory strategies, potentially enabling them to sit below the diagnostic threshold. This study aimed to investigate social compensatory strategies, and their effect on diagnosis and clinical outcome, in adults with and without autism.

METHODS

In this study, individuals aged 18 years or older who responded to a study advert that was distributed worldwide via social media and the UK National Autistic Society formed a convenience sample. Participants self-reported their use and experiences of compensatory strategies using an online platform. Novel analyses, including a qualitative thematic approach, were used to interpret their responses and gain insight into compensatory strategies in autism.

FINDINGS

Between Oct 19, 2017, and Jan 2, 2018, 136 adults (58 had a clinical diagnosis of autism, 19 self-identified but were not formally diagnosed as autistic, and 59 were not diagnosed or self-identified, but nevertheless reported social difficulties) completed the online study questions. The findings suggested that there are multiple compensatory strategies with distinct characteristics, individual and environmental factors that modulate compensatory strategy use and success, positive (social relationships, independence, employment) and negative (poor mental health, late diagnosis) outcomes associated with compensatory strategy use, and that individuals without a diagnosis use compensatory strategies that are qualitatively similar to individuals with a diagnosis.

INTERPRETATION

Increased awareness and measurement of compensatory strategy use in autism should guide future diagnostic guidelines, towards improved diagnostic accuracy and support for people with autism spectrum disorder whose cognitive difficulties are not immediately evident in observable behaviour.

FUNDING

UK Medical Research Council and UK National Institute for Health Research.

Resilience as a translational endpoint in the treatment of PTSD

Resilience is a neurobiological entity that shapes an individual's response to trauma. Resilience has been implicated as the principal mediator in the development of mental illness following exposure to trauma. Although animal models have traditionally defined resilience as molecular and behavioral changes in stress responsive circuits following trauma, this concept needs to be further clarified for both research and clinical use. Here, we analyze the construct of resilience from a translational perspective and review optimal measurement methods and models. We also seek to distinguish between resilience, stress vulnerability, and posttraumatic growth. We propose that resilience can be quantified as a multifactorial determinant of physiological parameters, epigenetic modulators, and neurobiological candidate markers. This multifactorial definition can determine PTSD risk before and after trauma exposure. From this perspective, we propose the use of an 'R Factor' analogous to Spearman's g factor for intelligence to denote these multifactorial determinants. In addition, we also propose a novel concept called 'resilience reserve', analogous to Stern's cognitive reserve, to summarize the sum total of physiological processes that protect and compensate for the effect of trauma. We propose the development and application of challenge tasks to measure 'resilience reserve' and guide the assessment and monitoring of 'R Factor' as a biomarker for PTSD.

Validation of short instruments assessing parental and caregivers' perceptions on child health and development for personalized prevention

Systematically exploring parental as well as other caregivers' concerns is a main component in preventive child health care (PCHC) for family-centred practice and personalized health care. To facilitate communication and early identification of emerging mental health problems, a PCHC toolkit based on short instruments was developed. This article investigates the reliability and validity of (1) two visual analogue scales (VAS) to assess parent-reported 'parenting' and 'child behaviour', (2) a professional caregiver-reported VAS to assess 'child competence' and (3) the parents' evaluation of developmental status (PEDS) in Dutch PCHC. Parents as well as child care, kindergarten and preschool teachers completed instruments in a community-based sample of children (N = 346) aged 3 years at baseline. The three VAS and PEDS were associated with standardized questionnaires assessing the same constructs. Overall predictive accuracy showed: good to excellent for 'parenting' VAS, fair to good for 'child behaviour' VAS and poor for 'child competence' VAS. The PEDS, 'parenting' VAS and 'child behaviour' VAS, demonstrated high sensitivity at various cut-off points of index test and reference standard. At follow-up, approximately 1 year later, results were similar. Although the 'child competence' VAS scored lower on one aspect of validity, the PEDS and the different VAS are reliable, valid and useful as brief monitoring tools in daily Dutch PCHC practice.

Cognitive ability as a moderator of the association between social disadvantage and psychological distress: evidence from a population-based sample

BACKGROUND

Social disadvantage consistently predicts both self-reported distress and clinically diagnosed disorders such as depression. Yet, many individuals who are exposed to disadvantage do not report high levels of distress. This study extends our recent work showing that high cognitive ability may protect against the negative health consequences of exposure to disadvantaged backgrounds. We test whether this 'buffer effect' exists across clinically relevant indices of mental health in a population-representative sample.

METHODS

In total, 27 985 participants were drawn from the UK Household Longitudinal Study (Understanding Society). Clinical diagnoses of depression and clinically relevant measures of psychological distress [i.e. Short Form-12 (SF-12) Mental Component, General Health Questionnaire (GHQ)] and trait neuroticism were assessed. Cognitive ability was derived from performance on word recall, verbal fluency and numerical ability tasks. Early-life disadvantage was gauged using family background measures assessing parental education and occupation at age 14.

RESULTS

Background disadvantage predicted increased levels of reported psychological distress and neuroticism. These associations were moderated by cognitive ability. Across all available mental health measures, the negative association between early-life disadvantage and poor adult mental health was strongest at low (-1 s.d.) cognitive ability and was no longer evident at high (+1 s.d.) levels of cognitive ability.

CONCLUSIONS

The results provide support for a cognitive buffering hypothesis linking high cognitive ability to a decrease in the magnitude of the social gradient in mental health. Those disadvantaged by both low socioeconomic status and low cognitive ability may benefit from targeted prevention and treatment programmes aiming to reduce socioeconomic disparities in mental health.

Self-Regulation in Early and Middle Childhood as a Precursor to Social Adjustment Among Low-Income, Ethnic Minority Children

Although existing research has shed much light on the development of ethnic minority children, many studies focus on maladjustment, such as behavioral problems, without also speaking to positive experiences in children's lives, such as friendship. An aspect of development that predicts both positive and negative outcomes for children is self-regulation. The present study investigates precursors and sequelae of self-regulation in middle childhood among low-income, ethnic minority children. The four self-regulatory constructs examined in the current study include low-level executive function (EF; e.g., working memory), high-level EF (e.g., planning), effortful control (EC; e.g., delay of gratification), and impulsivity (e.g., does not think before doing). EC in preschool was related to high-level EF and impulsivity in elementary school. High-level EF explained positive and negative aspects of social development during middle childhood. Additionally, self-regulation during elementary school played a mediating role between EC in preschool and social development in middle childhood.

Coping but not allowing the coping to be everything: Resilience in informal dementia care

Health and social sciences literature recognises the significance of psychological resilience in relation to stressful life events. Providing ongoing care for a friend or relative with dementia can be inherently stressful. The aims of this qualitative study were to: (a) explore discrepancies and congruency between definitions of resilience in the academic literature and carers own conceptualisations; (b) assess differences and similarities in conceptualisations of resilience between carers with high, medium and low resilience scores; (c) compare carers' perceived level of resilience with the level of resilience when measured on a standardised tool. Participants were recruited from an earlier study examining levels of resilience and well-being in UK carers of people with dementia. A subset of carers were identified using theoretical sampling, to ensure a diversity of participant characteristics and caring experience. Thirteen carers took part in semi-structured interviews between September and October 2017. Interpretative description was used to elicit findings relevant to clinical practice. We found carers' definitions were concordant with clinical and academic definitions described in the literature. However, they extended the concept and placed greater value on the role of self-compassion. Carers recognised that the appearance of resilience may have negative consequences in terms of securing support from others. Scores on the Brief Resilient Coping Scale did not always match carers' own perceptions of their level of resilience. Additionally, service providers' offers of support did not always reflect carers' priorities. Aligning these two areas would better enable carers and providers to work together to identify resources to support resilience.

The moderating effects of traumatic stress on vulnerability to emotional distress during pregnancy

Emotional distress during pregnancy is likely influenced by both maternal history of adversity and concurrent prenatal stressors, but prospective longitudinal studies are lacking. Guided by a life span model of pregnancy health and stress sensitization theories, this study investigated the influence of intimate partner violence (IPV) during pregnancy on the association between childhood adversity and prenatal emotional distress. Participants included an urban, community-based sample of 200 pregnant women (aged 18-24) assessed annually from ages 8 to 17 for a range of adversity domains, including traumatic violence, harsh parenting, caregiver loss, and compromised parenting. Models tested both linear and nonlinear effects of adversity as well as their interactions with IPV on prenatal anxiety and depression symptoms, controlling for potential confounds such as poverty and childhood anxiety and depression. Results showed that the associations between childhood adversity and pregnancy emotional distress were moderated by prenatal IPV, supporting a life span conceptualization of pregnancy health. Patterns of interactions were nonlinear, consistent with theories conceptualizing stress sensitization through an "adaptive calibration" lens. Furthermore, results diverged based on adversity subdomain and type of prenatal IPV (physical vs. emotional abuse). Findings are discussed in the context of existing stress sensitization theories and highlight important avenues for future research and practice.

Neuroimaging Markers of Risk, Disease Expression, and Resilience to Bipolar Disorder

PURPOSE OF REVIEW

Familial predisposition to bipolar disorder is associated with increased risk of affective morbidity in the first-degree relatives of patients. Nevertheless, a substantial proportion of relatives remain free of psychopathology throughout their lifetime. A series of studies reviewed here were designed to test whether resilience in these high-risk individuals is associated with adaptive brain plasticity.

RECENT FINDINGS

The findings presented here derive from structural and functional magnetic resonance imaging data obtained from patients, their resilient first-degree relatives, and healthy individuals. Patients and relatives showed similar abnormalities in activation and connectivity while performing tasks of interference control and facial affect recognition and in the resting-state connectivity of sensory and motor regions. Resilient relatives manifested unique neuroimaging features that differentiated them from patients and healthy individuals. Specifically, they had larger cerebellar vermis volume, enhanced prefrontal connectivity during task performance, and enhanced functional integration of the default mode network in task-free conditions. Resilience to bipolar disorder is not the reverse of risk but is associated with adaptive brain changes indicative of increased neural reserve. This line of research may open new avenues in preventing and treating bipolar disorder.

The influence of resilience and coping strategies on suicidal ideation among Chinese undergraduate freshmen in Hong Kong

INTRODUCTION

The purpose of this study was to examine the relationship between resilience and suicidal ideation, with coping strategies regarded as a mediator.

METHODS

A total of 422 Hong Kong undergraduate students were recruited with convenience sampling.

RESULTS

Simple linear regression was used to verify the negative relationship between resilience and suicidal ideation (P < 0.001). The results revealed that two out of four tested mediation models were accepted, with the coping strategies of approach and reappraisal acting as mediators (P < 0.001); the other two models were rejected when the coping strategies of emotional regulation and avoidance were the mediators. Regression analysis was performed to explore the effectiveness in reducing suicidal ideation in terms of the reappraisal coping strategy and the approach coping strategy, and the results indicated that the reappraisal coping strategy had greater effects than the approach coping strategy.

DISCUSSION

Overall, the results of this study confirmed previous findings in the literature that resilience can alleviate the degree of suicidal ideation. Additionally, these results suggest further implications that adopting the approach and reappraisal coping strategies might make significant contributions to reducing the number of suicidal cases in society.

“Exposed and Vulnerable”: Parent Reports of Their Child’s Experience of Multidisciplinary Craniofacial Consultations

Objective:

Childhood is a period of extensive socioemotional development, which can be impacted by the presence of a congenital craniofacial anomaly (CFA). Complex multidisciplinary treatment and long-term follow-up are normally required, yet understanding of children’s treatment experiences is limited. The objective of this study was to investigate children’s experiences of multidisciplinary team (MDT) consultations from the perspective of their parents.

Design:

Thirty-eight parents of children with a rare CFA were interviewed in person or over the telephone. Interviews were transcribed verbatim, translated into English, and explored using thematic analysis.

Results:

Background factors influencing the child’s experience of the consultation included age, developmental stage, personality, and prior treatment experiences. Participants tried to prepare their child for meeting the MDT, but did not fully understand what to expect themselves. During consultations, participants were acutely focused on their child’s emotional state, making it difficult to balance their desire to protect the child from potentially negative experiences, and the need to engage in a constructive dialogue with health professionals. Participants believed that health professionals’ conduct could considerably influence the child’s well-being and subsequent treatment decisions. Finally, participants highlighted the need to debrief their child to help them adjust positively.

Conclusions:

The ultimate goal of craniofacial care is to help children develop into confident adults who are able to cope with the challenges associated with their condition. Multidisciplinary teams play a vital role in creating a safe and supportive environment in which children feel genuinely informed and involved in key aspects of their care.

Teachers' Sense of Meaning Associations With Teacher Performance and Graduates' Resilience: A Study of Schools Serving Students of Low Socio-Economic Status

Adolescents from lower socio-economic status (SES) often experience distress in their personal life as well as at school. Moreover, their ability to overcome such difficulties and pave their path to a higher SES depends, to a certain extent, on their ability to develop resilience despite their disadvantaged background. Acknowledging the critical contribution of teachers to students’ development, in the present study, we focused on teachers as agents who may influence graduates’ resilience, and on their sense of meaning at work–a resource these teachers may draw upon to increase their performance and contribute to their disadvantaged students and to their relationships with them. Specifically, we postulated that teachers’ sense of meaning at work will be associated with teachers’ performance and that teachers’ relationships with their students would mediate this association, as they serve as the main vehicle through which teachers impact their students. We further suggested that teachers’ sense of meaning would have long-term effects on students’ coping abilities, reflected in school graduates’ resilience levels. The study comprised 857 participants, teachers and graduates, from 30 Arab vocational schools in Israel, comprising mainly low SES students. Teachers (N = 436) completed self-report measures of their sense of meaning at work, relationships with students, and performance. Furthermore, to reveal potential long-term effects of teachers’ sense of meaning at work, school graduates (N = 421) completed measures of their relationships with teachers and resilience. Analyses indicated a significant association of teachers’ sense of meaning with their performance, which was mediated by teachers’ reports of their relationships with students. Furthermore, teachers’ sense of meaning at work and graduates’ perceptions of their relationships with the teachers were both significantly associated with graduates’ resilience. The findings highlight teachers’ sense of meaning at work as a potential contributor to their performance, which may also contribute to students’ resilience in lower SES schools. They point to teachers’ sense of meaning as a potential resource for teachers of lower SES students and highlight the importance of nurturing and developing it in various programs and practices (e.g., teacher training, teacher development, organizational routines).

Use of mental health services by community-resident adults with DSM-IV anxiety and mood disorders in a violence-prone area: São Paulo, Brazil

BACKGROUND

While under-use of mental health services by adults with anxiety and/or depression is well established, use in a violence-prone area, and as a function of diagnosis and personality characteristics such resilience, is little known. We examine the sociodemographic and personality characteristics (specifically resilience), associated with use of mental health services in a violence-prone city by those with anxiety, depression, and their comorbidity.

METHODS

The structured Composite International Diagnostic Interview was used to identify 12-month DSM-IV- and ICD-10-defined anxiety and depression in a cross-sectional, representative, community-resident sample age 15-75y (N = 2536) in São Paulo, Brazil, and their use of mental health services. Resilience was determined by the Wagnild and Young scale. Analyses, using weighted, design-corrected statistical tests, included frequency measures and multivariable logistic regression.

RESULTS

Mental health services were used by 10% with only anxiety, 22% with only depression, and 34% with comorbidity, with odds of use in controlled analyses doubling from anxiety to depression to comorbidity. Use was significantly higher among those who were white, older (age >30 years, with substantial social support, low resilience, living in low homicide rate areas; use was not affected by experience of traumatic events. Psychiatrists, general practitioners, and psychologists were the primary providers.

LIMITATIONS

Cross-sectional design CONCLUSIONS: Contrary to expectation, use was greater among residents of lower homicide areas, and was not associated with personal traumatic experience. This may reflect increased immunity to violence in higher homicidal rate areas, lower resilience, and poorer access to services. Increased access to mental health services is needed.

The neural development of empathy is sensitive to caregiving and early trauma

Empathy is a core human social ability shaped by biological dispositions and caregiving experiences; yet the mechanisms sustaining maturation of the neural basis of empathy are unknown. Here, we followed eighty-four children, including 42 exposed to chronic war-related adversity, across the first decade of life, and assessed parenting, child temperament, and anxiety disorders as contributors to the neural development of empathy. At preadolescence, participants underwent magenetoencephalography while observing others’ distress. Preadolescents show a widely-distributed response in structures implicating the overlap of affective (automatic) and cognitive (higher-order) empathy, which is predicted by mother-child synchrony across childhood. Only temperamentally reactive young children growing in chronic adversity, particularly those who later develop anxiety disorders, display additional engagement of neural nodes possibly reflecting hyper-mentalizing and ruminations over the distressing stimuli. These findings demonstrate how caregiving patterns fostering interpersonal resonance, reactive temperament, and chronic adversity combine across early development to shape the human empathic brain.

People’s early experiences and dispositions influence their ability to show and feel empathy. Here, using a sample of children exposed to war-related trauma, the authors examine how parenting, temperament, anxiety, and adversity affect the maturation of neural responses associated with empathy.

Resilience in Extremely Preterm/Extremely Low Birth Weight Kindergarten Children

OBJECTIVES

Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age &lt;28 weeks and/or birth weight &lt;1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls.

METHODS

Adaptive competence (i.e., "resilience" in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The "adaptive" children who met these criteria were compared to the "maladaptive" children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence.

RESULTS

A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p&lt;.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years.

CONCLUSIONS

The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362-374).

Exploring the mutual regulation between oxytocin and cortisol as a marker of resilience

Early trauma can increase the risk for developing posttraumatic stress disorder (PTSD) in adulthood. Early trauma has also been associated with the dysregulation between the hypothalamic-pituitary-adrenal (HPA) and oxytocin systems and may influence the co-regulation between these two systems. But whether the mutual regulation of the two systems represents a sign of resilience and/or mutual dysregulation could be a sign of vulnerability to PTSD and the dissociative subtype of PTSD (PTSD-D) is unknown. The study aims to synthesize and conduct a preliminary test of a conceptual model of the mutual regulation between these two systems as a marker of resilience. We analyzed a pilot data with 22 pregnant women in 3 groups (PTSD only, PTSD-D, and trauma-exposed resilient controls) and repeated measures of plasma oxytocin and cortisol. Oxytocin and cortisol seemed reciprocal in all three groups, but both levels were relatively high in women with PTSD-D and low in those with PTSD compared with controls. This suggests that both hormones in women with PTSD-D and PTSD only are dysregulated, but not lacking in reciprocity.

Understanding the effects of emotional reactivity on depression and suicidal thoughts and behaviors: Moderating effects of childhood adversity and resilience

BACKGROUND

Early adulthood is a period of increased risk for depression and suicide. Emotional reactivity (a tendency to react to stress with increases in negative affect and maladaptive interpretations of events) is an important risk factor for these outcomes that has been under-studied. We hypothesized that elevated emotional reactivity would be associated with higher levels of depressive symptoms and suicidal thoughts and behaviors. Further, we hypothesized that experiences of childhood maltreatment would amplify this relationship, whereas the presence of resilience would act as a buffer.

METHODS

1703 young adults (Mean Age = 19.56 years), 71% female) completed well-validated self-report questionnaires at a single time point.

RESULTS

Higher emotional reactivity was directly associated with higher levels of depressive symptoms and suicidal thoughts and behaviors. Further, resilience levels significantly moderated the relationships between emotional reactivity and depressive symptoms and suicidal thoughts and behaviors. Finally, childhood trauma significantly moderated the relationship between emotional reactivity and suicidal thoughts and behaviors only.

LIMITATIONS

This study was cross-sectional in design and relied upon self-report measures only.

CONCLUSIONS

The current study demonstrates an association between emotional reactivity, depressive symptoms, and suicidal thoughts and behaviors during emerging adulthood. Whereas a history of childhood maltreatment may amplify the relationship between emotional reactivity, depression, and suicidal thoughts and behaviors, certain qualities associated with resilience may buffer against the effects of emotional reactivity. Future studies can identify the resilience-promoting factors that are most protective and develop and test interventions that can potentially augment those factors.

Arthritis in adults, socioeconomic factors, and the moderating role of childhood maltreatment: cross-sectional data from the National Epidemiological Survey on Alcohol and Related Conditions

These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history.

INTRODUCTION

CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis.

METHODS

Data were drawn from Wave 2 (2004-2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis.

RESULTS

Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis.

CONCLUSIONS

Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.

Editorial: 'It's a family affair' - the social drivers of child and adolescent resilience

Studies of risk and vulnerability processes may provide important ways of identifying new treatment targets - based on the principle that mending something is much easier if you know in what way it is broken. However, in our field, knowing its source may not always tell us about how to remediate impairment. Studies focusing on resilience may be more informative from this perspective. In this editorial I discuss four papers that highlight the value of resilience studies from a translational perspective - in particular contrasting the strengths and limitations of observational and experimental designs.

Maternal depression impacts child psychopathology across the first decade of life: Oxytocin and synchrony as markers of resilience

BACKGROUND

While maternal depression is known to carry long-term negative consequences for offspring, very few studies followed children longitudinally to address markers of resilience in the context of maternal depression. We focused on oxytocin (OT) and mother-child synchrony - the biological and behavioral arms of the neurobiology of affiliation - as correlates of resilience among children of depressed mothers.

METHOD

A community birth-cohort was recruited on the second postbirth day and repeatedly assessed for maternal depression across the first year. At 6 and 10 years, mothers and children underwent psychiatric diagnosis, mother-child interactions were coded for maternal sensitivity, child social engagement, and mother-child synchrony, children's OT assayed, and externalizing and internalizing problems reported.

RESULTS

Exposure to maternal depression markedly increased child propensity to develop Axis-I disorder at 6 and 10 years. Child OT showed main effects for both maternal depression and child psychiatric disorder at 6 and 10 years, with maternal or child psychopathology attenuating OT response. In contrast, maternal depression decreased synchrony at 6 years but by 10 years synchrony showed only child disorder effect, highlighting the shift from direct to indirect effects as children grow older. Path analysis linking maternal depression to child externalizing and internalizing problems at 10 years controlling for 6-year variables indicated that depression linked with decreased maternal sensitivity and child OT, which predicted reduced child engagement and synchrony, leading to higher externalizing and internalizing problems. OT and synchrony mediated the effects of maternal depression on child behavior problems and an alternative model without these resilience components provided less adequate fit.

CONCLUSIONS

Maternal depression continues to play a role in children's development beyond infancy. The mediating effects of OT and synchronous, mutually regulated interactions underscore the role of plasticity in resilience. Results emphasize the need to follow children of depressed mothers across middle childhood and construct interventions that bolster age-appropriate synchrony.

School adjustment of children from rural migrant families in urban China

The purpose of this study was to examine school adjustment of rural-to-urban migrant children and its relations with acculturation in China. Migrant children were those whose official hukou status was in a rural region outside the city. Data were collected for 1175 students (M age = 11 years) in urban public schools from multiple sources including peer evaluations, teacher ratings, self-reports, and school records. The results showed that migrant students performed more competently than urban non-migrant students in social and academic areas. Migrant students displayed better psychological adjustment than non-migrant students in higher grades, but not in lower grades. Among migrant students, those with higher scores on accommodation to urban culture and maintenance of rural culture tended to be better adjusted. These results indicate the implications of migration and change in life circumstances for children's school functioning in social, academic, and psychological domains.

Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Gender-based violence (GBV) and trauma can dysregulate and recalibrate environmentally sensitive physiological (i.e. central nervous, endocrine, and immune) systems placing survivors at risk for multiple health problems. The researchers build the case that the effects of GBV are likely to be particularly high impact and contribute to health disparities for marginalized survivors of GBV. Further, the researchers underscore a need for a multi-level bio-socio-ecological model that deciphers, characterizes, and explains individual differences in these effects and the need to establish an evidence base from which to derive interventions that address biological effects of toxic stress among marginalized survivors of GBV.

It can be beautiful or destructive: Street-involved youth's perceptions of their romantic relationships and resilience

INTRODUCTION

This study examined romantic relationships among street-involved youth through the overlapping perspectives of resilience, attachment and social bonding. The main goal was to assess how youth understand their romantic attachment bonds as supporting or undermining resilience. While there are qualitative reports on how the social relationships of street-involved youth are linked to resilience, romantic relationships have yet to be differentiated with regard to resilience. This paper also builds on existing research by providing further information on the characteristics of their romantic relationships, and the impact of street life and risky behaviours within relationships.

METHODS

Twenty-one youth (11 men and 10 women) in shelters, in a Canadian metropolitan city, aged 16-24 years, participated in semi-structured interviews. A thematic analysis of the data was conducted exploring how the youth understand their romantic attachments as well as their links in supporting or undermining resilience.

RESULTS

Results indicated that connection, support, validation, and encouragement within a relationship were of value to the youth's resilience, in the form of addressing drug use, achieving goals, supporting self-worth, and promoting positive coping. The youth also reported many negative experiences within their romantic relationships, including dating violence and the stress of street-life, which they saw as undermining their resilience. A key finding was that the youth had considerable difficulty integrating the positive and negative aspects of their relationships. Overall the findings highlight the co-occurrence of positive and negative romantic experiences, and support the importance of developing healthy relationship programs for street-involved youth. Key words: street-involved; homeless; youth; romantic relationship; resilience; dating violence.

Resilience and health (care): A dynamic adaptive perspective

This special forum on resilience explores particular worldviews of resilience-clinical, psychosocial, sociological, complexity science, organizational, and political economy through eight papers. This forum aims to open up the wealth of understandings and implications in health care by taking a transdisciplinary overview.

A Path Analysis of Self-determination and Resiliency for Consumers Living with Mental Illness

Over the last three decades, resilience has become a key area in mental health research, practice and policy, due to its potential to positively impact on wellbeing and quality of life. Research findings have identified that resilience positively correlates with an individual's subjective sense of well-being and decreased mental health problems. Given the potential benefits of resilience for those living with mental illness, research should examine ways in which these individuals can increase their resilience levels. One such method of examining resilience in people living with mental illness is through a motivational lens. Using Self-Determination Theory (SDT) lens, this study examined the potential of a proposed model for understanding the correlation and influence of motivational constructs on the resilience of people with a lived experience of mental illness. Results illustrated a goodness-of-fit for the proposed model. Results can be used to illustrate the importance of motivation and self-determination for people living with mental illness.

Adolescence as a neurobiological critical period for the development of higher-order cognition

The transition from adolescence to adulthood is characterized by improvements in higher-order cognitive abilities and corresponding refinements of the structure and function of the brain regions that support them. Whereas the neurobiological mechanisms that govern early development of sensory systems are well-understood, the mechanisms that drive developmental plasticity of association cortices, such as prefrontal cortex (PFC), during adolescence remain to be explained. In this review, we synthesize neurodevelopmental findings at the cellular, circuit, and systems levels in PFC and evaluate them through the lens of established critical period (CP) mechanisms that guide early sensory development. We find remarkable correspondence between these neurodevelopmental processes and the mechanisms driving CP plasticity, supporting the hypothesis that adolescent development is driven by CP mechanisms that guide the rapid development of neurobiology and cognitive ability during adolescence and their subsequent stability in adulthood. Critically, understanding adolescence as a CP not only provides a mechanism for normative adolescent development, it provides a framework for understanding the role of experience and neurobiology in the emergence of psychopathology that occurs during this developmental period.

Interprofessional training on resilience-building for children who experience trauma: Stakeholders' views from six low- and middle-income countries

Children exposed to multiple adversities are at high risk of developing complex mental health and related problems, which are more likely to be met through integrated interprofessional working. Combining the expertise of different practitioners for interprofessional care is especially pertinent in low- and middle-income countries (LMIC) in the absence of specialist resources. The aim of this study was to work with practitioners who deliver care to vulnerable children in six LMIC (Turkey, Pakistan, Indonesia, Kenya, Rwanda, and Brazil) to understand their perspectives on the content of an interprofessional training programme in building resilience for these children. Seventeen participants from different professional backgrounds, who were in contact with vulnerable children were interviewed. A thematic analytic framework was used. Four themes were identified, which were the benefits of a tiered approach to training, challenges and limitations, perceived impact, and recommendations for future training. The findings indicate the importance of co-ordinated policy, service, and training development in an interprofessional context to maximize resources; the need for cultural adaptation of skilled-based training and interventions; and the usefulness of new technologies to enhance accessibility and reduce costs in LMIC.

A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity

Resilience factors (RFs) help prevent mental health problems after childhood adversity (CA). RFs are known to be related, but it is currently unknown how their interrelations facilitate mental health. Here, we used network analysis to examine the interrelations between ten RFs in 14-year-old adolescents exposed ('CA'; n = 638) and not exposed to CA ('no-CA'; n = 501). We found that the degree to which RFs are assumed to enhance each other is higher in the no-CA compared to the CA group. Upon correction for general distress levels, the global RF connectivity also differed between the two groups. More specifically, in the no-CA network almost all RFs were positively interrelated and thus may enhance each other, whereas in the CA network some RFs were negatively interrelated and thus may hamper each other. Moreover, the CA group showed more direct connections between the RFs and current distress. Therefore, CA seems to influence how RFs relate to each other and to current distress, potentially leading to a dysfunctional RF system. Translational research could explore whether intervening on negative RF interrelations so that they turn positive and RFs can enhance each other, may alter 'RF-mental distress' relations, resulting in a lower risk for subsequent mental health problems.

Nurturing a Resilient Mindset in School-Aged Children Who Stutter

PURPOSE

To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have negative psychological consequences for some, including the development of a negative attitude toward their speech from a young age (Vanryckeghem, Brutten, & Hernandez, 2005) and possible co-occurring psychopathology in adolescence and adulthood, in particular, anxiety disorders (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Iverach & Rapee, 2014; McAllister, Kelman, & Millard, 2015). Children who stutter also frequently report teasing and bullying by their peers (Blood & Blood, 2007; Boyle, 2011; Langevin, Packman, & Onslow, 2009), which can have a significant impact on children's confidence and psychological well-being. However, the capacity of children who stutter to cope or "bounce back" from adversity is not routinely explored or incorporated in therapy for stuttering.

METHOD

This clinical focus article will explore the construct of resilience and consider why it may be important for children who stutter and their parents. A framework for understanding resilience in relation to stuttering is used, drawing from the Reaching In Reaching Out Resiliency Program (for children aged under 8 years and their parents) and the Penn Resiliency Program (for children aged 8 years and over).

CONCLUSIONS

The role of parents is key in modeling resilient responses to children and creating a resilience-rich environment. As children who stutter may be more vulnerable to adversity, some may benefit from targeted support to build their resilience, in order to enhance their ability to overcome challenges and thrive.

The Role of Attention in Therapy for Children and Adolescents Who Stutter: Cognitive Behavioral Therapy and Mindfulness-Based Interventions

METHOD

This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being.

CONCLUSIONS

Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.

'Best friends forever'? Friendship stability across school transition and associations with mental health and educational attainment

BACKGROUND

Friendships have been linked to mental health and school attainment in children. The effects of friendlessness and friendship quality have been well researched, but less is known about the role of friendship stability (i.e., maintaining the same friend over time), an aspect of friendship which is often interrupted by the transition between phases of schooling. Many children report concerns about the secondary school transition which introduces a number of new social and academic challenges for children.

AIMS

To explore rates of friendship stability and whether maintaining a stable best friend across the primary to secondary school transition provided benefits to children's adjustment during this period.

SAMPLE

Data were from 593 children (M age = 11 years 2 months).

METHODS

This study used longitudinal data from children transitioning into 10 UK secondary schools and explored the association between self-reported friendship stability and three outcomes: academic attainment, emotional problems and conduct problems. Analyses controlled for friendship quality and pre-transition psychological adjustment or attainment as appropriate.

RESULTS

Rates of friendship stability were relatively low during this period. Children who kept the same best friend had higher academic attainment and lower levels of conduct problems. Exploratory analyses indicated that secondary school policies that group children based on friendships may support friendship stability.

CONCLUSIONS

Helping maintain children's best friendships during the transition to secondary school may contribute to higher academic performance and better mental health.

Parental Bereavement in Young Children Living in South Africa and Malawi: Understanding Mental Health Resilience

BACKGROUND

Parental loss is a major stressful event found to increase risk of mental health problems in childhood. Yet, some children show resilient adaptation in the face of adversity across time.

SETTING

This study explores predictors of mental health resilience among parentally bereaved children in South Africa and Malawi and their cumulative effect. The study also explores whether predictors of resilience differed between orphaned and nonorphaned children.

METHODS

Consecutive attenders of community-based organizations (children; 4-13 years, and their caregivers) were interviewed at baseline and 15- to 18-month follow-up (n = 833). Interviews comprising inventories on demographic information, family data, child mental health, bereavement experience, and community characteristics. Mental health screens were used to operationalize resilience as the absence of symptoms of depression, suicidality, trauma, emotional, and behavioral problems.

RESULTS

Almost 60% of children experienced parental loss. One-quarter of orphaned children showed no mental health problems at either wave and were classified as resilient. There were equal proportions of children classified as resilient within the orphaned (25%) versus nonorphaned group (22%). Being a quick learner, aiding ill family members, positive caregiving, household employment, higher community support, and lower exposure to domestic violence, physical punishment, or stigma at baseline predicted sustained resilience. There were cumulative influences of resilience predictors among orphaned children. Predictors of resilience did not vary by child age, sex, country of residence or between orphaned and nonorphaned children.

CONCLUSIONS

This study enhances understanding of resilience in younger children and identifies a number of potential environmental and psychosocial factors for bolstering resilience in orphaned children.

Vulnerabilities in sequencing and task switching in healthy youth offspring of parents with mood disorders

INTRODUCTION

Visuospatial processing and task switching are impaired in individuals with mood disorders. It is unknown whether early deficits are present before mood symptom on set or are related to risk for a specific type of mood disorder. To investigate, we compared visual attention and task switching during sequencing among never-disordered youth with parental family histories of bipolar (BD) and major depressive disorders (MDD) and healthy controls (HC) with no personal or family history of psychopathology.

METHOD

8-17-year-old youth of parents with BD (n = 31, "BD-risk"), youth of parents with MDD (n = 49, "MDD-risk"), and demographically similar HC (n = 31, "HC") were examined using the Delis-Kaplan Executive Functioning System Trail Making Test. Seed-based resting-state functional connectivity (RSFC) was collected from a subset of 88 participants (25 BD-risk, 37 MDD-risk, 26 HC) to investigate group differences in RSFC related to visuospatial processing.

RESULTS

BD-risk and MDD-risk offspring had impaired sequencing and task switching, demonstrated by reduced scores on visual scanning, F(2, 108) = 4.12, p = .02, number sequencing, F(2, 88) = 4.75, p = .01, letter sequencing, F(2, 108) = 4.24, p = .02, and number-letter sequencing, F(2, 108) = 4.66, p = .01, compared to scores in HC. RSFC between the posterior cingulate (PCC) and clusters in the subcallosal cortex, amygdala, and hippocampus significantly differed among HC, BD-risk, and MDD-risk groups. PCC-subcallosal/limbic RSFC was positively coupled in the MDD-risk and BD-risk groups and negatively coupled in HCs.

CONCLUSIONS

Youth at familial risk for mood disorders demonstrate visuospatial deficits early in the processing stream. Improved methods for identifying at-risk children with the earliest possible neurocognitive impairments may inform remediation strategies that could prevent mood disorders.

Childhood Adversities and Thriving Skills: Sample Case of Older Swiss Former Indentured Child Laborers

OBJECTIVE

The study of life-long consequences of severe childhood adversities or trauma has recently received much attention. However, little is known about the subjective coping success and development of positively evaluated resources that may originate within these adverse experiences and may be conceptualized as thriving. This study set out to examine the relationship between thriving in response to early adversity and successful aging with a sample of former indentured child laborers in Switzerland (Verdingkinder).

METHODS

Participants were screened according to subjective and objective health-related attributes, and those who were evaluated to be "successful agers" were included. Semistructured interviews were conducted with 12 former Verdingkinder (mean age: 71 years) that lasted 60-120 minutes. The interviews were analyzed using the paradigm model of the Grounded Theory.

RESULTS

In the interviews adverse experiences and negative consequences were reported. However, where thriving was triggered in response to these experiences, the factors identified as "lightheartedness," "social purpose," and "self-enhancement" were associated with successful aging. Factors including motivation, reflection, personality traits, social support, individual coping strategies, turning points, and processing were reported as central to thriving.

CONCLUSION

The identified factors show similarities with established predictors of health and well-being. Thus, under certain circumstances early and prolonged adverse experiences can also provide the opportunity to develop positive resources for successful aging.

A resilience framework: Sexual health trajectories of youth with maltreatment histories

There is a wealth of knowledge regarding negative sexual outcomes experienced by youth with childhood maltreatment (CM) histories, yet a dearth of research examines healthy sexual development among these youth. This gap exists despite evidence of resilience highlighting alternative and healthy physical, social, and psychological futures for youth who were abused. This study tested whether trajectories of resilience identified in studies of psychological functioning were applicable to sexual health. Using data from the first four waves of the National Longitudinal Study of Adolescent to Adult Health, latent class growth analysis was conducted among individuals with histories of CM (N = 1,437). On average, participants were 15, 16, 21, and 28 years old, respectively, by waves of data collection. About half of the sample was female (55%), the majority were White (66%), and a sizeable portion had experienced multiple forms of CM prior to Wave I (38%). Controlling for CM severity, three distinct sexual health trajectory classes were identified: resilient, survival, and improving, which were differentiated by age and biological sex. Older participants' sexual health was more likely to diminish over time, girls were more likely to show gains in sexual health over time, and significant differences in levels of sexual behaviors between the classes were only present during adolescence. Findings support the need for increased attention on the potential for sexual health despite experiences of CM, and highlight the applicability of resilience theory to youth sexuality.

Relación entre apoyo social percibido y disposición resiliente en adolescentes paraguayos

El estudio de la adolescencia ha destacado la vulnerabilidad del proceso asociado con variables como la disposición resiliente, presente en aquellos recursos que pueden hacer la diferencia para el sustento del bienestar o su ausencia. De estos recursos se destaca el apoyo social que el adolescente percibe de su entorno. El objetivo de la investigación se centró en establecer la relación entre el apoyo social percibido y la disposición resiliente, y compararlas conforme el sexo y la edad de una muestra de adolescentes paraguayos escolarizados. Se llevó a cabo un diseño comparativo y correlacional, con 1334 adolescentes escolarizados de 12 a 18 años (ME= 14.99; DE= 1.66), 725 mujeres y 609 varones. Se empleó la Escala de Apreciación de Apoyo Social –EAAS y el Inventario de Resiliencia IRES. Los datos evidenciaron que no existe correlación entre apoyo social y disposición resiliente en esta muestra específica de adolescentes paraguayos, por factores que habrá que seguir investigando. Se observan diferencias en el apoyo social de amigos y de otros, mayormente en los varones. En las mujeres, se observan diferencias significativas en las escalas de resiliencia, en el sentido del humor, autoeficiencia y empatía. En cuanto a edad, los adolescentes de 16 a 18 años puntúan más en religiosidad y en el apoyo social, familiar, de amigos y de otros. Se sugiere estudiar otras variables relacionadas con el apoyo social y la disposición resiliente, en tanto muchas de las políticas públicas preventivas de atención a la salud positiva refuerzan su importancia en la adolescencia.