Measuring resilience in adult women using the 10-items Connor-Davidson Resilience Scale (CD-RISC). Role of trauma exposure and anxiety disorders

Is trait resilience characterized by specific patterns of attentional bias to emotional stimuli and attentional control?

BACKGROUND AND OBJECTIVES

Attentional processes have been suggested to play a crucial role in resilience defined as positive adaptation facing adversity. However, research is lacking on associations between attentional biases to positive and threat-related stimuli, attentional control and trait resilience.

METHODS

Data stem from the follow-up assessment of a longitudinal study investigating mental health and related factors among German soldiers. Trait resilience was assessed with the Connor-Davidson Resilience Scale and attentional control with the Attentional Control Scale. A subset of n = 198 soldiers also completed a dot probe task with happy, neutral and threatening faces.

RESULTS

Attentional control was positively related to trait resilience. Results revealed no associations between both attentional biases and trait resilience. However, there was a negative association between attentional bias to threat and trait resilience when attentional control was low and a positive association between attentional bias to threat and trait resilience when attentional control was high. No such associations were found for attentional bias to positive stimuli.

LIMITATIONS

Generalizability to other populations may be limited since we exclusively focused on male soldiers. Also, the cross-sectional design does not allow for causal conclusions.

CONCLUSIONS

Findings suggest that attentional processing may promote trait resilience. Future research on preventive interventions should consider these findings.

The mediating role of individual resilience resources in stigma-health relationship among people living with HIV in Guangxi, China

Despite the vigorous global efforts to reduce stigma, HIV-related stigma continues to undermine the health status of people living with HIV (PLHIV). Internalized HIV stigma may cause stress adversely affecting the health of PLHIV. Resilience is the process of an effective coping and positive adaption in the face of adversities. To date, limited data are available on the mediating role of resilience in the relationship of internalized HIV stigma and health status among PLHIV in China. A cross-sectional survey was conducted among 2987 PLHIV in Guangxi Autonomous Region (Guangxi) in China. A mediation analysis was employed and Sobel test was used to test the mediation effect of individual resilience. Of the 2987 PLHIV, 62.8% were men. The mean age of the sample was 42.5 years (SD = 12.8). Over 57.7% of PLHIV reported their overall health status being poor. About 72% of PLHIV reported experiencing internalized HIV stigma. Internalized HIV stigma had a negative direct effect on self-rated health status (p < .001). Individual resilience resources mediated the relationship between internalized HIV stigma and self-rated health status (p < .001). Sobel test confirmed the mediation effect of resilience (z = -8.359, SE = 0.003, p < .001). Resilience as a protective factor might buffer the effect of internalized HIV stigma on health status. Multilevel interventions are needed to foster resilience of PLHIV in order to mitigate the negative impact of HIV stigma and to improve the overall health status of PLHIV.

Resilience Moderates the Association Between Childhood Sexual Abuse and Depressive Symptoms Among Women with and At-Risk for HIV

Childhood sexual abuse (CSA) places women at risk for HIV infection and once infected, for poor mental health outcomes, including lower quality of life and depressive symptoms. Among HIV-positive and demographically matched HIV-negative women, we investigated whether resilience and HIV status moderated the relationships between CSA and health indices as well as the relationships among CSA, depressive symptoms, and health-related quality of life (HRQOL). Participants included 202 women (138 HIV+, 64 HIV-, 87 % African American) from the Women's Interagency HIV Study Chicago CORE Center site. Results indicated that in both HIV-positive and HIV-negative women, higher resilience significantly related to lower depressive symptoms and higher HRQOL. CSA related to higher depressive symptoms only for women scoring low in resilience. Interventions to promote resilience, especially in women with a CSA history, might minimize depressive symptoms and poor HRQOL among HIV-positive and HIV-negative women.

Resilience in adult cancer care: an integrative literature review

PROBLEM IDENTIFICATION

In cancer care, empirical research and theory development on resilience has primarily been the domain of pediatric settings. This article aims to (a) describe current scientific perspectives on the concept of resilience, (b) summarize quantitative research on resilience in adult cancer care, and (c) identify implications for cancer nursing.

LITERATURE SEARCH

An integrative literature review using PubMed, CINAHL®, and PsycINFO databases was performed and full-text, peer-reviewed articles published since 2003 were included.

DATA EVALUATION

To summarize quantitative research, 252 articles were retrieved yielding 29 eligible studies, of which 11 articles were evaluated and synthesized. Appropriate articles were reviewed and data were extracted and tabulated for synthesis.

SYNTHESIS

Resilience is a dynamic process of facing adversity related to a cancer experience. It may be facilitated through nursing interventions after people affected by cancer have been confronted with the significant adversity posed by diagnosis, treatment, (long-term) symptoms, and distress.

CONCLUSIONS

Resilience in adult cancer care is an under-researched area. Studies confirm the association with improved health outcomes (e.g., psychological well-being, mental and physical health).

IMPLICATIONS FOR RESEARCH

Resilience is an important issue for adult cancer care. Researchers must carefully define a conceptual framework for developing nursing interventions aimed at furthering resilience in adult cancer care.

Resilience and unmet supportive care needs in patients with cancer during early treatment: A descriptive study

PURPOSE

The concept of resilience is gaining increasing importance as a key component of supportive care but to date has rarely been addressed in studies with adult cancer patients. The purpose of our study was to describe resilience and its potential predictors and supportive care needs in cancer patients during early treatment and to explore associations between both concepts.

METHODS

This descriptive study included adult cancer patients under treatment in ambulatory cancer services of a Swiss hospital. Subjects completed the 25-item Connor-Davidson-Resilience Scale and the 34-item Supportive Care Needs Survey. Descriptive, correlational and regression analysis were performed.

RESULTS

68 patients with cancer were included in the study. Compared to general population, resilience scores were significantly lower (74.4 ± 12.6 vs. 80.4 ± 12.8, p = .0002). Multiple regression analysis showed predictors ("age", "metastasis", "recurrence" and "living alone") of resilience (adjusted R2 = .19, p < .001). Highest unmet needs were observed in the domain of psychological needs. Lower resilience scores were significantly and strongly associated with higher levels of unmet psychological needs (Rho = -.68, p < .001), supportive care needs (Rho = -.49, p < .001) and information needs (Rho = -.42, p = .001).

CONCLUSION

Ambulatory patients with higher levels of resilience express fewer unmet needs. Further work is needed to elucidate the mechanism of the observed relationships and if interventions facilitating resilience have a positive effect on unmet needs.

Factors associated with resilience of adult survivors five years after the 2008 Sichuan earthquake in China

Given the paucity of quantitative empirical research on survivors’ resilience and its predictors in the context of long-term recovery after disasters, we examined how resilience predictors differed by gender among adult survivors five years after the Sichuan earthquake. This was a cross-sectional survey study of adult survivors (N = 495; aged 18–60) living in reconstructed communities five years into the recovery process after the Wenchuan earthquake. The instruments we used included assessments of sociodemographic characteristics and earthquake exposure level, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale. Support-seeking behaviors emerged as a significant predictor of male survivors’ resilience, while subjective support and marital status were found to be predictors of female survivors’ resilience. Annual household income and chronic disease were predictors for both male and female groups. The findings of this study can be used in devising methods to boost survivors’ resilience by promoting their satisfaction with social support and their ability to obtain effective support. Additionally, the results suggest how to assist survivors who may have relatively poor resilience.

Promoting Resilience in Stress Management: A Pilot Study of a Novel Resilience-Promoting Intervention for Adolescents and Young Adults With Serious Illness

OBJECTIVE

To examine the feasibility and format of the Promoting Resilience in Stress Management (PRISM) intervention among two groups of adolescents and young adults (AYAs) at-risk for poor outcomes: those with Type 1 diabetes (T1D) or cancer.

METHODS

PRISM consists of two long or four short skills-based modules. English-speaking patients 12-25 years old were eligible if they had T1D for >6 months or cancer for >2 weeks. Feasibility was defined as an 80% completion rate and high satisfaction. Ongoing monitoring shaped iterative refinement of disease-specific approach.

RESULTS

12 of 15 patients with T1D (80%) completed the two-session intervention. 3 of 15 patients with cancer declined to complete the two-session version, citing prohibitive length of individual sessions. 12 (80%) completed the four-session version. Patient-reported satisfaction was high across groups.

CONCLUSIONS

The PRISM intervention is feasible and well-accepted by AYAs with cancer or T1D. Differences in patient populations warrant differences in approach.

Physical disease and resilient outcomes: a systematic review of resilience definitions and study methods

BACKGROUND

Findings from physical disease resilience research may be used to develop approaches to reduce the burden of disease. However, there is no consensus on the definition and measurement of resilience in the context of physical disease.

OBJECTIVE

The aim was to summarize the range of definitions of physical disease resilience and the approaches taken to study it in studies examining physical disease and its relationship to resilient outcomes.

METHODS

Electronic databases were searched from inception to March 2013 for studies in which physical disease was assessed for its association with resilient outcomes. Article screening, data extraction, and quality assessment were carried out independently by 2 reviewers, with disagreements being resolved by a third reviewer. The results were combined using a narrative technique.

RESULTS

Of 2280 articles, 12 met the inclusion criteria. Of these studies, 1 was of high quality, 9 were of moderate quality, and 2 were low quality. The common findings were that resilience involves maintaining healthy levels of functioning following adversity and that it is a dynamic process not a personality trait. Studies either assessed resilience based on observed outcomes or via resilience measurement scales. They either considered physical disease as an adversity leading to resilience or as a variable modifying the relationship between adversity and resilience.

CONCLUSION

This work begins building consensus as to the approach to take when defining and measuring physical disease resilience. Resilience should be considered as a dynamic process that varies across the life-course and across different domains, therefore the choice of a resilience measure should reflect this.

"I know it when I see it." The complexities of measuring resilience among parents of children with cancer

PURPOSE

Promoting parent resilience may provide an opportunity to improve family-level survivorship after pediatric cancer; however, measuring resilience is challenging.

METHODS

The "Understanding Resilience in Parents of Children with Cancer" was a cross-sectional, mixed-methods study of bereaved and non-bereaved parents. Surveys included the Connor-Davidson Resilience scale, the Kessler-6 psychological distress scale, the Post-Traumatic Growth Inventory, and an open-ended question regarding the ongoing impact of cancer. We conducted content analyses of open-ended responses and categorized our impressions as "resilient," "not resilient," or "unable to determine." "Resilience" was determined based on evidence of psychological growth, lack of distress, and parent-reported meaning/purpose. We compared consensus impressions with instrument scores to examine alignment. Analyses were stratified by bereavement status.

RESULTS

Eighty-four (88 %) non-bereaved and 21 (88 %) bereaved parents provided written responses. Among non-bereaved, 53 (63 %) were considered resilient and 15 (18 %) were not. Among bereaved, 11 (52 %) were deemed resilient and 5 (24 %) were not. All others suggested a mixed or incomplete picture. Rater-determined "resilient" parents tended to have higher personal resources and lower psychological distress (p = <0.001-0.01). Non-bereaved "resilient" parents also had higher post-traumatic growth (p = 0.02). Person-level analyses demonstrated that only 50-62 % of parents had all three instrument scores aligned with our impressions of resilience.

CONCLUSIONS

Despite multiple theories, measuring resilience is challenging. Our clinical impressions of resilience were aligned in 100 % of cases; however, instruments measuring potential markers of resilience were aligned in approximately half. Promoting resilience therefore requires understanding of multiple factors, including person-level perspectives, individual resources, processes of adaptation, and emotional well-being.

Abuse and resilience in relation to HAART medication adherence and HIV viral load among women with HIV in the United States

Abuse is highly prevalent among HIV+ women, leading to behaviors, including lower adherence to highly active antiretroviral therapy (HAART) that result in poor health outcomes. Resilience (functioning competently despite adversity) may buffer the negative effects of abuse. This study investigated how resilience interacted with abuse history in relation to HAART adherence, HIV viral load (VL), and CD4+ cell count among a convenience sample of 138 HIV+ women from the Ruth M. Rothstein CORE Center/Cook County Health and Hospital Systems site of the Women's Interagency HIV Study (WIHS). Resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC). HAART adherence (≥95% vs. <95% self reported usage of prescribed medication) and current or prior sexual, physical, or emotional/domestic abuse, were reported during structured interviews. HIV viral load (≥20 vs. <20 copies/mL) and CD4+ count (200 vs. <200 cells/mm) were measured with blood specimens. Multiple logistic regressions, controlling for age, race, income, enrollment wave, substance use, and depressive symptoms, indicated that each unit increase in resilience was significantly associated with an increase in the odds of having ≥95% HAART adherence and a decrease in the odds of having a detectable viral load. Resilience-Abuse interactions showed that only among HIV+ women with sexual abuse or multiple abuses did resilience significantly relate to an increase in the odds of ≥95% HAART adherence. Interventions to improve coping strategies that promote resilience among HIV+ women may be beneficial for achieving higher HAART adherence and viral suppression.

Resilience among women with HIV: Impact of silencing the self and socioeconomic factors

In the U.S., women account for over a quarter of the approximately 50,000 annual new HIV diagnoses and face intersecting and ubiquitous adversities including gender inequities, sexism, poverty, violence, and limited access to quality education and employment. Women are also subjected to prescribed gender roles such as silencing their needs in interpersonal relationships, which may lessen their ability to be resilient and function adaptively following adversity. Previous studies have often highlighted the struggles encountered by women with HIV without focusing on their strengths. The present cross-sectional study investigated the relationships of silencing the self and socioeconomic factors (education, employment, and income) with resilience in a sample of women with HIV. The sample consisted of 85 women with HIV, diverse ethnic/racial groups, aged 24 - 65 enrolled at the Chicago site of the Women's Interagency HIV Study in the midwestern region of the United States. Measures included the Connor-Davidson Resilience Scale -10 item and the Silencing the Self Scale (STSS). Participants showed high levels of resilience. Women with lower scores on the STSS (lower self-silencing) reported significantly higher resilience compared to women with higher STSS scores. Although employment significantly related to higher resilience, silencing the self tended to predict resilience over and above the contributions of employment, income, and education. Results suggest that intervention and prevention efforts aimed at decreasing silencing the self and increasing employment opportunities may improve resilience.

Resilience and social support promote posttraumatic growth of women with infertility: the mediating role of positive coping

According to previous research, clinical experience with individuals facing infertility has demonstrated that positive psychological changes can arise from the struggle involved (Paul et al., 2010), which is called posttraumatic growth (PTG). However, little knowledge has been gained about the relationships between PTG and its facilitating factors. The present study examined whether resilience and social support could predict PTG in women with infertility. The role of positive coping as a potential mediator was also assessed. Using a cross-sectional design, all members of a convenience sample of 182 women with infertility completed self-report measures of PTG, resilience, perceived social support, positive coping and background information. It was found that resilience, social support and positive coping positively correlated with PTG, which explained 34.0% of the total variance. The results suggested that positive coping partially mediated the impact of resilience on PTG while it totally mediated the relationship between social support and PTG. These findings demonstrated that, in clinical settings, improving positive coping in women with infertility may be helpful for the attainment of PTG.

Alcohol misuse and psychological resilience among U.S. Iraq and Afghanistan era veterans

OBJECTIVE

The present study sought to investigate the longitudinal effects of psychological resilience against alcohol misuse adjusting for socio-demographic factors, trauma-related variables, and self-reported history of alcohol abuse.

METHODOLOGY

Data were from the National Post-Deployment Adjustment Study (NPDAS) participants who completed both a baseline and one-year follow-up survey (N=1090). Survey questionnaires measured combat exposure, probable posttraumatic stress disorder (PTSD), psychological resilience, and alcohol misuse, all of which were measured at two discrete time periods (baseline and one-year follow-up). Baseline resilience and change in resilience (increased or decreased) were utilized as independent variables in separate models evaluating alcohol misuse at the one-year follow-up.

RESULTS

Multiple linear regression analyses controlled for age, gender, level of educational attainment, combat exposure, PTSD symptom severity, and self-reported alcohol abuse. Accounting for these covariates, findings revealed that lower baseline resilience, younger age, male gender, and self-reported alcohol abuse were related to alcohol misuse at the one-year follow-up. A separate regression analysis, adjusting for the same covariates, revealed a relationship between change in resilience (from baseline to the one-year follow-up) and alcohol misuse at the one-year follow-up. The regression model evaluating these variables in a subset of the sample in which all the participants had been deployed to Iraq and/or Afghanistan was consistent with findings involving the overall era sample. Finally, logistic regression analyses of the one-year follow-up data yielded similar results to the baseline and resilience change models.

CONCLUSIONS

These findings suggest that increased psychological resilience is inversely related to alcohol misuse and is protective against alcohol misuse over time. Additionally, it supports the conceptualization of resilience as a process which evolves over time. Moreover, our results underscore the importance of assessing resilience as part of alcohol use screening for preventing alcohol misuse in Iraq and Afghanistan era military veterans.