Validation of the Korean version of the Connor-Davidson Resilience Scale-2 in firefighters and rescue workers

The Impact of Depression on Bedtime Procrastination in High School Students in Pandemic era: The Mediating Roles of Conscientiousness and Emotional Stability

BACKGROUND

Bedtime procrastination is a common sleep problem that adolescents encounter. This study aimed to investigate the association between bedtime procrastination and depression in Korean high schoolers, while accounting for possible mediators including viral anxiety, resilience, and personality traits.

METHOD

A total of 300 high school students participated in the study. An online survey was conducted from October 18 to 24, 2021. The survey included the Bedtime Procrastination Scale, Patient Health Questionnaire-9 items, Stress and Anxiety to Viral Epidemics-6 items, Connor Davidson Resilience Scale 2-items, and Ten-Item Personality Inventory.

RESULTS

Bedtime procrastination was positively associated with depression (r = 0.31, p < 0.001) and negatively associated with resilience (r = -0.14, p = 0.020), extraversion (r = -0.14, p = 0.015), conscientiousness (r = -0.33, p < 0.001), and emotional stability (r = -0.30, p < 0.001). Linear regression revealed that higher levels of bedtime procrastination were significantly associated with increased depression (β = 0.21, p < 0.001) and personality traits such as lower conscientiousness (β = -0.22, p < 0.001) and lower emotional stability (β = -0.14, p = 0.022). Mediation analysis showed that depression had a direct effect on bedtime procrastination, and depression had an indirect effect on bedtime procrastination that was partially mediated by conscientiousness or emotional stability.

CONCLUSION

In Korean high school students, more bedtime procrastination shows a significant association with higher levels of depression, which is in part mediated by personality traits.

Interpersonal Factors and Resilience Mediate the Association Between Work-Related Stress in Response to a Viral Epidemic and Depression Among Healthcare Workers in the COVID-19 Pandemic

OBJECTIVE

This study aims to explore the association between work-related stress of healthcare workers in response to the coronavirus disease-2019 (COVID-19) pandemic and their depressive symptoms. Additionally, it focuses on the impact of insomnia symptoms, interpersonal factors, and resilience on depressive symptoms.

METHODS

The results of an anonymous survey of 329 healthcare workers were analyzed, including the Stress and Anxiety to Viral Epidemics-3 items, Insomnia Severity Index, Interpersonal Needs Questionnaire, Connor-Davidson Resilience Scale-2 items, and Patient Health Questionnaire-9 items. Mediation analysis assessed whether insomnia symptoms, resilience, and interpersonal factors mediate the association between work-related stress and depressive symptoms.

RESULTS

Work-related stress directly influenced depressive symptoms (standardized estimator=0.11, p=0.010, 95% confidence interval [CI] 0.03-0.19). The association between the former and latter was positively mediated by insomnia symptoms (standardized estimator=0.10, p<0.001, 95% CI 0.05-0.14), thwarted belongingness (standardized estimator=0.04, p=0.006, 95% CI 0.01-0.07), and perceived burdensomeness (standardized estimator=0.05, p=0.002, 95% CI 0.02-0.08) and was negatively mediated by resilience (standardized estimator=0.02, p=0.041, 95% CI 0.0001-0.04).

CONCLUSION

This study highlights the connection between heightened work-related stress experienced by healthcare workers amid the COVID-19 pandemic and the subsequent development of depressive symptoms mediated by insomnia, interpersonal factors, and resilience. Interventions that focus on building resilience could be pivotal in mitigating the detrimental mental health consequences of workplace stress among healthcare workers in a viral epidemic.

Connor-Davidson Resilience Scale: a systematic review psychometrics properties using the COSMIN

Background

Psychometrical evaluation of persons of diverse contexts and different populations, including general or clinical.

Objective

This review study aimed to evaluate the psychometrics quality of resilience scales.

Methods

International and Iranian databases were searched with MESH terms, including "psychometric", "validity", "reliability", "Connor-Davidson resilience scale", "Resilience scale", for published articles up to 1 February 2023. For each of the selected studies, the risk of bias was evaluated using the COSMIN Risk of Bias Checklist. Then the COSMIN checklist was used to evaluate the entire text of the article for methodological quality.

Results

Considering the inclusion criteria, 80 documents were evaluated. According to the COSMIN's criteria for evaluating the risk of bias, the current study findings revealed the included studies' limitations in assessing the three versions of CD-RISC cross-cultural and content validity as well as their stability (e.g. conducting test re-test), whereas the majority of psychometric studies of CD-RISC-25, and CD-RISC-2 rated as very good or adequate in terms of structural validity. In terms of quality assessment of the included studies, the current study indicated that investigating the structural validity of the CD-RISC was mainly done based on exploratory factor analysis (EFA), and confirmatory factor analysis was absent.

Conclusion

The general result indicates the acceptability of the quality of the studies. However, concerns for measurement properties such as responsiveness and criterion validity as well as the standard error of measurement have been neglected.

Resilience and empathy in pharmacy interns: Insights from a three-year cohort study

Background

Resilience and empathy are important attributes for healthcare professionals to navigate challenging work environments and providing patient-centred care. Knowledge about pharmacists' levels of resilience and empathy, particularly during the early stages of their careers, is limited.

Objectives

To explore pharmacy interns' levels of resilience and empathy using the Connor-Davidson-Resilience-Scale-25 (CD-RISC-25) and the Kiersma-Chen-Empathy-Scale (KCES), examine potential associations with demographic characteristics and ascertain what challenges interns' resilience and which support mechanisms they identify.

Methods

Hard copies of the surveys were distributed to three cohorts during face-to-face intern pharmacy workshops from 2020 to 2022. Additionally, a qualitative questionnaire explored interns' experiences while completing an accredited internship program during the COVID-19 pandemic. Data were analysed using descriptive and inferential statistics, open-ended questions were analysed through qualitative and quantitative content analysis.

Results

Among 134 completed surveys, most respondents were female, aged 18-22, and worked in hospitals. The CD-RISC-25 mean score was 66.6 (SD 11.7) and the KCES mean was 84.3 (SD 9.23) indicative of intermediate levels of resilience and empathy. Resilience and empathy scores did not significantly differ between the three cohorts (p-value > 0.05), and both were not consistently correlated with each other (p-value > 0.05). No significant associations were found between demographic characteristics and resilience scores. However, age and pre-internship employment history showed a statistically significant association with empathy scores (p-value < 0.05), with younger age groups and those who worked part-time during undergraduate studies demonstrating higher levels of empathy. Challenges undermining interns' resilience included the COVID-19 pandemic, internship requirements, and feelings of inadequacy and inexperience.

Conclusions

This study showed that resilience and empathy scores among interns were at what can be regarded as intermediate levels, largely unaffected by the COVID-19 pandemic or cohort demographics. It highlights professional aspects and strategies which are professionally sustaining and may assist interns in navigating challenges to their resilience and empathy.

Mediating Effect of Intolerance of Uncertainty and Cancer-Related Dysfunctional Beliefs About Sleep on Psychological Symptoms and Fear of Progression Among Cancer Patients

OBJECTIVE

This study aimed to explore the mediating effects of cancer-related dysfunctional beliefs regarding sleep and intolerance of uncertainty on the effect of depression, insomnia, and anxiety on fear of progression (FoP).

METHODS

We retrospectively reviewed medical records of patients with cancer who visited the Sleep Clinic for cancer patients in Asan Medical Center for the first time between December 2021 and March 2022. Data collected included age, sex, types of cancer, staging, current treatment modalities, and history of surgical procedures. In addition, psychological symptoms were rated using the Insomnia Severity Scale (ISI), Patient Health Questionnaire-9 items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Short form of Fear of Progression Questionnaire, Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), single item of pain and fatigue, Connor Davidson Resilience Scale 2-item (CD-RISC2), and Intolerance of Uncertainty-12 (IUS-12). The predictive variables for FoP were determined by linear regression analysis.

RESULTS

The FoP was significantly correlated with age (r=-0.289), ISI (r=0.178), PHQ-9 (r=0.703), STAI-S (r=0.377), fatigue (r=0.452), CD-RISC2 (r=-0.270), IUS-12 (r=0.585), and C-DBS (r=0.427, all p<0.01). A mediation analysis showed that intolerance of uncertainty and dysfunctional beliefs about sleep mediated the relationship of FoP with insomnia, depression, or anxiety.

CONCLUSION

Psychological support for intolerance of uncertainty and cancer-related dysfunctional beliefs about sleep in patients with cancer may be beneficial to reduce their FoP.

Mediating Effect of Viral Anxiety and Perceived Benefits of Physical Distancing on Adherence to Distancing Among High School Students Amid COVID-19

BACKGROUND

The aim of this study is to explore whether high school students' adherence to physical distancing was associated with health beliefs, social norms, and psychological factors during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Overall, 300 high school students participated in this anonymous online survey conducted from October 18-24, 2021. The survey included rating scales such as attitude toward physical distancing during the pandemic, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items, Satisfaction with Life Scale, and Connor Davidson Resilience Scale 2-items.

RESULTS

The results revealed that perceived susceptibility or severity (β = -0.13, P = 0.038), perceived benefit (β = 0.32, P < 0.001), descriptive social norms (β = 0.10, P = 0.041), social injunctive norms (β = 0.19, P < 0.001), and SAVE-6 (β = 0.24, P < 0.001) predicted students' adherence to physical distancing (adjusted R² = 0.42, F = 19.2, P < 0.001). Social injunctive norms and personal injunctive norms directly influenced adherence to physical distancing. Viral anxiety, measured by SAVE-6, mediated the association between social injunctive norms and adherence to physical distancing, and perceived benefits mediated the relationship between personal injunctive norms and adherence to physical distancing. The influence of perceived susceptibility or severity on adherence to physical distancing was entirely mediated by perceived benefits or viral anxiety.

CONCLUSION

Explaining the rationale or benefits of physical distancing may be important in increasing adherence to physical distancing among high school students.

Father Phubbing and Adolescents' Depressive Symptoms: Perceived Father Acceptance as a Mediator and Resilience as a Moderator

Prior research shows that parents' phubbing has negative impacts on children's well-being. The aim of our study was to explore the relationship between father phubbing (FPh) and adolescents' depressive symptoms, the mediating and moderating mechanisms in this relationship. That is, whether FPh would be positively related to adolescents' depressive symptoms, whether perceived father acceptance (PFA) would be a mediator between the relationship of FPh and adolescents' depressive symptoms, and whether adolescent resilience would be a moderator in the pathways of FPh on adolescents' depressive symptoms. In this study, 3,770 Chinese adolescents (M = 16.44 years, SD = 0.78) were surveyed about their demographics, FPh, depressive symptoms, PFA, and resilience through questionnaires. After controlling for demographic information, the results showed that (1) FPh was positively correlated with depressive symptoms; (2) PFA was a mediator between FPh and adolescents' depressive symptoms; (3) resilience moderated the two indirect paths that the relationships between FPh and PFA and the relationship between PFA and adolescents' depressive symptoms. Our study shows that FPh is positively correlated with adolescents' depressive symptoms, which is of great significance to the theoretical construction and intervention of adolescents' depressive symptoms in this digital era.

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic

BACKGROUND

This study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields.

RESULTS

Married, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic.

CONCLUSION

It is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.

Posttraumatic stress disorder symptoms and neurocognitive functioning in fire fighters: The mediating role of sleep problems and resilience

BACKGROUND

Firefighters are often exposed to terrible and dangerous scenes due to their duties, and thus have a high risk of developing posttraumatic stress disorder(PTSD). The purpose of the study is to examine the relationship between PTSD symptoms, sleep problems, resilience and neurocognitive functioning of firefighters, and to identify the sequential mediating effects of sleep problems and resilience on the relationship between PTSD symptoms and neurocognitive functioning (especially psychomotor speed and processing speed).

METHODS

Data were collected from 325 firefighters in eight fire departments in four regions of Korea. Subjects performed neurocognitive function tests and completed the following questionnaires: Primary Care PTSD Screening, Pittsburgh Sleep Quality Index-K and Connor-Davidson Resilience Scale-2. The correlation and dual mediation effects were analysed using SPSS 22.0 program and PROCESS macro 3.4 program.

RESULTS

PTSD symptoms, neurocognitive functioning, sleep problems and resilience were significantly correlated with each other. In the sequential mediation model, the relationship between PTSD and psychomotor speed/processing speed was sequentially mediated by sleep problems and resilience after adjusting for demographic variables.

CONCLUSIONS

The PTSD symptoms of firefighters were related to a sequential link between sleep problems, low resilience and decreased neurocognitive function. These findings could serve as a basis for more effective and integrated interventional strategies for facilitating better neurocognitive functioning in firefighters.

Identifying Patient Strengths Instruments and Examining Their Relevance for Chronic Disease Management: A Systematic Review

INTRODUCTION

Most health care focuses on patients' deficits to encourage behavior change. A strengths-based approach, which relies on identifying patient strengths, has great potential to facilitate behavior change for chronic disease management. Little is known about instruments used to assess patient strengths. We conducted a systematic review to identify validated instruments that assess personal strengths by using a theory elaboration approach.

METHODS

We searched 8 databases including Web of Science, Cumulative Index of Nursing and Allied Health (CINAHL), and PsycINFO (through July 2019) to identify peer reviewed, English-language studies that described strength-based instruments. Thereafter, we evaluated the validity and reliability of the instruments according to 18 Scientific Advisory Committee of the Medical Outcome Trust (SACMOT) criteria, and used an inductive, iterative editing process to identify constructs measured by the instruments.

RESULTS

We identified 26 instruments that met our inclusion criteria. The instruments were validated in various clinical and nonclinical populations. Only 4 instruments met most of the SACMOT criteria for validation. We extracted 91 unique constructs that fell into 3 domains: inner strengths (49), external strengths (13), and personality constructs (29).

CONCLUSION

A limited number of reliable and valid instruments are available to assess strengths for the adult population, particularly for clinical populations. Internal strengths can be leveraged to improve patient health; however, the development and validation of additional instruments to capture personal strengths is necessary to examine the multilevel influence of external strengths on individual behaviors and well-being.

Psychometric properties of two abbreviated Connor-Davidson Resilience scales in Chinese infertile couples

PURPOSE

This study aimed to evaluate the psychometric properties of the 10-item and 2-item Connor-Davidson Resilience Scale (CD-RISC), the agreement between these two versions, and the measurement invariance of the CD-RISC-10 across genders in Chinese infertile couples.

METHODS

A total of 170 infertile couples were enrolled from an infertility outpatient clinic between September 2019 and January 2020. The CD-RISC scores were tested for floor and ceiling effects. Reliability was evaluated by calculating Cronbach's α. Convergent and divergent validity were assessed by bivariate correlations between resilience and infertility-related stress, depression, anxiety, and two divergent variables. Agreement between the two versions was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. A multiple-group confirmatory factor analysis (CFA) was conducted to assess the measurement equivalence of CD-RISC-10 across genders.

RESULTS

No floor or ceiling effects were observed. Internal consistencies of CD-RISC-10 and CD-RISC-2 were 0.91 and 0.63, respectively. The CFA analysis indicated an excellent model fit for a one-factor structure of CD-RISC-10 (TLI > 0.950, CFI > 0.950, RMSEA < 0.060). Both scales displayed good convergent and divergent validity, and the agreement between them was significant with an ICC of 0.80 (95% CI ranging from 0.76 to 0.84). Measurement invariance across genders was supported by multigroup CFA, and a higher level of resilience was found in men than in women.

CONCLUSION

Our findings showed significant reliability, validity, and stability of CD-RISC-10 and acceptable internal consistency and validity of CD-RISC-2. CD-RISC-10 is recommended as a resilience measure in clinical evaluations of infertile patients.

Can Resilience be Measured and Used to Predict Mental Health Symptomology Among First Responders Exposed to Repeated Trauma?

OBJECTIVES

To examine whether baseline measures of resilience among active first responders predicts future mental health symptomology following trauma exposure.

METHODS

Multivariate linear regression examined the associations between baseline resilience and future mental health symptomatology following repeated trauma exposure. Symptomatology at 6-month follow-up was the dependent variable.

RESULTS

The associations between baseline resilience and future posttraumatic stress disorder (PTSD) (P = 0.02) and depression (P = 0.03) symptoms were statistically significant. Those reporting higher resilience levels had lower symptomology at 6-month follow-up. Eighty percent of first-responders who screened positive for low resilience went on to develop more PTSD symptoms.

CONCLUSIONS

Examining resilience may serve as a more effective means of screening, given resilience is a malleable construct which can be enhanced via targeted interventions. Higher levels of resilience may protect the long-term mental health of first-responders, particularly in regard to future PTSD.

Correlates of mental health in occupations at risk for traumatization: a cross-sectional study

BACKGROUND

Hospitals, police stations, and fire departments are highly demanding workplaces. Staff members are regularly exposed to various stressors including traumatic events. Correspondingly, several studies report high rates of mental health issues among these occupations. Nevertheless, despite these challenging circumstances, some staff members manage to sustain their mental health. The current study is the first to investigate three health-promoting factors simultaneously among three different, highly demanding occupations.

METHODS

The present cross-sectional survey investigated health-promoting factors (sense of coherence - SOC, trait-resilience, locus of control - LOC) and mental health outcomes (general psychopathological symptom burden, posttraumatic stress, burnout) in medical staff (n = 223), police officers (n = 257), and firefighters (n = 100).

RESULTS

Among all occupations, SOC, trait-resilience, and an internal LOC were negatively associated with general psychopathological symptoms, posttraumatic stress, and burnout symptoms. By contrast, all these outcome measures were positively correlated with an external LOC. Multiple regression models including all health-promoting factors explained 56% of the variance in general psychopathological symptoms and 27% in posttraumatic stress symptoms. Among all occupations, SOC was the strongest predictor of both general psychopathological symptom burden and posttraumatic stress symptoms. Multigroup path analyses revealed minor differences across occupations, mainly driven by a stronger influence of LOC in police officers.

CONCLUSION

Across all occupations, SOC was identified as the most important health-promoting factor. Future longitudinal studies should further examine the causal link between health-promoting factors and mental distress in different workplaces. Such studies will also allow for further development and evaluation of resilience promoting programs.

Correlates of resilience after childhood sexual abuse among men who have sex with men

Men who have sex with men (MSM) are at high risk for physical and mental health conditions and are often discussed in the health literature as "at risk" versus "at promise". However, there is an ongoing need to examine factors that place MSM "at promise" for optimal well-being. This manuscript examines correlates of resilience, the ability to "bounce back" and function adaptively after adversities, among MSM. One hundred and five MSM with a history of childhood sexual abuse, who were enrolled in a randomized control trial were recruited for a supplemental study assessing resilience and other psychosocial factors. Participants completed measures assessing resilient trait and coping (i.e. "I am able to adapt" and "I tend to bounce back"), symptoms of trauma, trauma-related thoughts, and distress tolerance (ability to regulate unpleasant feelings). Findings from multivariable linear regressions controlling for covariates (age, education, race/ethnicity, and income) indicated that higher resilience was associated with (a) lower trauma scores on reexperiencing severity (b = -1.41, SE = .53, p = .01) and avoidance severity (b = -1.61, SE= .67, p = .02), (b) lower post-traumatic cognitions (b = -11.39, SE = 5.08, p = .03) especially negative cognitions about the self (b = -.44, SE = .16, p = .007), and (c) higher distress tolerance (b = .26, SE = .10, p = .01). Our preliminary findings suggest that resilient coping/traits are important to research after childhood sexual abuse among MSM, potentially assess in clinical settings, and address in interventions.

Participation to Leisure Activities and Well-Being in a Group of Residents of Naples-Italy: The Role of Resilience

We explored the relationship between cultural and social participation, physical activity, and well-being in a group of residents of the metropolitan area of Naples, Italy and the role that resilience plays in this relationship. Naples offers a remarkable urban environment with the potentially beneficial psychological effects of outstanding natural beauty, and one of the world’s most impressive repositories of tangible and intangible cultural heritage. However, Naples was also, and still is, heavily affected by the 2008 economic crisis, in addition to preexisting social and economic issues. The major finding of this study is that, despite this highly contrasting urban environment, the combination of physical activity and engagement in social and cultural activities has a positive effect on subjective (self-reported) psychological well-being (SPWB) in a group of residents, and that resilience mediates this relationship.

Factors on the Pathway from Trauma to Suicidal Ideation in Adolescents

Objectives:

Suicide is the most frequent cause of death among Korean adolescents, and adolescents who have experienced trauma have an increased risk of post-traumatic stress disorder (PTSD) symptoms, depression, and suicide attempts. However, resilience and self-esteem are protective factors. We examined the effects of resilience and self-esteem on the relationship among traumatic experiences, PTSD symptoms, depression, and suicidal ideation.

Methods:

-school students (n=403) completed questionnaires assessing traumatic experiences, PTSD symptoms, depression, suicidal ideation, resilience, and self-esteem. Path analysis was performed to investigate the mediating effects of PTSD symptoms, resilience, self-esteem, and depression on the relationship between trauma exposure and suicidal ideation.

Results:

Traumatic experience was positively correlated with PTSD symptoms, depression, and suicidal ideation. PTSD symptoms and depression were positively correlated with suicidal ideation. The relationship between traumatic experiences and suicidal ideation was mediated by PTSD symptoms, which had both direct and indirect effects on suicidal ideation; the indirect effect was mediated by resilience, self-esteem, and depression.

Conclusion:

Korean adolescents who had experienced trauma were more likely to develop PTSD symptoms, increasing their risk of depression and suicidal ideation. However, self-esteem and resilience may help protect against depression and suicidal ideation. Our findings could inform suicide prevention initiatives.

Validity and reliability of the ten-item Connor-Davidson Resilience Scale (CD-RISC10) instrument in patients with axial spondyloarthritis (axSpA) in Singapore

We aimed to assess the validity and reliability of the ten-item Connor-Davidson Resilience Scale (CD-RISC10) in patients with axial spondyloarthritis (axSpA) in Singapore. We used cross-sectional data from 108 patients with axSpA recruited from a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2017 to 2018. Analyses were guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework. Face validity was assessed through cognitive debriefing interviews (CDIs). Internal consistency was assessed through Cronbach's alpha. Test-retest reliability was assessed through intraclass correlation (ICC). Measurement error was assessed through smallest detectable change (SDC). Construct validity was assessed through six a priori hypotheses through correlation of the CD-RISC10 score with other patient-reported outcome measures. Structural validity was assessed using confirmatory factor analysis (CFA). Fit indices evaluated were root-mean-square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TFI), and standardized root-mean-squared residual (SRMR). Ten patients completed the CDIs and face validity was supported. Among 108 patients (median age: 37(21-77), 81.5% males, 93.5% Chinese), the CD-RISC10 demonstrated good internal consistency (Cronbach's alpha = 0.94), and excellent test-retest reliability [ICC = 0.964 (95% CI 0.937-0.980)]. SDC was calculated as 1.88. Construct validity was established by meeting five out of the six a priori hypotheses. Structural validity was supported as CFA confirmed a one-factor model, with adequate fit statistics after adding three covariances (RMSEA = 0.077; CFI = 0.975; TLI = 0.964; SRMR = 0.036). This study supports the CD-RISC10 as a valid and reliable measure of resilience for use in patients with axSpA.

Socioeconomic factors, psychological factors, and function in adults with chronic musculoskeletal pain from rural Nepal

Background

Both socioeconomic and psychological factors have been shown to predict patient function in samples of individuals with chronic pain in Western countries. However, little is known about their role as predictors of function in individuals with chronic pain from developing countries.

Purpose

The purpose of this study was to examine the associations between measures of socioeconomic factors (income, education) and psychological factors (catastrophizing and resilience) and measures of function in a sample of individuals with chronic pain from rural Nepal. In addition, we sought to evaluate the moderating effects of socioeconomic factors on the associations between the psychological variables and function.

Methods

We interviewed 143 adults with chronic musculoskeletal pain from rural areas of Nepal to assess income, education level, pain intensity, catastrophizing, resilience, physical function, and depression. We performed two regression analyses to evaluate the direct and unique effects of the socioeconomic and psychological variables and pain intensity as predictors of patient function, as well as the moderating influence of income, education level, and pain intensity on the associations between the psychological variables and function.

Results

Education and income both predicted physical function, but only income predicted depression. In addition, pain catastrophizing, but not resilience, evidenced a direct and significant independent association with depression. Neither catastrophizing nor resilience made independent and significant direct contributions to the prediction of physical function. The association between resilience and physical function was moderated by pain intensity and income, and income (but not education or pain intensity) moderated the associations between both 1) resilience and depression and 2) catastrophizing and depression.

Conclusion

The results suggest the possibility that cultural differences may influence the role that psychosocial factors play in chronic pain adjustment. These findings have important implications regarding how psychosocial pain interventions should be adapted by individuals in developing countries.

Measurement properties of the Nepali version of the Connor Davidson resilience scales in individuals with chronic pain

BACKGROUND

Resilience is an individual's ability to recover or "bounce back" from stressful events. It is commonly identified as a protective factor against psychological dysfunctions in wide range of clinical conditions including chronic pain. Resilience is commonly assessed using the Connor Davidson Resilience Scale (CD-RISC). Translation and cross-cultural adaptation of the CD-RISC into Nepali will allow for a deeper understanding of resilience as an important domain in health in Nepal, and will allow for cross-cultural comparison with other cultures. Therefore, the aims of the study were to translate and culturally adapt 10- and 2-item versions of the CD-RISC into Nepali and evaluate their psychometric properties.

METHODS

After translating the measures, we performed exploratory and confirmatory factor analyses of the 10-item version in two independent samples (ns = 131 and 134) of individuals with chronic pain. We then evaluated the internal consistency, test-retest stability, and construct validity of the 10- and 2-item measures in these samples. We also evaluated the internal consistency, and the construct and concurrent validity of the 2-item version in an additional sample of 140 individuals.

RESULTS

The results supported a single factor model for the 10-item measure; this measure also evidenced good to excellent internal consistency and excellent test-retest stability. Construct validity was supported via moderate associations with pain catastrophizing. The internal consistency of 2-item version was marginal, although construct validity was supported via weak to moderate associations with measures of pain catastrophizing, depression and anxiety, and concurrent validity was supported by strong association with the 10-item CD-RISC scale.

CONCLUSION

The findings support the reliability and validity of the 10-item Nepali version of the CD-RISC, and use of the 2-item version in survey studies in individuals with chronic pain. The availability of these translated measures will allow for cross-cultural comparisons of resilience in samples of individuals with chronic pain.

Validation of the Center for Epidemiological Studies Depression Scale among Korean Adolescents

OBJECTIVE

The Center for Epidemiological Studies Depression Scale (CES-D) is designed to measure the current level of depressive symptomatology in the general population. However, no review has examined whether the scale is reliable and valid among children and adolescents in Korea. The purpose of this study was to test whether the Korean form of the CES-D is valid in adolescents.

METHODS

Data were obtained from 1,884 adolescents attending grades 1-3 in Korean middle schools. Reliability was evaluated by internal consistency (Cronbach's alpha). Concurrent validity was evaluated by a correlation analysis between the CES-D and other scales. Construct validity was evaluated by exploratory factor and confirmatory factor analyses.

RESULTS

The internal consistency coefficient for the entire group was 0.88. The CES-D was positively correlated with scales that measure negative psychological constructs, such as the State Anxiety Inventory for Children, the Korean Social Anxiety Scale for Children and Adolescents, and the Reynold Suicidal Ideation Questionnaire, but it was negatively correlated with scales that measure positive psychological constructs, such as the Korean version of the Rosenberg Self-Esteem Scale and the Connor-Davidson Resilience Scale-2. The CES-D was examined by three-dimensional exploratory factor analysis, and the three-factor structure of the scale explained 53.165% of the total variance. The variance explained by factor I was 24.836%, that explained by factor II was 15.988%, and that explained by factor III was 12.341%. The construct validity of the CES-D was tested by confirmatory factor analysis, and we applied the entire group's data using a three-factor hierarchical model. The fit index showed a level similar to those of other countries' adolescent samples.

CONCLUSION

The CES-D has high internal consistency and addresses psychological constructs similar to those addressed by other scales. The CES-D showed a three-factor structure in an exploratory factor analysis. The present findings suggest that the CES-D is a useful and reliable tool for measuring depression in Korean adolescents.