Resilience in the face of potential trauma: Clinical practices and illustrations

Trajectories and influencing factors of psychological resilience among Chinese patients with maintenance hemodialysis

Objective

To identify distinct trajectories of psychological resilience among Chinese patients with maintenance hemodialysis, explore influencing factors and inform the formulation of corresponding interventions.

Methods

This was a multi-center longitudinal study with a 6-month follow-up. With convenience sampling, a total of 231 patients with maintenance hemodialysis were recruited between September 2020 and July 2021. Patients' characteristics, including sociodemographic information, social support and family resilience was collected through structured questionnaires as potential baseline influencing factors of psychological resilience trajectories. Psychological resilience was evaluated using the 25-item Chinese version of the Conner and Davidson resilience scale. Latent class growth modeling was conducted to identify homogeneous subgroups with distinct trajectories of psychological resilience. Univariable and multinomial logistic regression analysis were used to examine whether baseline influencing factors were associated with trajectories in patients with maintenance hemodialysis.

Results

Five distinct psychological resilience trajectory groups were identified: declining group (n = 20, 8.7 %), rising group (n = 17, 7.4 %), moderate-stable group (n = 128, 55.4 %), high-stable group (n = 7, 3.0 %) and low-stable group (n = 59, 25.5 %). High-stable group and moderate-stable group were combined into the well-psychological resilience group for multinomial logistic regression analysis. The multinomial logistic regression analysis showed that influencing factors associated with trajectories of psychological resilience were age, religion, monthly household income per capita, and baseline family resilience.

Conclusions

The results highlight the heterogeneity in the development of psychological resilience among Chinese patients with maintenance hemodialysis. There is a need for healthcare professionals to screen for trajectories of psychological resilience in Chinese maintenance hemodialysis patients and prepare individual mental healthcare interventions.

Reflective functioning mediates the relationship between insecure adult attachment and the severity of prolonged grief symptoms

Background

This study aimed to investigate the mediation role of reflective functioning (i.e., certainty and uncertainty about mental states) in the relationship between insecure attachment (i.e., attachment avoidance and attachment anxiety ) and the severity of prolonged grief symptoms.

Methods

A cross-sectional study was conducted with 329 bereaved participants (51.7% females, mean age= 46.94 ± 14.62 years). Participants completed the Prolonged Grief Scale (PG-13), the Attachment Style Questionnaire (ASQ), and the Reflective Functioning Questionnaire (RFQ). Demographic and bereavement-related information were also collected.

Results

Certainty about mental states fully mediated the relationship between both the attachment avoidance and attachement anxiety and severity of prolonged grief symptoms.

Conclusions

The findings of this study indicate that reflective functioning impairment, specifically certainty about mental states of self and others, mediate the paths from insecure attachment to prolonged grief symptoms. This suggests that improving reflective functioning may contribute to the treatment bereaved individuals at risk of PGD.

Do all roads lead to Rome? An ideal-type study on trajectories of resilience in advanced cancer caregiving

OBJECTIVE

Studies on resilience in advanced cancer caregiving typically focus on the interplay between resilience-promoting resources and coping strategies that may be associated with resilience. However, no studies have investigated the emergence of trajectories of resilience and distress in individuals confronted with a cancer diagnosis of a loved one.

METHODS

Ideal-type analysis, a method for constructing typologies from qualitative data, was used to identify trajectories involving resilience or the lack thereof based on fifty-four interviews conducted with seventeen partners of patients recently diagnosed with advanced cancer over a period of three years.

FINDINGS

Six trajectories could be distinguished, three of which involved resilience (rapidly adapting resilience, gradually adapting resilience, and slowly adapting resilience), while the other three trajectories (continuing distress, delayed distress, and frozen disconnection) reflected a less optimal adjustment. These different trajectories seemed to be rooted in the individual characteristics of partners, the behavior of a support network, and interactions between the two.

CONCLUSION

The differentiation between these trajectories in partners of patients diagnosed with cancer not only furthers research on resilience in the face of adversity, but also promises to assist healthcare professionals in optimizing support for this often-neglected group of partners of patients diagnosed with cancer.

What and when to debrief: a scoping review examining interprofessional clinical debriefing

INTRODUCTION

Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts.

METHODS

Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches.

RESULTS

Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD.

CONCLUSIONS

The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

Struggling With Change: The Fragile Resilience of Collectives

Collectives form nonequilibrium social structures characterized by volatile dynamics. Individuals join or leave. Social relations change quickly. Therefore, unlike engineered or ecological systems, a resilient reference state cannot be defined. We propose a novel resilience measure combining two dimensions: robustness and adaptivity. We demonstrate how they can be quantified using data from a software-developer collective. Our analysis reveals a resilience life cycle (i.e., stages of increasing resilience are followed by stages of decreasing resilience). We explain the reasons for these observed dynamics and provide a formal model to reproduce them. The resilience life cycle allows distinguishing between short-term resilience, given by a sequence of resilient states, and long-term resilience, which requires collectives to survive through different cycles.

Injustice and Embitterment: Crucial Stressors in Psychosomatic Patients

OBJECTIVE

"Disorders specifically associated with stress" are receiving increasing attention in clinical practice, research, and modern classification systems of mental disorders. This includes not only reactions to "extremely threatening or horrific events" as it is characteristic for "post-traumatic stress disorders" but also a variety of day-to-day experiences. Examples are experiences of injustice, humiliation, or breach of trust which can have dire psychological consequences such as feelings of embitterment, a strong and crippling emotion. This study investigated the frequency of feelings of injustice and concomitant embitterment across different areas of daily life of psychosomatic patients.

METHODS

In an observational archival study, 200 inpatients of a department of behavioral medicine filled in the "Differential Life Burden Scale, DLB-Scale" and the "Post-Traumatic Embitterment Scale, PTED-Scale" which asks for experiences of injustice and embitterment.

RESULTS

More than half of all patients (58.5%) reported about very or extremely unjust and unfair life events and 51.5% additionally about feelings of embitterment. This was primarily associated with complaints about problems in the family and the workplace and was accompanied by an impairment of well-being.

CONCLUSIONS

The findings indicate that experiences of injustice and embitterment are frequently seen in psychosomatic inpatients and should get special attention.

Visual Analysis of Psychological Resilience Research Based on Web of Science Database

Background

The importance of psychological resilience that people show in coping with stress and adversity is prominent, but few studies have used rigorous bibliometric tools to analyze the knowledge structure and distribution of psychological resilience research.

Objective

The purpose of this study was to sort out and summarize the previous studies on psychological resilience by using bibliometrics. Specifically, the time distribution of psychological resilience research was determined by publication trend, the power distribution was determined by the distribution of countries, authors, institutions and journals, the hot research spots were analyzed according to the results of keyword cluster analysis, and the research frontier was explored according to the results of burst keywords.

Methods

CiteSpace5.8.R3 was used to analyze the literatures on psychological resilience collected in Web of Science core Collection database from January 1, 2010, to June 16, 2022.

Results

A total of 8462 literatures were included after screening. Research on psychological resilience has been on the rise in recent years. The United States had made a high contribution in this field. Robert H Pietrzak, George A Bonanno, Connor KM and others were highly influential. J Pers Soc Psychol has the highest citation frequency and centrality. The research hot spots focus on five aspects: study on psychological resilience related to COVID-19 pandemic, influencing factors of psychological resilience, psychological resilience related to PTSD, study on psychological resilience of special population, and the molecular biology and genetic basis of psychological resilience. Psychological resilience related to COVID-19 pandemic was the most cutting-edge research aspect.

Conclusion

The current situation and trend of psychological resilience research were found in this study, which may be used to identify more hot issues and explore new research directions in this field.

Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image

PURPOSE

This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship.

METHODS

We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure.

RESULTS

SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (β = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62).

CONCLUSIONS

Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.

Reliving a traumatic experience through emotional creativity: the bright side of cancer during the COVID-19 pandemic

Purpose

The COVID-19 outbreak has undoubtedly affected overall mental health. Thus, researching resilience is important, as it has been previously discussed as a means to protect people from mental health problems. This study aims to clarify whether survivors of a traumatic event (i.e. cancer survivors) are more resilient to living through another traumatic experience, such as COVID-19, compared to those who have never had such an experience. The study also examines the role of emotional creativity in this process.

Design/methodology/approach

A quantitative research design was adopted. The data collection was performed through a survey (N = 338), which was conducted among two separate groups of participants. The first group (N = 152) included the survivors of a traumatic event (i.e. cancer survivors), and the second group (N = 186) included those who did not have such an experience.

Findings

The results demonstrate that living through a traumatic experience results in a higher level of resilience during another traumatic experience (i.e. COVID-19), which is the result of higher post-traumatic growth. Moreover, emotional creativity is discussed as an explanatory variable that explains a significantly higher level of post-traumatic growth among survivors of a traumatic event.

Originality/value

This research offers a better understanding of the effect of living through a traumatic event on post-traumatic growth and resilience in living through another traumatic experience. Moreover, post-traumatic growth is explained through emotional creativity improvement, which happens after experiencing a traumatic life event.

The Resilience of Adolescent Girls: An Archival Diary Study of the Protective Advantages of Ordinary Adolescence in the Holocaust-Era Diaries of Anne Frank and Renia Spiegel

In view of recent calls for psychology to use more strengths-based approaches when studying the life experiences of girls, this qualitative archival diary study examined two famous Holocaust-era diaries for evidence of the resilience of adolescence in girls. Adolescent-themed passages were selected from the posthumously published diaries of Anne Frank and Renia Speigel, who kept private diaries while under grave threat and devastation of WWII and the Holocaust. To explore how the ordinary affairs of adolescent development may have contributed to their resilience, we used thematic analysis to explore the prevalence and emotional valence of four themes of adolescence: evolving social-relationships, emotional fluctuation, cognitive-identity changes, and physical changes. Adolescent-themed diary passages were predominantly positive, focused on love, joy, excitement, lust, self-efficacy, trust, contentment, and justice. Negatively valanced adolescent-themed passages described commonplace social concerns of relationship conflict, sadness, social-emotional distance, embarrassment, frustration, and jealousy. Whether positive or negative in valence, the adolescent-themed passages revealed gender-role consistent attention to relationships, alongside gender-role violating confessions of unrestrained sexuality and independence, as well. Theoretical conceptions of the resilience of adolescent girls and implications for theorists and trauma care providers are discussed.

Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV

OBJECTIVE

Women living with HIV (WLWH) are commonly symptomatic during perimenopause and menopause (≥1 y without menstruation), however, little is known of risks for symptoms and their timing. We analyzed these unwanted experiences to inform care.

METHODS

WLWH (≥40 y) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study rated midlife experiences for seven symptoms and a symptom composite (from 0 to 21). Timing was categorized into four phases: i) perimenopause (flow in the last year), ii) 1-2 years from final menstrual period (FMP), iii) 2-5 years post-FMP; and iv) >5 years post-FMP. Resilience (standardized out of 100) was assessed based on Wagnild's Resilience Scale. Univariable/multivariable mixed effects linear regression assessed correlates of symptom intensity by composite score.

RESULTS

Among 457 peri-/menopausal women mean age 54.7 (±6.6) over two time points (703 observations), 88% experienced ≥1 mild symptom; 75% were of moderate and 55% severe intensity. The most frequently reported symptoms were joint/muscle stiffness (67%), depressed mood (67%), and hot flashes (57%). After adjusting for reproductive phase, we found that women with greater resilience had fewer/lower intensity symptoms (symptom score 1.37 [2.30 to 0.44] lower; P = 0.004); those with depressive symptoms and recreational drug use (respectively) had more/higher intensity symptoms (scores 1.71 [0.61 to 2.82] [P = 0.002]; 2.89 [2.09 to 3.77] [P<0.001] higher). Symptoms were most intense in perimenopause and declined with increasing menopausal years (P = 0.03).

CONCLUSIONS

WLWH experiences a high burden of midlife symptoms, decreased by resilience and most intense during perimenopause. Unwanted experiences were linked to psychosocial and behavioral factors. These data encourage HIV providers to adopt a bio-psychosocial approach to midlife management.

Resilience, depression and anxiety and hazardous alcohol use behaviour among community dwelling older adults

INTRODUCTION

We examined the psychometric properties of the CD-RISC, including factor structure. Secondly, we examined if resilience factors moderate the association between negative affect and hazardous alcohol use.

METHOD

The sample population consisted of 1,368 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behaviour, depression and anxiety and resilience by using respectively the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI) and the Connor-Davidson Resilience Scale (CD-RISC).

RESULTS

Of the total sample (N 1.368), 80.1% reported using alcohol. The total sample and the drinking sample reported, respectively, a mean of 65.75 (SD 15.40) and 65.79 (SD 15.90) on the CD-RISC. Concerning the CD-RISC, exploratory factor analysis presents four factors of which three with a good reliability. Moderation analyses reflects that older adults with higher levels of resilient characteristics didn't report an association between negative affect and hazardous drinking. Alternatively, low resilient older adults did report an positive and significant association between negative affect and hazardous drinking.

CONCLUSION

The CD-RISC appeared to be a reliable instrument, containing three factors. In our sample, high resilience moderated the association between negative affect and hazardous drinking and may serve as a buffer against hazardous drinking.

The interaction of exposure to adverse childhood and combat experiences on the current mental health of new post-9/11 veterans

Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post-9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community-based mental health services are discussed.

Resilience in adolescent refugees living in Malaysia: The association with religiosity and religious coping

BACKGROUND

Until now, there is scarcity of information regarding resilience, religiosity and religious coping among adolescent refugees. Currently, most researches emphasize on the physical, psychological and social distresses experienced by refugees while overlooking these crucial aspects, that is, resilience and coping.

AIM

The study aimed to examine resilience and its association with religiosity and religious coping among adolescent refugees living in Malaysia.

METHODS

This is a cross-sectional study conducted in five community-based learning centres in Malaysia from July 2019 till December 2019. A total of 152 refugees, aged 13 to 19-years-old, were recruited. The study gauged resilience using the 14-Item Resilience Scale (RS-14), the Duke University Religion Index (DUREL) for religiosity and the Brief Religious Coping Scale (Brief RCOPE) for religious coping.

RESULTS

The majority of adolescent refugees portrayed moderate levels of resilience (43.5%). The study highlighted the interconnectedness between resilience and intrinsic religiosity (IR) (p < .001), as well as, positive (p < .001) and negative (p = .010) religious coping. Additionally, the results demonstrated that certain sociodemographic factors could potentially confound resilience, namely, countries of origin (p < .001), religion (p < .001), education centre (p < .001) and refugee status (p = .018).

CONCLUSION

With knowledge from this study, mental health professionals can initiate or improve liaison with religious-based services in working together to provide resources for adolescent refugees. Incorporating information regarding mental health with religious teachings may help increase resilience in young refugees and, in turn, alleviate their psychological distress.

Twelve tips for facilitating and implementing clinical debriefing programmes

Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.

Rates and prospective psychosocial correlates of pre-loss grief in cancer and dementia family members

This study examined changes in Pre-Loss Grief (PLG) among individuals whose family member has a life limiting illness and how baseline psychosocial factors predicted PLG. This two-wave study recruited family members of advanced cancer ( N = 100) and dementia ( N = 38) patients. A subsample completed 1-month follow-up (Cancer = 33; Dementia = 28). Higher caregiver burden and female participants predicted greater PLG at follow-up, accounting for baseline PLG. Family members of dementia patients (10.5%) were significantly more likely than family members of cancer patients (2.1%) to be in the “severe PLG” group. Findings demonstrate psychosocial factors related to PLG, informing interventions aimed at reducing PLG.

Identifying Women's Strengths for Promoting Resilience After Experiencing Intimate Partner Violence

Guided by the Resilience Portfolio Model, this study examined strengths associated with well-being and post-traumatic growth (PTG) among women who had experienced intimate partner violence (IPV). Participants were 109 Spanish women who were receiving specialized psychological services for IPV. They completed a survey on multiple indicators of strengths, subjective well-being, and PTG. The results indicated that PTG was positively correlated with well-being and all strengths. Univariate analysis comparing levels of PTG showed significant differences in all factors, except emotional regulation and optimism. Post hoc analyses revealed two patterns, with some strengths distinguishing across all levels of PTG, and others only discriminating the most resilient women (as indicated by PTG) from the rest. Multivariate analyses accounted for 42% of the variance in posttraumatic growth and 52% in well-being. The results suggest ways to promote well-being and resilience among victimized women.

Autophagy status as a gateway for stress-induced catecholamine interplay in neurodegeneration

The catecholamine-containing brainstem nuclei locus coeruleus (LC) and ventral tegmental area (VTA) are critically involved in stress responses. Alterations of catecholamine systems during chronic stress may contribute to neurodegeneration, including cognitive decline. Stress-related catecholamine alterations, while contributing to anxiety and depression, might accelerate neuronal degeneration by increasing the formation of toxic dopamine and norepinephrine by-products. These, in turn, may impair proteostasis within a variety of cortical and subcortical areas. In particular, the molecular events governing neurotransmission, neuroplasticity, and proteostasis within LC and VTA affect a variety of brain areas. Therefore, we focus on alterations of autophagy machinery in these nuclei as a relevant trigger in this chain of events. In fact, these catecholamine-containing areas are mostly prone to autophagy-dependent neurodegeneration. Thus, we propose a dynamic hypothesis according to which stress-induced autophagy alterations within the LC-VTA network foster a cascade towards early neurodegeneration within these nuclei.

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

Background

Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance.

Methods

Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD.

Results

During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD.

Conclusions

Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care.

Features of Childhood Maltreatment and Resilience Capacity in Adulthood: Results from a Large Community-Based Sample

Childhood maltreatment is consistently associated with poor outcomes. However, few epidemiological studies have examined the association between childhood maltreatment and adult resilience capacity, defined as one's perceived ability to cope successfully with challenges. This study aimed to determine associations between adult resilience capacity and specific types and features of childhood maltreatment. Participants were African American adults recruited from a public urban hospital in Atlanta, GA (N = 1,962) between 2005 and 2013. Childhood maltreatment, including witnessing domestic violence or physical, emotional, and sexual abuse, was assessed retrospectively using the Traumatic Events Inventory. Perceived resilience capacity was assessed using the Connor-Davidson Resilience Scale. Linear regressions were performed assessing the association between resilience capacity and childhood maltreatment exposure in general, as well as specific dimensions of exposure, including type, co-occurrence, and developmental timing, adjusting for covariates. Participants exposed to any maltreatment reported lower resilience capacity than unexposed peers, B = -0.38, SE = 0.04, p < .001. All maltreatment types were negatively associated with resilience capacity, even after adjusting for other lifetime trauma exposure. Only emotional abuse remained significantly associated with resilience capacity after accounting for current psychological distress, B = -0.11, SE = 0.05, p = .022. Maltreatment co-occurrence followed an inverse dose-response relationship with resilience capacity: For each additional maltreatment type, scores decreased by 0.18 units (SD = 0.02), p < .001. Finally, the developmental timing of maltreatment did not reveal any differential influences on resilience capacity. The results suggest that childhood emotional abuse and co-occurrence of maltreatment types may be particularly deleterious to adult resilience capacity.

An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness

Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (vs. passive) and approach-oriented (vs. avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles, and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.

Querulant delusion and post-traumatic embitterment disorder

Injustice, breach of trust, and humiliation are social stressors which can result in embitterment, known to everybody and which has been described in the Bible (Cain and Abel) or by Aristotle in the Nicomachean Ethics. It has been discussed by several authors since the early days of psychiatric classification. In the textbook 'Psychiatry' by E. Kraepelin a full chapter is devoted to 'querulant delusion', named a reactive psychosis, which can be discriminated from endogenous psychosis or personality disorders. Core symptoms are embitterment, negativism, helplessness, self blame, unspecific somatic symptoms, phobic avoidance of persons or situations related to the event, intrusions, phantasies of revenge and aggression. Another name is 'Posttraumatic Embitterment Disorder' according to the leading emotion. This severe mental disorder has by and large been ignored over the years by health professionals. In ICD-11 the term embitterment is mentioned for the first time in the category '6B43 adjustment disorder'. Embitterment can be measured with the 'Bern Embitterment Inventory (BVI)' and the 'Post-Traumatic Embitterment Self-rating Scale (PTED scale)'. Treatment must take into account the special features of embitterment including often aggressive rejection of help. A promising treatment approach is, to refer to wisdom psychology and transfer this in 'wisdom psychotherapy'.

Anxiety about aging, resilience and health Status among Chinese older adults: Findings from Honolulu and Wuhan

A growing body of literature found that anxiety about aging is related to health and well-being of older adults. However, very few studies have been conducted on Chinese older adults residing in different countries and examined the role of resilience. Using the Pearlin's Stress Process Model, this study aims to fill in this gap by examining the relationship between anxiety about aging as the stressor and health status among Chinese older adults living in Honolulu, the United States (N = 292) and Wuhan, China (N = 532). The survey data were collected through June 2017 to September 2018, using snowball and convenience sampling strategy. The moderating role of resilience on the focal relationship is also explored. Results showed that for both samples, the negative relationship between anxiety about aging and self-rated health was significantly moderated by resilience (18 % and 13 %, respectively), implying the stress-buffering role of resilience. Although both mean levels of resilience and anxiety about aging were lower for the Honolulu sample, the moderating effect appeared to be stronger, implying that older adults in the Honolulu sample might rely more on psychological resources such as resilience in coping with stressors, compared with their counterparts in Wuhan. However, the moderating effect of resilience did not work for the association between anxiety about aging and number of chronic conditions for both samples. Our findings suggest that future research needs to take into account both social and psychological resources when examining anxiety about aging and health status among Chinese older adults residing in different cultural contexts.

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.

Measurement properties and implications of the Brief Resilience Scale in healthy workers

Objectives

The aim of this study was to study measurement properties of the Dutch Language Version of the Brief Resilience Scale (BRS‐DLV) in blue and white collar workers employed at multiple companies and to compare the validity and factor structure to other language versions.

Methods

Workers (n = 1023) were assessed during a cross‐sectional health surveillance. Construct validity was tested with exploratory and confirmatory factor analyses (EFA and CFA) and hypothesis testing. Reliability was tested with Cronbach's alpha.

Results

A two‐factor structure of the BRS‐DLV had good model fit in both EFA and CFA, which could be explained by difficulties of workers with reversed order items. After excluding these inconsistent answering patterns, a one‐factor structure showed good model fit resembling the original BRS (χ² = 16.5; CFI & TLI = 0.99; SRMR = 0.02;RMSEA = 0.04). Internal consistency is sufficient (Cronbach's α = 0.78). All five hypotheses were confirmed, suggesting construct validity.

Conclusions

Reliability of the BRS‐DLV is sufficient and there is evidence of construct validity. Inconsistent answering, however, caused problems in interpretation and factor structure of the BRS‐DLV. This can be easily detected and handled because item 2, 4 and 6 are in reversed order. Other language versions differ in factor structure, most likely because systematic errors are not corrected for. To collect valid data, it is advised to be aware of inconsistent answering of respondents.

The resilience status of Chinese left-behind children in rural areas: a meta-analysis

The resilience has become the main trend of the left-behind children's (LBC) mental health research. To evaluate the resilience status of Chinese LBC in rural areas, a meta-analysis was performed. Relevant studies were identified using electronic databases from 1990 to 2017. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) were calculated with fixed and random effects models. A total of 14 cross-sectional studies with 9777 individuals were included in this meta-analysis. The results showed there was significant difference in the aspects of family support and RSCA (Resilience Scale for Chinese Adolescents) total score between LBC and non-left-behind children (NLBC). After stratification subgroup, significant difference in RSCA total score was also found in subgroup with sample size ≥700 and target population (LBC) between LBC and NLBC. In addition, there was no significant difference in resilience of male and female among LBC (P >0.05). We also found RSCA total score of LBC whose one parents migratingwere higher than both parents (P <0.05) and the time of parental migration (≤2 years) were higher than others (>2 years). In conclusion, more attention should be paid to the LBC, especially both parents migrating or parental migration (>2 years).

Practical non-pharmacological intervention approaches for sleep problems among older adults

Poor sleep is common among older adults, often caused by multiple underlying factors such as chronic stress. Poor sleep is subsequently associated with negative health outcomes including higher morbidity and mortality. Our primary purpose is to explore practical non-pharmacological intervention approaches integrating stress management to improve sleep quality among older adults. In doing so, we highlight approaches that appear to hold promise in real-world settings with older individuals. We conducted a tailored literature review specifically on approaches to improve sleep quality among older adults, with emphasis on those integrating stress management. Online search engines were reviewed to identify research in these areas. Various non-pharmacological intervention approaches, such as mindfulness and cognitive behavioral therapy, have shown promise in improving sleep quality and health outcomes within this population. Those integrating chronic stress management appear to be particularly successful. Thus further development of multidimensional sleep interventions integrating stress management with seniors is warranted.

Neurobiological Mechanisms of Stress Resilience and Implications for the Aged Population

BACKGROUND

Stress is a common reaction to an environmental adversity, but a dysregulation of the stress response can lead to psychiatric illnesses such as major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and anxiety disorders. Yet, not all individuals exposed to stress will develop psychiatric disorders; those with enhanced stress resilience mechanisms have the ability to adapt successfully to stress without developing persistent psychopathology. Notably, the potential to enhance stress resilience in at-risk populations may prevent the onset of stress-induced psychiatric disorders. This novel idea has prompted a number of studies probing the mechanisms of stress resilience and how it can be manipulated.

METHODS

Here, we review the neurobiological factors underlying stress resilience, with particular focus on the serotoninergic (5-HT), glutamatergic, and γ-Aminobutyric acid (GABA) systems, as well as the hypothalamic-pituitary axis (HPA) in rodents and in humans. Finally, we discuss stress resiliency in the context of aging, as the likelihood of mood disorders increases in older adults.

RESULTS

Interestingly, increased resiliency has been shown to slow aging and improved overall health and quality of life. Research in the neurobiology of stress resilience, particularly throughout the aging process, is a nascent, yet, burgeoning field.

CONCLUSION

Overall, we consider the possible methods that may be used to induce resilient phenotypes, prophylactically in at-risk populations, such as in military personnel or in older MDD patients. Research in the mechanisms of stress resilience may not only elucidate novel targets for antidepressant treatments, but also provide novel insight about how to prevent these debilitating disorders from developing.

Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial

Homicidally bereaved individuals may experience symptoms of Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD). This Randomized Controlled Trial examined the effectiveness of an 8-session treatment encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to reduce self-rated CG and PTSD symptoms in 85 Dutch adult homicidally bereaved men and women. We compared changes in symptoms of CG (assessed using the Inventory of Complicated Grief) and PTSD (assessed using the Impact of Event Scale) between an intervention group and a waitlist control group. The treatment was effective in reducing CG and PTSD symptoms, from pretreatment to posttreatment. It can be concluded that EMDR and CBT seem promising treatments for homicidally bereaved individuals for both men and women, and regardless of the time since the loss. Further research is needed to examine whether a combined treatment of EMDR and CBT together is of added value in situations where grief and trauma are intertwined over offering only one of the two treatment modalities.

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.

Validity and reliability of the Mexican resilience measurement scale in families of children with chronic conditions

Background

The resilience to face disease is a process of positive adaptation despite the loss of health. It involves developing vitality and skills to overcome the negative effects of adversity, risks, and vulnerability caused by disease. In Mexico, the Mexican Resilience Measurement Scale (RESI-M) has been validated with a general population and has a five-factor structure. However, this scale does not allow evaluation of resilience in specific subpopulations, such as caregivers.

Method

This study investigated the psychometric properties of RESI-M in 446 family caregivers of children with chronic diseases. A confirmatory factor analysis (CFA) was performed, internal consistency values were calculated using Cronbach’s alpha coefficient, and mean comparisons were determined using t-tests.

Results

The expected five-factor model showed an adequate fit with the data based on a maximum likelihood test. The internal consistency for each factor ranged from .76 to .93, and the global internal consistency was .95. No average difference in RESI-M and its factors was found between women and men.

Conclusion

The RESI-M showed internal consistency and its model of five correlated factors was valid among family caregivers of children with chronic diseases.

Measuring Resilience in Two Generations: Psychometric Properties of Available Instruments

BACKGROUND AND PURPOSE

This study examines measures of resilience to identify the best available measure for future research to assess efficacy of a low-cost intervention that enhances resilience of older adults and youth (i.e., intergenerational transfer of ethnic culture).

METHODS

Scanning the literature produced no obvious choice; 3 measures showed promise: the Wagnild-Young Resilience Scale, Windle-Markland-Woods Psychological Resilience Scale, and the Connor-Davidson Resilience Scale (CD-RISC); 200 ethnicityalike older adults and 192 youths completed all three scales.

RESULTS

Factor analyses interpreted in consultation with a panel of community advisers showed no measure was statistically robust. The CD-RISC had acceptable reliability and a conceptually interpretable structure.

CONCLUSIONS

Results suggest the CD-RISC, supplemented by qualitative input, provides a way forward for research on efficacy of intergenerational interventions.

Substantiated childhood maltreatment and young adulthood cannabis use disorders: A pre-birth cohort study

This study investigates the association between exposure to prospectively-substantiated childhood maltreatment between 0 and 14 years of age and lifetime cannabis use, abuse and dependence reported at 21 years. Data were taken from 2526 (51.6% female) participants in the Mater Hospital-University of Queensland Study of Pregnancy, a pre-birth, prospective, cohort study. Prospectively-substantiated cases of childhood maltreatment, reported to the government child protection agencies between 0 and 14 years of age, were linked to CIDI DSM-IV self-report data from the 21-year follow-up. Exposure to any childhood maltreatment, and childhood neglect in particular, predicted subsequent cannabis abuse with adjusted odds ratios (AORs) of 1.79 and 2.62, respectively. Any childhood maltreatment, physical abuse, emotional abuse and neglect predicted cannabis dependence with AORs of 2.47, 2.81, 2.44 and 2.68, respectively. The associations for an early age of onset of cannabis abuse and dependence were significant and consistent for maltreated children. In addition, frequency of maltreatment substantiations predicted cannabis abuse, dependence and an early age of onset of these disorders. The AORs for cannabis ever use without any DSM-IV cannabis disorder were 1.78 for any maltreatment and 2.15 for emotional abuse. Any childhood maltreatment and neglect predicted lifetime ever cannabis use, as well as cannabis use disorder. There was little evidence for any interaction between gender and different forms of childhood maltreatment and its association with cannabis use disorders. Physical abuse, emotional abuse and neglect, as well as multiple episodes of maltreatment independently predicted cannabis use disorders.

Trajectories of traumatic stress symptoms during conflict: A latent class growth analysis

BACKGROUND

The ways in which traumatic stress symptoms unfold under situations of ongoing threat and trauma exposure are poorly understood. The current study aims to identify traumatic stress symptom trajectories during conflict, as well as potential risk factors.

METHODS

Experience sampling methods were used to study traumatic stress symptoms during the 2014 Israel-Gaza conflict in 100 Israeli civilians exposed to rocket fire. Summary reports of traumatic symptoms were made twice-daily for 30 days via mobile phone.

RESULTS

Latent class growth analysis revealed four distinct classes (low, reducing, moderate, and high) characterised by their trajectory of traumatic stress symptoms during the conflict. Female gender, not being in a relationship, and higher prior trauma exposure were identified as potential risk factors.

LIMITATIONS

Data were not collected in the early phase of the conflict, the sample was relatively small, and only traumatic stress symptoms were investigated as outcomes.

CONCLUSIONS

This study identified heterogeneous traumatic stress symptom trajectories among civilians during a conflict, with different subgroups showing distinct response patterns over time, associated with various risk factors. Investigating responses to ongoing trauma, and identifying predictors of different stress symptom trajectories has clinical implications for the targeted delivery of interventions. Further exploration of heterogeneous trajectories could potentially elucidate mechanisms that drive resilience and recovery, including in situations of ongoing exposure such as during conflict.

A Skill Set for Supporting Displaced Children in Psychological Recovery After Disasters

Helping children, adolescents, and families displaced following a natural disaster is a daunting task made more challenging by the relatively small research base to inform services and interventions. This paper describes the current literature pertaining to intervention practices used with displaced youth. Where gaps in the literature exist, we pull from the more general research on relocation and post-disaster intervention to assist practitioners in tailoring their efforts. Specifically discussed are ways to enhance youth resilience, to help youth build new social connections and adjust to change and uncertainty while coping with trauma-related symptoms, and to meet needs through the systems in which children are embedded. The need for focused attention to cultural factors is discussed with an emphasis on collaborating with culture brokers.

A study of burden of care and its correlates among family members supporting relatives and loved ones with traumatic spinal cord injuries

Objective:

To understand and describe in a sample of caregivers of persons with spinal cord injury, their burden of care, resilience and life satisfaction and to explore the relationship between these variables.

Design:

Cross-sectional design.

Setting:

One Spinal Cord Injury Acute Inpatient Unit from a general hospital.

Subjects:

Seventy-five relatives of persons with spinal cord injuries (84% women) with a mean age of 48.55 ( SD = 12.55) years.

Interventions:

None.

Measures:

Demographics (neurological loss and severity according to the American Spinal Injury Association criteria), the Zarit Burden Interview, the Resilience Scale and the Life Satisfaction Checklist.

Results:

All caregivers experienced feelings of different intensities of burden (52% mild-to-moderate, 43% moderate-to-severe and 5% severe), and none of them expressed little or no burden at the assessment moment. Caregivers’ main worries were “dependence” and “the future of the injured.” Resilience was medium-to-high (mean = 141.93, SD = 23.44) for the whole sample with just a minority of them revealing low (15%) or very low resilience (7%). The highest scores were obtained in relation to “caregivers’ independence” and “meaning of their lives.” Life satisfaction scores were medium-to-high (mean = 36.6, SD = 6). These scores were not related to demographics or the severity of the injury. Zarit Burden Interview scores were negatively correlated to Resilience Scale ( r = −.370, P = .001) and Life Satisfaction Checklist scores ( r = −.412, P < .001).

Conclusion:

More resilient and satisfied caregivers experienced lower burden. Burden is moderate-to-high and mainly related to uncertainty about the future, caregivers’ insecurity with caregiving and dependence of the injured.

The mediating role of resilience in the relationship between social support and posttraumatic growth among colorectal cancer survivors with permanent intestinal ostomies: A structural equation model analysis

PURPOSE

Information on posttraumatic growth (PTG) among colorectal cancer (CRC) survivors with permanent intestinal ostomies is limited. The aim of this cross-sectional study was to investigate the occurrence of PTG among CRC survivors with permanent intestinal ostomies and its association with perceived social support and resilience.

METHODS

This study was conducted with 164 CRC survivors with permanent intestinal ostomies at least one month after surgery. Participants completed questionnaires assessing socio-demographic and clinical characteristics, perceived social support, resilience and PTG.

RESULTS

The mean total score on the Post Traumatic Growth Inventory was 66.74 (SD = 13.99). Perceived social support (r = 0.450) and resilience (r = 0.545) were significantly positively correlated with PTG. Structural equation modeling analysis showed that resilience mediated the relationship between perceived social support and PTG in which the indirect effect of perceived social support on PTG through resilience was 0.203 (P < 0.001).

CONCLUSIONS

Moderate to high PTG was found in CRC survivors with permanent intestinal ostomies. The most important implication of this study was that improving social support and resilience might be scientific intervention strategies for promoting PTG among CRC survivors.

Psychological resilience in U.S. military veterans: A 2-year, nationally representative prospective cohort study

Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who completed web-based surveys in two waves (2011 and 2013) as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of cumulative lifetime exposure to potentially traumatic events and Wave 2 measures of current symptoms of posttraumatic stress, major depressive, and generalized anxiety disorders was performed to characterize different profiles of current trauma-related psychological symptoms. Different profiles were compared with respect to sociodemographic, clinical, and psychosocial characteristics. A three-group cluster analysis revealed a Control group with low lifetime trauma exposure and low current psychological distress (59.5%), a Resilient group with high lifetime trauma and low current distress (27.4%), and a Distressed group with both high trauma exposure and current distress symptoms (13.1%). These results suggest that the majority of trauma-exposed veterans (67.7%) are psychologically resilient. Compared with the Distressed group, the Resilient group was younger, more likely to be Caucasian, and scored lower on measures of physical health difficulties, past psychiatric history, and substance abuse. Higher levels of emotional stability, extraversion, dispositional gratitude, purpose in life, and altruism, and lower levels of openness to experiences predicted resilient status. Prevention and treatment efforts designed to enhance modifiable factors such as gratitude, sense of purpose, and altruism may help promote resilience in highly trauma-exposed veterans.

Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN): A Proposed Concept for Science and Practice

BACKGROUND

Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes.

PURPOSE

This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.

Finding Meaning in Life Following Emergency Postpartum Hysterectomy: What Doesn't Kill Us Makes Us Stronger

INTRODUCTION

Childbirth is generally perceived to be a triumphant and joyous moment in a woman's life. However, current research indicates that it can also be a time of fear, dread, and apprehension, particularly when the birth experience is traumatic. Some women attempt to seek the positives of their traumatic or unexpected childbirth experience to be able to cope with their experience. However, little attention is directed toward how women rebuild their lives and grow following traumatic birth experiences such as severe postpartum hemorrhage and emergency hysterectomy.

METHODS

Twenty-one Australian women, aged 24 to 57 years, who had experienced severe postpartum hemorrhage and emergency hysterectomy were interviewed in an in-depth qualitative study about their experiences.

RESULTS

Thematic analysis revealed the major theme of moving forward and 4 subthemes: appreciating life and what you have; what really counts: learning and growing; accepting it: it's just the way it is; and reframing the experience: seeking the positives All of the women found meaning following their hysterectomy, which produced a positive perspective on their lives.

DISCUSSION

The way that women find meaning and cope with the trauma of having a severe postpartum hemorrhage and emergency hysterectomy is significant to their ability to move forward and live life to the fullest. Midwives and other health care providers may be in a position to provide support for women in the aftermath of severe postpartum hemorrhage and emergency hysterectomy.

The impact of resilience among older adults

The purpose of this literature review was to provide an overview of resilience for the purpose of informing potential intervention designs that may benefit older adults. While numerous reviews have focused on various specific aspects of resilience, none have provided the necessary information required to design an effective resilience intervention. Research examining resilience suggests that older adults are capable of high resilience despite socioeconomic backgrounds, personal experiences, and declining health. Thus opportunities to inform interventions in this area exist. Research studies have identified the common mental, social, and physical characteristics associated with resilience. High resilience has also been significantly associated with positive outcomes, including successful aging, lower depression, and longevity. Interventions to enhance resilience within this population are warranted, but little evidence of success exists. Thus this review provides an overview of resilience that may aid in the design of resilience interventions for the often underserved population of older adults.

The Association of Social Inhibition and Posttraumatic Stress Disorder: A Vicious Circle?: Results From the Population-Based KORA F4 Study With 1232 Participants With Trauma Exposure

This cross-sectional analysis investigated the association between posttraumatic stress disorder (PTSD) and social inhibition (SI). A total of 1232 individuals aged 32-71 years with a history of traumatic experience were identified from the population-based Cooperative Health Research in the Region of Augsburg F4 study conducted in 2006-2008. PTSD was assessed by the Impact of Event Scale, Posttraumatic Diagnostic Scale, and interview data. SI was measured by the SI subscale of the German version of the Type-D scale and dichotomized in a high (score of ≥10) and nonhigh group. Even in the fully adjusted multinomial logistic regression model (adjusted for age, sex, sociodemographic and metabolic risk factors, anxiety, depression), high levels of SI were significantly associated with PTSD (partial: odds ratio, 1.58; 95% confidence interval, 1.19-2.09; p = 0.002; full: odds ratio, 2.45; 95% confidence interval, 1.25-4.82; p = 0.009). Our findings suggest a dose-response relationship between PTSD and SI and should be integrated in individual therapy plans, especially of patients with interpersonal violence experience.

Resilience is associated with low psychological distress in renal transplant recipients

OBJECTIVE

Renal transplantation (RT) is a significant life event; its subsequent challenges often lead to psychological distress, which substantially lowers patients' quality of life. The purpose of this study was to screen psychological distress and examine the relationships between resilience and psychological distress in RT recipients.

METHODS

Participants were 139 RT recipients from the RT follow-up clinic and ward in the departments of nephrology of three general hospitals in Jinan, China. They were assessed using the Connor-Davidson Resilience Scale, Perceived Social Support Scale and Kessler Psychological Distress Scale. Logistic regression analyses were used to evaluate the relationships between resilience and psychological distress after adjusting for perceived social support.

RESULTS

Fifty-nine (42.4%) RT recipients were considered as experiencing "psychological distress" (K10 score ≥ 22). Resilience was associated with psychological distress after controlling for perceived social support and sociodemographic variables: a one-point increase in resilience decreased the likelihood of having possible psychological distress (odds ratio=0.945, 95% confidence interval=0.914-0.976, P<.01).

CONCLUSIONS

The present study suggests that resilience was significantly associated with low psychological distress in RT recipients. Psychosocial interventions focused on resilience might provide useful approaches to overcome psychological distress in RT recipients.

What is resilience? An Integrative Review of the empirical literature

AIM

To use systematic methods to examine how resilience is defined in empirical research.

BACKGROUND

Resilience is a term that is increasingly being used to describe and explain the complexities of individual and group responses to traumatic and challenging situations. It is now frequently mentioned in relation to many areas of nursing practice, including research. Given the increasing use of the term, it is timely to examine how resilience has been defined in empirical research.

DESIGN

An integrative review of the empirical literature (2000-2015).

DATA SOURCES

Three health-related databases were searched: Medline, PsycINFO and the Cumulative Index for Nursing and Allied Health (CINAHL). Reference and citation tracking was performed on all articles included in the review.

REVIEW METHODS

The methods described by Whittemore and Knafl were used to guide this review. Two reviewers were involved in screening articles for inclusion and in the data extraction process. Data were synthesized using the constant comparative method of analysis.

RESULTS

One hundred articles were included in the final data analysis. The most significant finding of the review was that there is no universal definition of resilience. There were, however, some common themes identified: rising above, adaptation and adjustment, dynamic process, 'ordinary magic' and mental illness as a marker of resilience.

CONCLUSION

Despite the increasing use of the term 'resilience', this review has identified that there is no universal definition of resilience adopted in the research literature. Further research is required to explore this construct in the context of nursing.

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 professional chaplaincy: a paradigm shift in focus

Research into the area of resilience provides a challenge and a great opportunity for professional chaplaincy. In this article, we will consider the challenge that the research primarily of George Bonanno of Columbia University offers to the traditional, clinical perspectives and assessments of professional chaplains serving in health care. Secondly, we will propose the practical implications for a wider paradigm and an expanded focus on intentionality and interventions of chaplains. Resilience is seen as a positive response possibility for those facing potentially traumatic events. It is understood to be a predominant response to traumatic events more often than the grief recovery model usually presumed to be active. Resilience has heuristic value and merits being factored in to professional chaplaincy as it relates to patient assessment, interventions, interdisciplinary care, staff and corporate support, and transcultural usefulness.