Study of resilience and environmental adversity in midlife health (STREAM)

Early predictors of mental health in mid-adulthood

AIM

Substantial research has focused on the examination of factors that contribute to the development of psychiatric problems. However, much less is known about factors early in life that may protect from poor mental health outcomes in midlife. This study aimed to identify the extent to which a set of key perinatal demographic variables and adolescent academic performance were associated with good mental health in mid-adulthood.

METHODS

In a sample of 525 individuals (aged 34-44, 55.4% male) born and raised in Jerusalem, Israel (STREAM study) we attempted to differentiate those who did and did not report psychiatric symptoms in mid-adulthood. Using χ² and regression analysis, we explored birth factors (year of birth, sex, birth weight, and number of older siblings, data on parental immigration and socioeconomic status), academic achievement in eighth grade and contemporaneous measures of lifestyle factors, personality traits, and perceived resilience.

RESULTS

Participants with good mental health were more often male (P = .005) and had better academic performance already at adolescence than participants who reported psychiatric symptoms in midlife (P < .001). They reported fewer physical complaints (P = .008), were less likely to smoke (P = .001) and considered themselves to be more "resilient" (P < .001).

CONCLUSIONS

The results showed that better academic performance in adolescence may be associated with better stress-coping strategies, resulting in fewer psychiatric complaints, more perceived resilience, and less stress-related behaviours in mid-adulthood. Future studies confirming this hypothesis could inform public mental health interventions.

Psychiatric symptoms and related dysfunction in a general population sample

Background

Along with the key clinical features of major psychiatric disorders such as psychosis, mania, and depression, these disorders are also associated with cognitive, social, and functional deficits. A growing body of evidence suggests that these disorders exist at the extreme end of a continuum of symptoms rather than as binary entities, so it is plausible that the associated cognitive, social, and functional deficits assume a similar pattern. Consistent with this approach, we sought to determine whether adults in the general population with psychiatric symptoms also demonstrate milder forms of the cognitive, social, and functional deficits that are often associated with the psychiatric disorders.

Methods

Using data from the Study of Resilience and Environmental Adversity in Midlife Health (STREAM), which includes survey responses of 811 individuals, we compared early academic achievement and self-reported social and functional outcomes between respondents who reported psychotic symptoms, manic symptoms, depressive symptoms, or no psychiatric symptoms (controls).

Results

Adults with psychotic symptoms had significantly poorer early academic performance (p = .04) and social and functional outcomes (self-reported marital status, p = .021, income, p = .001, and health, p < .001) than controls. Adults with depressive symptoms had significantly lower early academic performance and income and poorer health than controls (p's = 0.033, 0.037, 0.013 respectively), and adults with manic symptoms also reported significantly lower rates of marriage than controls (p = .006).

Conclusions

The results are consistent with the continuum view of the etiology of psychiatric disorders in which psychiatric disorders are dimensional and experienced in varying degrees of severity across the general and clinical population. Importantly, the results highlight the potential impact of psychiatric symptomatology on functional outcomes in the population.

Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia

BACKGROUND

Research conducted by Ward, Muller, Tsourtos, et al. (Soc Sci Med 72(7):1140-1148, 2011) has led to the development of the psycho-social interactive model of resilience, which reveals the interaction between individual resilience factors (i.e. coping, confidence and self esteem) and external resilience environments (i.e. employment, supportive family environments and health promoting policies) in facilitating the development of resilience. This present study explored the utility of this model of resilience for understanding how people self-manage type-2 diabetes.

METHODS

Data were collected via 14 semi-structured life-history interviews with women and men living with type-2 diabetes mellitus (T2DM). Participants varied according to socio-demographics (gender, age, education level, income) and were recruited based on their self-reported management (or lack thereof) of T2DM.

RESULTS

The inter-play of internal traits and external resources with additive and subtractive resilience strategies were consistent with the psycho-social interactive model of resilience. Self-management was influenced by life history. Differences in self-management and material disadvantage were also identified. Alongside increased disadvantage are higher levels of external barriers to self-management practices.

CONCLUSIONS

This paper supports the concepts of additive and subtractive resilience strategies for use with diabetes populations; providing health professionals and policy makers with an increased understanding of how to recognize and foster patient resilience for the improvement of self-care, disease management and ultimately health outcomes.