A resilience framework for promoting stable remission from depression

Components of hot and cold executive functions and their relations to different forms of stress resilience: A systematic review

Increasing evidence points out that Executive Functions (i.e., EFs) may be core mechanisms for the generation of resilient responses to adversity. A systematic review testing the relations between either affective (hot) and/or non-affective (cold) EFs (i.e., inhibition, flexibility and working memory updating) and resilience was conducted. A total of 449 articles were initially identified. After two steps of title-and-abstract (k = 449), and full-text reading filtering (k = 67), 11 studies were reviewed. Three studies included cold measures of working memory and supported significant positive relations between higher working memory functioning and higher trait resilience levels. One study included cold measures of inhibition and another one both hot and cold measures, with only the first one supporting a positive relation between more efficient inhibition and higher trait resilience levels. Finally, 7 studies measured flexibility in its cold and/or hot dimensions and overall supported significant relations between higher flexibility and higher levels of trait, process and outcome resilience measures. These results support the role of EFs performance to promote different forms of resilience. This review allows to identify different issues that need to be addressed in future research and highlight the need to integrate the analysis of all hot and cold EFs components to understand their role in the generation of resilience.

The correlation between social adaptability and academic procrastination of undergraduate nursing students: the mediating role of resilience

BACKGROUND

How to mobilize nurses students' learning initiative, reduce the incidence of academic procrastination, and improve their social adaptability is a key factor in lowering nursing brain drain and improving nursing quality.

OBJECTIVE

To explore the mediating role of resilience in the correlation between social adaptability and academic procrastination of undergraduate nursing students.

METHODS

This study is a cross-sectional survey. The researchers conducted an electronic questionnaire survey of 962 nursing undergraduates in Guanzhong District, Shaanxi Province from November 2022 to April 2023, and adopted the intention sampling method. And make the following assumptions: (1) There is a significant negative correlation between academic procrastination and social adaptability. (2) Academic procrastination can directly affect the social adaptability of undergraduate nursing students, and it has a significant negative predictive effect. (3) Resilience can directly affect academic procrastination and social adaptability. At the same time, resilience plays an intermediary role between the two. In this study, the Aitken procrastination scale, the resilience scale, and the social adaptability diagnostic scale were used to evaluate undergraduate nursing students. SPSS27.0 software is used to analyze the data statistically, and the Hayes PROCESS Macro method is used to test the model.

RESULTS

The study's findings are as follows: 1) Academic procrastination significantly and negatively impacts social adaptability (c = -0.292, t = -6.407, p < 0.001). 2) Even when accounting for resilience, academic procrastination still significantly predicts lower social adaptability (c'= -0.204, t = -4.338, p < 0.001). 3) The Bootstrap method test of percentile bias correction indicates that resilience serves as a significant mediator between academic procrastination and social adaptability. Bootstrap SE = 0.018, 95% CI = (-0.124, -0.055). The indirect effect contributes to 29.79% of the total effect.

CONCLUSION

Resilience not only directly affects the academic procrastination and social adaptability of nursing students, but also partially intermediate the relationship between academic procrastination and social adaptability.

Measurement of Psychological Resilience to Support Therapy Interventions for Clients in the Clinical Mental Healthcare Setting: A Scoping Review

Waves of psychological research over 50 years have resulted in the development of scales to measure psychological resilience. Multiple psychological resilience definitions and factors have emerged during this time, making its measurement complex. The overall aim of the review was to identify and describe developments in the measurement of psychological resilience in the clinical mental healthcare setting. Specific objectives included (1) consideration of the validity and reliability of psychological resilience scales, (2) the effectiveness of the scales in clinical mental healthcare settings and (3) to identify the scope that resilience factors are addressed in the included scales. It provides a timely update regarding psychological resilience measurement tools and considers further developments that may be required. Between 2011 and 2024, databases were searched, and English-language, peer-reviewed papers with full text were extracted. Eligible studies were those reporting validated existing resilience measures or the outcomes of new measures for use in clinical mental healthcare settings. Seventeen studies met the inclusion criteria. The review demonstrated that psychological resilience measures require further development, particularly focusing on the utility of measurement tools in clinical mental healthcare settings. In this review, we highlight an existing gap in resilience measurement and underscore the need for a new measure of psychological resilience that can effectively assess individuals' subjective experience of their psychological resilience in clinical mental healthcare settings. The currently available psychological resilience measures included in this review do not directly reflect all the factors that might impact a client's depression or anxiety and warrant further research.

Psychological readiness of football players for the match and its connection with self-esteem and competitive anxiety

For athletes, failure in a match is psychologically difficult. Since the movement abilities of athletes are often comparable, it is assumed that one of the key elements of victory is also their psychological readiness. Many experts recommend rigorously examining all factors affecting the performance of football players, especially in matches. The aim of our study is to determine whether a football player's coping with adversity, coachability, motivation to succeed, goal setting, peaking under pressure, or fear of failure are significantly predicted by their self-esteem or a specific aspect of competitive anxiety, which can be crucial for the direction of psychological preparation in collective sports. The research sample consisted of 107 male football players in the age range of 18-29 years registered with the Slovak Football Association, who actively participated in the team's matches. Football players filled out a booklet of psychological tests, including the Athletic Coping Skills Inventory, the Sport Anxiety Scale, and the Rosenberg Self-Esteem Scale. The results of the regression analysis showed that the self-esteem of football players is a significant predictor of achievement motivation and their ability to listen to the coach's instructions. Along with the somatic component of anxiety, it also predicts goal-setting. Cognitive anxiety of football players, characterized by negative thoughts, turned out to be a significant predictor of coping with adversity during a football match and their peaking under pressure, and together with concentration disruption, it also predicts the ability of football players to free themselves from worries about what the audience thinks about their sporting performance in the match.

Exploratory Clinical Trial of a Depression Diagnostic Software That Integrates Stress Biomarkers and Composite Psychometrics

OBJECTIVE

This study evaluated the clinical effectiveness of Minds.NAVI, a depression screening kit combining psychometric measures and stress hormone biomarkers, in a prospective clinical trial. The objective was to assess its potential as a depression screening tool and investigate the associations between psychological assessments, salivary hormone staging, and depression severity.

METHODS

Thirty-five participants with major depressive disorder and 12 healthy controls (HCs) were included. The Minds.NAVI software, utilizing the PROtective and Vulnerable factors battEry Test (PROVE) and salivary cortisol/dehydroepiandrosterone (DHEA) analysis, was employed. The PROVE test is a comprehensive self-report questionnaire that assesses depressive symptoms, suicide risk, attachment style, adverse childhood experiences, mentalization capacity, and resilience. In addition, salivary cortisol and DHEA levels were measured to evaluate the functional stage of the hypothalamic-pituitary-adrenal (HPA) axis.

RESULTS

Minds.NAVI exhibited 100% sensitivity, 91.7% specificity, and 97.9% accuracy in distinguishing depression from HCs within an exploratory small group. Salivary stress hormone phases showed changes with depression stage (p=0.030), and the proportion of patients with "adrenal exhaustion stage" was higher in the moderate/severe depression group (p=0.038). Protective/vulnerable factors differed significantly between controls and depressed groups (p<0.001). Cortisol awakening response inversely correlated with depressive symptom severity (r=-0.31, p=0.034).

CONCLUSION

This study suggested possible clinical effectiveness of Minds.NAVI, a depression screening tool that integrates psychometric measures and stress hormone biomarkers. The findings support the potential association between depression, chronic stress, and HPA axis hyporesponsiveness.

A Supported Online Resilience-Enhancing Intervention for Pregnant Women: A Non-Randomized Pilot Study

A 28-week supported online intervention for pregnant women, informed by the Behavior Change Wheel Framework, was developed. The intervention included exercises, group sessions and a peer support platform. The aim of this study was to examine the potential effectiveness of the intervention in enhancing resilience and promoting maternal mental health. Using a quasi-experimental design, assessments were conducted at baseline, postintervention and follow-ups at six and 12 months after childbirth. Resilience, resilience attributes, and maternal mental health were measured using standardised scales. The intervention group received the intervention (N = 70), while the control group (N = 32) received care-as-usual. A repeated-measures ANOVA was used to determine within- and between-group changes. Results showed no significant differences between groups regarding resilience and maternal mental health. However, the intervention group demonstrated stable resilience (p = 0.320) compared to a significant decrease in the control group (p = 0.004). Within the intervention group, perceived social support remained stable during the intervention, but decreased significantly at the first follow-up (p = 0.012). All participants faced additional stress from the COVID-19 pandemic alongside the challenges of parenthood. This study contributes to maternal mental health literature with an innovative, supported online intervention. The intervention consists of different deployable components, designed to be offered online, and the current pilot data are promising. Further research is warranted to explore its full potential in clinical practice.

Longitudinal Analysis of the Relationship Between Internalized HIV Stigma, Perceived Social Support, Resilience, and Depressive Symptoms Among People Living with HIV in China: A Four-Wave Model

Depression is one of the most common mental health problems among people living with HIV (PLWH). However, the longitudinal psychological mechanism underlying the link of internalized HIV stigma and depressive symptoms remains a research gap. This study attempted to articulate how and to what extent perceived social support and resilience mediate the longitudinal associations between internalized HIV stigma and depressive symptoms. A sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval and four waves of follow-up was used in the current study. Participants were asked to complete self-report questionnaires. The associations among main study variables were examined via a complete longitudinal mediation approach. Results indicated that the linkage between internalized HIV stigma at T1 and depressive symptoms at T4 was serially mediated by perceived social support at T2 and resilience at T3, and perceived social support at T2 and depressive symptoms at T3 serially mediated the relationship between resilience at T1 and internalized HIV stigma at T4. Depressive symptoms at a previous time point consistently predicted the levels of internalized HIV stigma at subsequent time points. The study highlights the complex interplay between internalized HIV stigma, mental health problems, and protective factors in a longitudinal context. The findings suggest the need to incorporate interventions aimed at enhancing social support and resilience in mental health programs for PLWH, as these factors may interrupt the pathway from internalized HIV stigma to depressive symptoms and potentially improve the overall psychological well-being of this population.

Links between mental health problems and future thinking from the perspective of adolescents with experience of depression and anxiety: a qualitative study

BACKGROUND

Depression and anxiety are common during adolescence and could have detrimental impacts on young people's ability to make and implement plans for their future. However, to the best of our knowledge, no other study has adopted a qualitative approach in investigating these effects from the perspective of adolescents with lived experiences of depression and anxiety. We sought to understand how young people perceive and interpret the impact of mental health conditions on their thinking about the future.

METHODS

We conducted semi-structured interviews with 19 adolescents aged 16-19 years in the UK (median age = 19, IQR = 1.5), who had a history of protracted periods of clinical or subclinical depression and/or anxiety. They were asked to reflect on how their ability to think about the future and the content of the future-related thinking was impacted during periods of poor mental health, compared with periods of feeling well. Interviews were transcribed verbatim and subjected to thematic content analysis.

RESULTS

Five domains were identified. First, the impact of mood on future thinking capability focuses on reduced ability and motivation to engage in future thinking. Second, the impact of mood on images, thoughts, and feelings about the future includes the emotional valence of future-related thoughts, their vividness, structure, and the extent to which they intimated subjective feelings of control (i.e., agency). Third, social influences focuses on social factors that might ameliorate or exacerbate future thinking. Fourth, reflections on personal worries and expectations about the future captures personal interpretations of past worries and hopes and how future thinking affected mood. Finally, personal coping refers to how young people cope with the negative emotions that come with future thinking.

CONCLUSIONS

This study provided a nuanced and granular account of how depression and anxiety impacted young people's future thinking based on their lived experiences. By highlighting the different ways that variations in future thinking were experienced as a function of depression and anxiety, our analysis highlighted new factors that should be considered in studies of adolescent mental health risk, which could inform the development of new therapeutic approaches.

Neurobiological correlates of resilience during childhood and adolescence - A systematic review

Research examining the neurobiological mechanisms of resilience has grown rapidly over the past decade. However, there is vast heterogeneity in research study design, methods, and in how resilience is operationalized, making it difficult to gauge what we currently know about resilience biomarkers. This preregistered systematic review aimed to review and synthesize the extant literature to identify neurobiological correlates of resilience to adversity during childhood and adolescence. Literature searches on MEDLINE and PsycINFO yielded 3834 studies and a total of 49 studies were included in the final review. Findings were synthesized based on how resilience was conceptualized (e.g., absence of psychopathology, trait resilience), and where relevant, the type of outcome examined (e.g., internalizing symptoms, post-traumatic stress disorder). Our synthesis showed that findings were generally mixed. Nevertheless, some consistent findings suggest that resilience neural mechanisms may involve prefrontal and subcortical regions structure/activity, as well as connectivity between these regions. Given substantial heterogeneity in the definition and operationalization of resilience, more methodological consistency across studies is required for advancing knowledge in this field.

Resilience in Mild Cognitive Impairment (MCI): Examining the Level and the Associations of Resilience with Subjective Wellbeing and Negative Affect in Early and Late-Stage MCI

The current study examines the relationship between the cognitive state of participants [healthy-early mild cognitive impairment (MCI)-late MCI], some subjective wellbeing factors (positive emotions, engagement, positive relationships, meaning in life, accomplishment, and negative emotions), and negative psychological outcomes (depression, anxiety, stress), as well as psychological resilience. We expected that people with advanced MCI would perceive increased negative psychological outcomes, poorer psychological resilience, and lower levels of subjective wellbeing in contrast to early MCI and healthy participants. The study involved 30 healthy, 31 early, and 28 late MCI individuals. A series of questionnaires have been applied to assess the aforementioned constructs. To examine the hypotheses of the study, path analysis (EQS program) was applied. Results showed that early MCI persons maintain the same levels of positive emotions and feelings of accomplishment with healthy peers. Late-stage patients present those feelings in a diminished form, which adversely impacts psychological resilience. Individuals with early and late MCI exhibit negative emotions and stress that impact their resilience; however, those with early MCI experience greater stress, negative emotions, depression, and anxiety. These findings may be utilized to design psychological interventions for resilience enhancement and support brain health in elderly adults who are at risk of neurodegeneration.

Memory biases in Alzheimer's disease and mild cognitive impairment. A systematic review and metanalysis

Several studies demonstrated that individuals are more likely to remember emotional than neutral information; this phenomenon is known as emotional enhancement of memory (EEM). Adults generally tend to remember negative information more efficiently than neutral or positive items. In contrast, healthy elders seem to show an opposite bias for positive information, but results are inconsistent, also because during aging, elaboration of emotional information could change as a consequence of cognitive impairment. In this systematic review and meta-analysis, we conducted literature search of studies investigating emotion memory biases in mild cognitive impairment (MCI) and Alzheimer's disease (AD) on PubMed, Scopus and PsycINFO databases following PRISMA guidelines. The findings showed that emotional memory biases are still present despite the presence of cognitive impairment, both in MCI and at least in early stages of AD. However, the direction of emotion memory biases is not consistent across studies. These results suggest that patients with cognitive impairment might still benefit from EEM and help to define targets of intervention for cognitive rehabilitation in pathological aging.

Stress, mental health and sociocultural adjustment in third culture kids: exploring the mediating roles of resilience and family functioning

Introduction

This cross-sectional study explores the contributions of personal and contextual factors in the adjustment process of a sample of internationally mobile children and adolescents having relocated to Switzerland. Based on evolutionary developmental theories and recommendations by Research Domain Criteria and The Hierarchical Taxonomy of Psychopathology theoretical frameworks, we hypothesized and tested a heuristic model of TCK adjustment, aiming to identify prevention and treatment targets tailored for our sampled population.

Methods

We assessed the relationships in the hypothesized models, particularly how perceived and acculturative stress influence TCK adjustment and whether the relationship between the predictors of TCK stress and the outcomes of TCK adjustment are mediated by resilience and family functioning. A total of 143 participants aged 7-17, having relocated internationally with their working parent(s), recruited in local and international schools in Switzerland, were included in this study. Data were collected using an online survey after we collected consent. We assessed factors of adjustment using validated questionnaires: perceived stress and acculturative stress and the potential mediating roles of family functioning and resilience. We measured the outcome of adjustment through mental health difficulties and sociocultural adjustment. We used path analysis to test the model.

Results

Results highlight the contributions of perceived stress and acculturative stress to TCK mental health and sociocultural adjustment. We also we found a mediation effect for resilience in the relationship between perceived stress and mental health. Family functioning was not a significant mediator in any relationship that we assessed.

Discussion

We discuss implications for future research, promoting TCK adjustment and preventative psychotherapeutic interventions.

Resilience as the Ability to Maintain Well-Being: An Allostatic Active Inference Model

Resilience is often characterized as the outcome of well-being maintenance despite threats to that well-being. We suggest that resilience can also be characterized as an emotional-intelligence-related ability to obtain this outcome. We formulate an allostatic active inference model that outlines the primary tools of this resilience ability as monitoring well-being, maintaining stable well-being beliefs while updating situational beliefs and flexibly prioritizing actions that are expected to lead to well-being maintenance or gathering the information needed to discern what those actions could be. This model helps to explain the role of positive emotions in resilience as well as how people high in resilience ability use regulatory flexibility in the service of maintaining well-being and provides a starting point for assessing resilience as an ability.

Functional neuroimaging of resilience to trauma: convergent evidence and challenges for future research

Resilience is broadly defined as the ability to adapt successfully following stressful life events. Here, we review functional MRI studies that investigated key psychological factors that have been consistently linked to resilience to severe adversity and trauma exposure. These domains include emotion regulation (including cognitive reappraisal), reward responsivity, and cognitive control. Further, we briefly review functional imaging evidence related to emerging areas of study that may potentially facilitate resilience: namely social cognition, active coping, and successful fear extinction. Finally, we also touch upon ongoing issues in neuroimaging study design that will need to be addressed to enable us to harness insight from such studies to improve treatments for - or, ideally, guard against the development of - debilitating post-traumatic stress syndromes.

Moderating Impact of Dispositional Mindfulness in the Relationship Between Future Expectancies and Psychological Well-Being

OBJECTIVES

Mindfulness has been studied under cultivated or dispositional divisions where the latter has strong implications for psychological well-being in meditators and non-meditators alike. In addition, future expectations, or prospections, regarding the occurrence of important events in a person's future have recently been hypothesized to be the main cause behind symptoms of major depression. There is, however, a lack of empirical research looking at possible links between dispositional mindfulness, as understood in its facet structure, and future expectations as understood via perceived risk of occurrence and vividness of mental imagery when prompted to imagine a given list of positive and negative prospective event item lists. Therefore, this research aimed at examining how dispositional mindfulness may be related to probabilistic risk assessments of positive and negative future events (Stage I); and how mental imagery vividness may be moderated by mindfulness facets (Stage II).

METHODS

Both stages included healthy participants and incorporated the PROCESS macro for moderated regression analysis done with the SPSS software. Stage I included 204 voluntary college students, and Stage II was conducted online with a public sample of 110 adults.

RESULTS

Although no interaction effect was found in Stage I, nonreactivity to inner experience facet of dispositional mindfulness moderated the relationship between negative imagery vividness and psychological distress in Stage II (F_(1,103) = 4.00, R² change=.018, p <.05).

CONCLUSIONS

This is a novel finding that could inform a future line of research looking into the relationship between prospection and mindfulness, holding a potential for informing research on mindfulness-based interventions.

Effects of treatment contents on changes in resilience among workers with mood or anxiety disorders: A 3-month longitudinal study

Aim

The aim of this study was to identify factors that influence changes in resilience among workers with mental health disorders, leading to effective treatment and support.

Methods

Among the new patients at an institution, 81 who were working and had the ICD-10 diagnoses F3 and F4 were included. Resilience was measured at the initial visit and 3 months later using the S-H resilience test. Univariate and multiple regression analyses were conducted using the change in resilience between the two measurements as the objective variable, and treatment and attendance at work as explanatory variables.

Results

There were no significant differences in resilience abilities between pre- and postmeasurement for the subjects as a whole. However, tests for the subgroups of diagnostic category, attendance at work, and treatment showed that resilience improved significantly in the mood disorder group, the leaving employment group, and the group receiving additional treatment. The results of the multiple regression analysis showed that treatment type (with or without additional treatment) had an effect on the degree of change in resilience, and among these "inpatient treatment" and "re-work program" were suggested to have an effect.

Conclusion

The resilience of workers with mental health disorders was found to improve even after only 3 months of treatment, depending on the content of the treatment. We believe the significance of this study is the quantitative indication of the transition of resilience, which has not been made concrete until now.

Resilience to depression: Implication for psychological vaccination

From the vulnerability perspective, we often ask the question "why someone suffers from depression?" Despite outstanding achievements along this line, we still face high occurrence or recurrence and unsatisfied therapeutic efficacy of depression, suggesting that solely focusing on vulnerability perspective is insufficient to prevent and cure depression. Importantly, although experiencing same adversity, most people do not suffer from depression but manifest certain resilience, which could be used to prevent and cure depression, however, the systematic review is still lack. Here, we propose the concept "resilience to depression" to emphasize resilient diathesis against depression, by asking the question "why someone is exempted from depression?" Research evidence of resilience to depression has been reviewed systematically: positive cognitive style (clear purpose in life, hopefulness, et al.), positive emotion (emotional stability, et al.), adaptive behavior (extraversion, internal self-control, et al.), strong social interaction (gratitude and love, et al.), and neural foundation (dopamine circuit, et al.). Inspired by these evidence, "psychological vaccination" could be achieved by well-known real-world natural-stress vaccination (mild, controllable, and adaptive of stress, with help from parents or leaders) or newly developed "clinical vaccination" (positive activity intervention for current depression, preventive cognitive therapy for remitted depression, et al.), both of which aim to enhance the resilient psychological diathesis against depression, through events or training. Potential neural circuit vaccination was further discussed. This review calls for directing attention to resilient diathesis against depression, which offers a new thinking "psychological vaccination" in both prevention and therapy of depression.

Resilience and Quality of Life in People with Mental Illness: A Systematic Review and Meta-Analysis

Purpose

Resilience is viewed as an individual' positive adaptation and experiences of adversity. The maintenance and recovery of mental health in people with mental disorder is considered a sign of coping with adverse conditions. The purpose of the present meta-analysis was to examine the association between resilience and quality of life in individuals with mental disorders.

Methods

Studies were included if research reported measures of association with resilience, as assessed using self-reported resilience scale and quality of life. A systematic literature search was conducted in PubMed and PsycINFO.

Results

Eight studies involving a total of 1439 patients were included in the meta-analysis. Assuming a random-effects model, the weighted mean Pearson correlation between resilience and quality of life was r = 0.551 (95% confidence interval [0.370; 0.691], p < 0.001). This association was moderate, although the heterogeneity among individual effect sizes was substantial (I² = 93.35%).

Conclusion

Despite substantial heterogeneity across included studies, the findings suggest a strong association between resilience and quality of life in people with mental disorders. In clinical practice, the promotion of resilience is important to enhance the quality of life among people with mental illness.

Blunted reward responsiveness prospectively predicts emotional distress when exposed to a naturalistic stressor

Both stress and blunted reward responsiveness have been identified as core risk factors of depression. Whether blunted reward responsiveness increases psychological vulnerability to real-life stress from a dynamic perspective (from stress reactivity to recovery) has not been investigated. By utilizing a real-world stressful event (i.e. the final examination), this study aimed to explore the role of reward responsiveness in the stress-emotional distress relationship during stress reactivity and recovery phases. We followed 57 undergraduates with three assessments, from six weeks before examination weeks (T1, baseline), one day before the examinations (T2) to two weeks after the examinations (T3), therefore, covering stress reactivity (T1 to T2) and recovery (T2 to T3) phases. At baseline, reward responsiveness was measured as the Reward Positivity (RewP) in the doors task. Stress and emotional distress (anxiety and depression) were reported at T1, T2 and T3 to capture their dynamic changes. Results showed that self-report stress levels significantly increased from T1 to T2 (stress reactivity phase) and decreased from T2 to T3 (stress recovery phase). Furthermore, blunted reward responsiveness at baseline prospectively predicted emotional distress during the stress reactivity phase but not the recovery phase. Specifically, during the stress reactivity phase, higher perceived stress was associated with greater anxiety and depression only in participants with relatively smaller residual RewP amplitudes but not in participants with relatively larger residual RewP amplitudes. Our study demonstrated that a blunted reward responsiveness is a vulnerable factor of depression, especially when exposed to stress. Our findings provide insights into prevention and intervention for stress-related disturbance.

Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods

BACKGROUND

There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems.

METHODS

We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model.

RESULTS

A model significantly fit our data (rel χ² = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction.

CONCLUSIONS

Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.

Enforced remote working: The impact of digital platform-induced stress and remote working experience on technology exhaustion and subjective wellbeing

The COVID-19 pandemic forced most individuals to work from home. Simultaneously, there has been an uptake of digital platform use for personal purposes. The excessive use of technology for both work and personal activities may cause technostress. Despite the growing interest in technostress, there is a paucity of research on the effects of work and personal technology use in tandem, particularly during a crisis such as the COVID-19 pandemic. Using a sample of 306 employees, this paper addresses this research gap. The findings highlight how both work and personal digital platforms induce technostress during the enforced remote work period, which in turn increases psychological strains such as technology exhaustion and decreases subjective wellbeing. Study results also show that employees with previous remote working experience could better negotiate technostress, whereas those with high resilience experience decreased wellbeing in the presence of technostress-induced technology exhaustion in the enforced remote work context.

Resilience in relation to older adults with multimorbidity: A scoping review

The purpose of this scoping review is to identify conceptual and theoretical resilience models, types of resilience measures, and outcomes regarding resilience in relation to older adults with multimorbidity. PubMed, Embase, CINAHL, and PsycINFO were searched, and we identified 14 studies to July 2021. Most models operationalize resilience as dependent on the social and environmental context of older adults. Three of the five resilience measures in the included studies are used to evaluate general resilience. They are primarily psychological or psychosocial in nature, and measuring physical resilience therefore may help to better understand individuals' ability to cope with the physical challenges associated with various chronic diseases. Quality of life and physical activity were common outcomes in studies of resilience. Findings highlight the need for studies that incorporate physiological measures or physical properties of resilience and longitudinal studies that capture the dynamic process of resilience in older adults with multimorbidity.

Further Examination of the Psychometric Properties of the Current Experiences Scale and Model of Resiliency

Background

Stress-related disease is increasing, with high resilience proposed as protective. Whilst the Current Experiences Scale (CES) shows promise as a measure of resilience, its psychological correlates and relationship to psychological stress remain unclear.

Objectives

(1) Further explore the psychometric properties of the CES, (2) identify modifiable psychological factors associated with the CES and (3) test a previously published model for the influence of adaptive strategies and stress management factors on resiliency and stress.

Methods

N = 455 individuals (mean age = 47.8, 65.1% female) completed measures of adaptive strategies: mindfulness (Cognitive and Affective Mindfulness Scale-Revised), positive affect (Positive and Negative Affect Schedule) and gratitude (The Gratitude Questionnaire), stress management skills: coping (Measure of Current Status-A), depression (Patient Health Questionnaire-8) and anxiety (General Anxiety Disorder Assessment) and outcomes: resilience (CES) and stress (Perceived Stress Scale). Cronbach's alpha and confirmatory factor analysis (CFA) examined the psychometric properties of the CES. Multivariable regression identified psychological variables associated with resilience. Structural equation modelling (SEM) tested the previously published model for resilience.

Results

The CES and its subscales showed good internal consistency (ɑ = .75-.93). The 23-item CES produced excellent results for model fit (Root Mean Square Error of Approximation (RMSEA) = .07, Standardized Root Mean Square Residual (SRMR) = .06, Comparative Fit Index (CFI) = .99; Tucker-Lewis Index (TLI) = .99). Higher gratitude (P < .0001), mindfulness (P < .0001), positive affect (P < .0001) and coping (P < .0001) were associated with higher resilience. Depression (P = .23) and anxiety (P = .34) were not. A model of resilience which included gratitude, mindfulness, positive affect and coping as determinants of resilience and perceived stress performed well (RMSEA = .03, SRMR = .02, CFI = .99; TLI = .99).

Conclusions

The CES was validated in a large sample. The association of gratitude, mindfulness, positive affect and coping with resilience may guide practitioners seeking to design resilience-enhancing programs.

Aspectos psicosociales del paciente en diálisis. Una revisión bibliográfica

Introducción: La enfermedad renal crónica es una patología progresiva e infradiagnosticada en sus primeros estadios y que va a necesitar un tratamiento renal sustitutivo en estadios avanzados, siendo el más utilizado la diálisis. Esto va a provocar un fuerte impacto en el bienestar psicosocial de los pacientes, con repercusión en su calidad de vida.Objetivo: Conocer la evidencia científica existente acerca de los factores psicosociales asociados a los pacientes sometidos a diálisis.Metodología: Se realizó una revisión bibliográfica sistematizada basada en la declaración PRISMA, en las bases de datos Pubmed, Proquest y Scielo. Para ello, se utilizaron una serie de estrategias de búsqueda en las que se utilizaron los siguientes términos Mesh: “Hemodyalisis”, “Peritoneal dyalisis”, “Factors psychosocial”, “Psychosocial cares”. La búsqueda se restringió a 5 años.Resultados: Se seleccionaron 28 artículos. Todos fueron de diseño observacional descriptivo, menos un ensayo controlado aleatorizado. De esta revisión emergieron como variables importantes: alteración del estado emocional, afrontamiento, situación laboral, depresión y ansiedad, apoyo social y calidad de vida relacionada con la salud.Conclusiones: Los principales aspectos psicosociales asociados a los pacientes en diálisis fueron la depresión y ansiedad, el apoyo social, la alteración del estado emocional, situación laboral y afrontamiento; siendo los más prevalentes la depresión y la ansiedad. La situación laboral y la depresión y ansiedad, se relacionan con una peor calidad de vida, mientras que la presencia de apoyo social y el estilo de afrontamiento de “evitación” mejoran la calidad de vida de estos pacientes.

The roles of trait and process resilience in relation of BIS/BAS and depressive symptoms among adolescents

Background

Extensive literature revealed the relations of depression with behavioral inhibition system (BIS) and behavioral activation system (BAS) as vulnerability and with resilience separately. Besides, the concept of resilience is still broad and ambiguous. Thus, this study aimed to reveal the mediation of two aspects of resilience: trait and process, in the relations of BIS and BAS to depression among adolescents.

Methods

The data set used in this study was a cross-sectional survey among 965 adolescents. The obtained data from the self-reported questionnaires used in this study were as below: Depression Serf-Rating Scale for Children (DSRS-C), Behavioral Inhibition and Behavioral Activation System Scale (BIS/BASS), and Bidimensional Resilience Scale (BRS). Structural equation modeling (SEM) was conducted to verify the hypothesized relations among BIS/BAS, trait and behavior resilience, and depressive symptoms.

Results

The obtained indices of fit from SEM were good or sufficient (χ 2 = 562.911, df = 96, p < 0.001; CFI = 0.925; NFI = 0.913; RMSEA = 0.073, 90% CI [0.067, 0.079]; SRMR = 0.066). And the modeling showed that both BIS/BAS directly and indirectly influenced to depression. The indirect effects of BIS/BAS were mediated only trait resilience except the indirect effect of BIS via behavioral resilience.

Discussion

Our results suggested that trait resilience played a significant mediation role in the relationships between BIS/BAS and depression. Trait but not process resilience could be considered suitable as an intervention target in line with decreasing depression.

Effectiveness of a resilience-targeted intervention based on "I have, I am, I can" strategy on nursing home older adults' suicidal ideation: A randomized controlled trial

BACKGROUND

Despite the potential for benefit, resilience remains an emergent area in late-life mental health care, and evidence of resilience intervention for suicide among nursing home residents is especially limited. This study aims to evaluate the effects of a resilience-targeted program based on the "I have, I am, and I can" strategy on suicidal ideation and related problems.

METHODS

From the 562 nursing home residents who were contacted, 68 with suicidal ideation were recruited and then randomly assigned to a resilience intervention group (eight-week resilience training; n = 34) or a wait-list control group (eight-week health education; n = 34). Self-reported suicidal ideation, and depression and anxiety symptoms as outcomes, and resilience as potential mediators were assessed at baseline, postintervention, and one-month follow-up.

RESULTS

Resilience training participants reported significant improvement in suicidal ideation (group × time interaction x²=12.564, p = 0.002) and depression symptoms (x²=9.441, p = 0.009) compared to wait-list control group participants. Changes in resilience mediated the intervention's effects on changes in suicidal ideation and depression symptoms. Limitations The observed effects must be considered preliminary due to the small sample size.

CONCLUSIONS

The findings support the benefits of resilience training based on the "I have, I am, and I can" strategy in reducing suicidal ideation and suicide-related symptoms in nursing home older adults, and provide insight into possible mechanisms.

Resilience-enhancing interventions for antepartum depressive symptoms: systematic review

BACKGROUND

Antepartum depressive symptoms (ADS) are highly prevalent and may affect the mother and child. Cognitive-behavioural therapy and interpersonal therapy are effective psychological interventions for depression. However, low adherence and high attrition rates in studies of prevention and treatment of antepartum depression suggest that these approaches might not be entirely suitable for women with mild/moderate ADS. Considering the protective association between resilience and ADS, women with ADS might benefit more from interventions focusing on promotion of mental well-being and resilience.

AIMS

We aimed to provide an overview of studies evaluating the effectiveness of antepartum resilience-enhancing interventions targeting the improvement of ante- and postpartum depressive symptoms. We also investigated whether these interventions improve resilience and resilience factors in the peripartum period.

METHOD

We conducted a systematic review, using PRISMA guidelines. Studies were eligible for inclusion when they utilised a randomised controlled trial or quasi-experimental design, studied pregnant women with ADS, and implemented psychological interventions that (a) aimed to reduce maternal ADS and/or prevent peripartum major depression, and (b) addressed one or more psychological resilience factors.

RESULTS

Five of the six included cognitive-behavioural therapy interventions and all four mindfulness-based interventions were effective in reducing peripartum depressive symptoms and/or the incidence of depression. However, the methodological quality of most of the included studies was low to moderate. Only three studies assessed change in resilience factors.

CONCLUSIONS

Resilience-enhancing interventions might be beneficial for mental well-being of pregnant women with ADS, although more rigorously designed intervention studies are needed.

Surviving the COVID-19 pandemic: An examination of adaptive coping strategies

The mental health consequences of the COVID-19 pandemic have been significant in Australia. The aim of this study was to investigate coping strategies that individuals have adopted to assist them through this stressful period. Survey data collected in September and December 2020 as part of a larger study (the COLLATE project) were analysed. The number of adaptive coping strategies endorsed by respondents had a significant negative relationship with depression and a significant positive relationship with resilience. Females tended to use more of these strategies than men, as did people who said their mental health had improved rather than deteriorated because of the COVID-19 restrictions imposed by government. Specific adaptive coping strategies differed for those with and without a mental illness. People with a mental illness were more likely to seek professional and online help, while people without a mental illness were more likely to use self-help. Focusing on what one is grateful for and keeping oneself productively occupied ("using the time to do things around the house") were the most beneficial coping strategies in terms of alleviating depression, anxiety and stress. Public health messaging promoting adaptive coping strategies may be useful in bolstering the mental health of individuals during lockdown periods. In particular, the promotion of coping flexibility should be recommended rather than the frequent use of the same coping strategies.

Savoring Interventions Increase Positive Emotions After a Social-Evaluative Hassle

Achieving a high quality of life is dependent upon how individuals face adversity. Positive psychological interventions are well-suited to support coping efforts; however, experimental research is limited. The purpose of the current research was to examine whether different savoring interventions could increase important coping resources (i.e., positive emotions) in response to a social-evaluative hassle. We completed an experimental mixed subject design study with a university student sample. All participants completed a hassle induction task and were then randomly assigned into different intervention groups. Positive emotion ratings were collected at three points in time (baseline, post-induction task, post-intervention). Results revealed a significant time x intervention interaction effect, such that individuals in the savoring the moment intervention reported higher levels of positive emotions (at post-intervention) compared to individuals assigned to the true control group, guided imagery control group, and savoring through reminiscence intervention. Such findings represent a significant extension to savoring theory and offer support for savoring the moment exercises as a primary prevention strategy to bolster effective responses to social-evaluative hassles.

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.

Regular physical exercise and its association with depression: A population-based study short title: Exercise and depression

This study is to estimate the relation between regular physical exercise and the risk of depressive disorder and depressive symptoms. Data from the Korean Longitudinal Study of Aging (KLoSA) from 2008 to 2018 were used, and 3,070 research samples were included at baseline at 2008. To analyze the relation between physical exercise and risk of depression, a generalized estimating equation (GEE) model and chi-square test were used. The estimate of Center for Epidemiologic Studies Depression (CESD) in those with "< 3 h" of exercise per week was 0.033 higher (95% Confidence Interval [CI]: 0.001 - 0.065 p-value: 0.046) compared to those with "5 h or more" of exercise per week. In terms of exercise duration, the estimates for CESD was 0.153 higher (95% CI: 0.111 - 0.195 p-value: <0.0001) in "< 1 year" and 0.143 higher (95% CI: 0.109-0.178 p-value: <0.0001) in "1-2 year", compared to "5 years or more" of exercise duration. This study showed a negative relationship between regular exercise and depressive symptoms in community-dwelling adults aged 45 years and above. To develop the habit of regular physical exercise and to reinforce self-esteem, simple and practical strategies of effective exercise may become important but effective exercise interventions.

Digital Resilience Among Individuals in School Education Settings: A Concept Analysis Based on a Scoping Review

BACKGROUND

Nowadays, in an informational society, digital technologies are present in most areas of life, including school education fields. Students encounter risks or threats during online experiences. Digital resilience helps individuals recognize and manage the risks and threats they come across when they socialize, explore, or work online and plays an important role in the digital technology challenges. However, so far, the concept of digital resilience among individuals in the educational field has not been analyzed in detail.

OBJECTIVES

The purpose of this study is to clarify the concept of digital resilience among students in a school education context, describe antecedents and consequences, and suggest a conceptual model for health educators.

METHODS

Walker and Avants' concept analysis method and standards of the scoping review were used to clarify the attributes, antecedents, and consequences from the included articles. A thematic analysis approach of literature was utilized to describe the study findings. No date limitations were applied.

RESULTS

A total of 22 included articles provided data for digital resilience conceptualization. Five defining attributes for the concept were identified as follows: (1) understanding online threats; (2) knowing solutions; (3) learning knowledge and skills; (4) recovering from stress; and (5) moving forward through self-efficacy. Antecedents included digital technology-related threats influenced by individual external and internal factors. Consequences were divided into two categories: behavioral performance and psychosocial functioning.

CONCLUSION

Based on the results of the concept analysis, a preliminary conceptual model of digital resilience was described as a circular process toward greater performance and function in the form of understanding, knowing, learning, recovering, and moving forward, when facing stressors, challenges, or adversity. The conceptual model of digital resilience can be further tested and may inform the enhancement of digital-specific resilience measures and interventions for students.

Athlete Resilience Trajectories Across Competitive Training: The Influence of Physical and Psychological Stress

Competitive sport involves physical and psychological stressors, such as training load and stress perceptions, that athletes must adapt to in order to maintain health and performance. Psychological resilience, one’s capacity to equilibrate or adapt affective and behavioral responses to adverse physical or emotional experiences, is an important topic in athlete training and performance. The study purpose was to investigate associations of training load and perceived sport stress with athlete psychological resilience trajectories. Sixty-one collegiate club athletes (30 females and 31 males) completed self-reported surveys over 6 weeks of training. Athletes significantly differed in resilience at the beginning of competitive training. Baseline resilience differences were associated with resilience trajectories. Perceived stress and training load were negatively associated with resilience. Physical and psychological stressors had a small but statistically significant impact on resilience across weeks of competitive training, indicating that both types of stressors should be monitored to maintain athlete resilience.

Effect of Resilience on Health-Related Quality of Life during the COVID-19 Pandemic: A Cross-Sectional Study

The unprecedented outbreak of coronavirus disease 2019 (COVID-19) has caused a huge global health and economic crisis. The aim of the study was to examine the extent to which the resilience of a person is associated with the quality of life (QoL) of adults amongst Saudi Arabia. A cross-sectional study was conducted among a sample of adults in Saudi Arabia. A total of 385 adults voluntarily participated in and completed the survey. The quality of life was measured using the “World Health Organization QoL”. The “Connor-Davidson Resilience Scale” instrument was also used to assess resilience during the COVID-19 pandemic. Amongst the 385 participants, 179 (46%) showed a good QoL, and 205 (54%) reported a relatively poor QoL. The resilience was found to be significantly associated with QoL. The study further revealed that gender-based differences were dominant in the QoL; the men respondents reported a significantly higher QoL in all the domains in comparison to the women respondents. The gender, income, and psychological health and interaction effect of resilience and age explained 40% of the variance in the total score of QoL. In reference to the predictors of the physical health domain of QoL, resilience, gender, and psychological health were significantly associated with the physical health domain of the QoL (R² = 0.26, p = 0.001). It was also noted that gender was not associated with the social relationships and environmental domains of QoL (p > 0.05). Findings showed a statistically significant association between the score of QoL and resilience, age, gender, income, and psychological health. These findings highlight the significant contribution of gender-based differences, psychological health, and resilience on the domains of QoL.

Genetic susceptibility for major depressive disorder associates with trajectories of depressive symptoms across childhood and adolescence

BACKGROUND

Early-onset depression during childhood and adolescence is associated with a worse course of illness and outcome than adult onset. However, the genetic factors that influence risk for early-onset depression remain mostly unknown. Using data collected over 13 years, we examined whether polygenic risk scores (PRS) that capture genetic risk for depression were associated with depressive symptom trajectories assessed from childhood to adolescence.

METHODS

Data came from the Avon Longitudinal Study of Parents and Children, a prospective, longitudinal birth cohort (analytic sample = 7,308 youth). We analyzed the relationship between genetic susceptibility to depression and three time-dependent measures of depressive symptoms trajectories spanning 4-16.5 years of age (class, onset, and cumulative burden). Trajectories were constructed using a growth mixture model with structured residuals. PRS were generated from the summary statistics of a genome-wide association study of depression risk using data from the Psychiatric Genomics Consortium, UK Biobank, and 23andMe, Inc. We used MAGMA to identify gene-level associations with these measures.

RESULTS

Youth were classified into six classes of depressive symptom trajectories: high/renitent (27.9% of youth), high/reversing (9.1%), childhood decrease (7.3%), late childhood peak (3.3%), adolescent spike (2.5%), and minimal symptoms (49.9%). PRS discriminated between youth in the late childhood peak, high/reversing, and high/renitent classes compared to the minimal symptoms and childhood decrease classes. No significant associations were detected at the gene level.

CONCLUSIONS

This study highlights differences in polygenic loading for depressive symptoms across childhood and adolescence, particularly among youths with high symptoms in early adolescence, regardless of age-independent patterns.

Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia

PURPOSE

To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life.

METHODS

Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS).

RESULTS

Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; r_s = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience.

CONCLUSION

Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.

The Short-Term Psychological Impact of the COVID-19 Pandemic in Psychiatric Patients: Evidence for Differential Emotion and Symptom Trajectories in Belgium

The spread of COVID-19 and the implementation of various containment strategies across the world have seriously disrupted people's everyday life, and it is especially uncertain what the psychological impact of this pandemic will be for vulnerable individuals, such as psychiatric (ex-)patients. Governments fear that this virus outbreak may prelude a major mental health crisis, and psychiatrists launch critical calls to flatten an upcoming mental ill-health surge. Here, we aim to add nuance to the idea that we are heading towards a mental health pandemic and that psychiatric populations will unavoidably (re)develop psychopathology. Despite being subjected to the same challenges posed by COVID-19, we argue that people with a history of psychiatric illness will psychologically deal with this adversity in different ways. To showcase the short-term differential impact of COVID-19 on patients' mental health, we present the day-to-day emotion and symptom trajectories of different psychiatric patients that took part in an experience sampling study before, during, and after the start of the first wave of the COVID-19 pandemic in March 2020 and associated lockdown measures in Belgium. Piecewise regression models show that not all patients' psychological well-being is affected to a similar degree. As such, we argue that emphasizing human resilience, also among the more vulnerable in society, may be opportune in these unsettling times.

The influence of maladaptive coping modes, resilience, and job demands on emotional exhaustion in psychologists

Although it is well established that emotion-focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion-focused coping and what kinds of emotion-focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty-three clinical and counselling psychologists completed online measures of job demands, EE, resilience, and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience-building practices and decreasing maladaptive coping.

Predictors and Correlates of Depression in Retired Elite Level Rugby League Players

Background: There is considerable interest in determining whether later-in-life depression is associated with lifetime history of concussions or the duration of a career in professional contact and collision sports. Rugby league is a high-intensity collision sport involving a large number of tackles per game and a high rate of concussions. We examined predictors and correlates of depression in retired elite level rugby league players in Australia. Methods: Retired elite level rugby league players (N = 141, age: M = 52.6, SD = 13.8; Range = 30-89 years) completed the Depression, Anxiety, and Stress Scale (DASS), Brief Pain Inventory, Connor-Davidson Resilience Scale (CD-RISC), and Epworth Sleepiness Scale; they also reported on lifetime history of concussions. The DASS depression score was regressed on age, total number of self-reported concussions, years played professionally, CD-RISC score, BPI pain interference score, and ESS score. Results: The retired players reported a median of 15 total lifetime concussions [interquartile range (IQR) = 6-30], and a median of 8 years playing professional sports (IQR = 3.5-11). The proportion of the sample endorsing at least mild current depression was 29%. The DASS depression score was positively correlated with the DASS anxiety (r = 0.54) and DASS stress scores (r = 0.58). The CD-RISC score was negatively correlated with the depression score (r = -0.53). Depression scores were not significantly correlated with pain severity (r = 0.14), and were weakly correlated with life interference due to pain (r = 0.20) and years playing professional sports (r = -0.17). Depression scores were not significantly correlated with lifetime history of concussions (r = 0.14). A multiple regression model, with age, total number of self-reported concussions, years played professionally, the CD-RISC, Brief Pain Inventory-pain interference score, and Epworth Sleepiness Scale score as predictors was significant, with 35% of the variance in DASS depression accounted for. The two significant independent predictors of depression were lower resilience and greater life interference due to pain. Conclusions: This is the first large study of depression in retired rugby league players. Depression in these retired players was not meaningfully associated with lifetime history of concussions or number of years playing elite level collision sport. Depression was associated with current anxiety, stress, resilience, and life interference due to chronic pain.

Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort

Background

During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied.

Methods

Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20).

Discussion

This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones.

Trial registration

Netherlands Trial Register (NTR), NL7499. Registered 5 February 2019.

Resilience-building module for undergraduate nursing students: A mixed-methods evaluation

In nursing students, resilience is recognised as a critical quality that will enable them to face and solve the challenges encountered in their studies and future careers. This mixed-methods study aimed to develop a resilience-building module for university nursing students and evaluate its effects on resilience, well-being and mindfulness. We recruited a convenience sample of 195 nursing students and delivered a resilience-building module comprising three 90-minute workshops on the following topics: resilience and emotion regulation, stress management and mindfulness, and burnout and depression. The participants' views and perceptions of the module were explored using pre-test and post-test questionnaires and focus group interviews. No significant changes in outcomes were observed from the pre-test to the post-test. However, a multivariable linear regression analysis indicated that mindfulness was significantly associated with resilience. A qualitative data analysis revealed that the resilience-building module evoked the participants' awareness of resilience and was considered an enjoyable learning experience. In conclusion, although the quantitative results demonstrated no significant changes in outcomes after the module, the qualitative results suggested that the resilience-building module could have beneficial effects if included in the undergraduate nursing curricula. Finally, better mindfulness was identified as important for enhancing resilience among undergraduate nursing students.

Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey

Background

The ability to cope with challenges and stress in life is generally understood as resilience. Pregnancy and parenthood are challenging times. The concept of resilience is receiving increasing interest from researchers, clinicians, and policy staff because of its potential impact on health, well-being, and quality of life. Nevertheless, the concept is less studied during the perinatal period.

Objectives

The aim of this study is to understand the concept of perinatal resilience, including the underlying processes and more specifically for the first 1,000 days of life.

Methods

A concept analysis according to the Walker and Avant (2011) framework was used, to investigate the basic elements of the concept. Concurrently, a two-round Delphi survey involving researchers, clinicians, epidemiologists, mothers, and fathers (N = 21), was conducted to prioritize the terms associated with perinatal resilience. Data collection took place between January and April 2019.

Results

Through concept analysis and Delphi survey, five defining attributes for perinatal resilience were identified: social support, self-efficacy, self-esteem, sense of mastery and personality. The additional terms, rated important by the Delphi survey, were linked to the consequences of being resilient during the perinatal period for the individual and his/her family. Specifically, highlighted were the experiences of families in personal growth and achieving family balance, adaptation, or acceptance.

Conclusion

Based on the results of the concept analysis and Delphi survey, we describe perinatal resilience for the first 1,000 days as a circular process towards a greater well-being in the form of personal growth, family balance, adaptation or acceptance, when faced with stressors, challenges or adversity during the perinatal period. The presence of resiliency attributes such as social support, sense of mastery, self-efficacy, and self-esteem enhance the capacity to be resilient and probably prevent mental health problems.

Associations between resilience and quality of life in patients experiencing a depressive episode

Despite the obvious assumption that resilience affects the course of affective disorders, studies investigating resilience in people experiencing a depressive episode are scarce. The current study explored whether resilience might differently impact quality of life (QoL) in these patients as compared to healthy control subjects. To this end, 60 patients and 75 control subjects were included into a cross-sectional study. In patients, psychopathology was assessed by means of the Montgomery Asberg Depression Rating Scale (MADRS). The Resilience Scale (RS-25) and the WHOQOL-BREF were used in both patients and control subjects to assess resilience and QoL. Depressive patients indicated significantly lower degrees of resilience and QoL compared to healthy subjects. However, there was evidence that patients experiencing a depressive episode do not inevitably have low RS-25 scores. In healthy subjects, a moderate correlation was found between resilience and all WHOQOL-BREF domains, whereas in patients, resilience correlated moderately with global and psychological QoL and with environment. The mediation analysis revealed that the difference in QoL between patients and healthy subjects was partially mediated by resilience. The present study confirms the assumption that resilience is not merely characterized by the absence of psychopathology but is important for the QoL of patients experiencing a depressive episode.

Community Gardening: Stress, Well-Being, and Resilience Potentials

The financial and health burdens of stress associated with increased urbanization have led to a demand for mental health enhancement strategies. While some extant literature details mental health benefits of community gardening, a coherent narrative on the construct of resilience and its relationship with the mental health benefits of community gardening is lacking. The present study examined the relationship between community gardening and a number of mental health benefits, in the forms of subjective well-being, stress, resilience potentials, and resilience factors (self-esteem, optimism, and openness). A total of 111 residents in Singapore completed a survey. Results from Multivariate Analysis of Covariance (MANCOVA) and Pearson’s correlation analyses show that, after controlling for age and levels of connection to nature, community gardeners reported significantly higher levels of subjective well-being than individual/home gardeners and non-gardeners, indicating that engagement in community gardening may be superior to individual/home gardening or non-gardening outdoor activities. Community gardeners reported higher levels of resilience and optimism than the non-gardening control group. These novel results indicate some potential for mental health benefits in urban environments, specifically in terms of subjective well-being and resilience. These findings have implications for future research in clinical psychology, mental health promotion, and policy.