State or trait? Measuring resilience by generalisability theory in breast cancer

Psychological endurance: how grit, resilience, and related factors contribute to sustained effort despite adversity

Many concepts describe how individuals sustain effort despite challenging circumstances. For example, scholars and practitioners may incorporate discussions of grit, hardiness, self-control, and resilience into their ideas of performance under adversity. Although there are nuanced points underlying each construct capable of generating empirically sound propositions, the shared attributes make them difficult to differentiate. As a result, substantial confusion arises when debating how these related factors concomitantly contribute to success, especially when practitioners attempt to communicate these ideas in applied settings. The model proposed here-psychological endurance-is a unified theory to explore how multiple concepts contribute to sustained goal-directed behaviors and individual success. Central to this model is the metaphor of a psychological battery, which potentiates and sustains optimal performance despite adversity. Grit and hardiness are associated with the maximum charge of the psychological battery, or how long an individual could sustain effort. Self-control modulates energy management that augments effort required to sustain endurance, whereas resilience represents the ability to recharge. These factors are constrained by both psychological and physiological stressors in the environment that drain the psychology battery. Taken together, these ideas form a novel framework to discuss related psychological concepts, and ideally, optimize intervention to enhance psychological endurance.

The interplay between stigma and sleep quality in breast cancer: A cross-sectional network analysis

PURPOSE

Stigma, a subjective internal shame, arises from the association of cancer with death. Sleep quality can be considered a product of stigma. However, the extent of overlap or difference between the two remains unclear.

METHODS

In total, 512 survivors with breast cancer were recruited from the "Be Resilient to Breast Cancer" project between May and August 2023. This study estimated the stigma, sleep quality, and their relationship by conducting a cross-sectional network analysis. The social impact scale and Pittsburgh Sleep Quality Index scale were employed in this study.

RESULTS

The core symptom for stigma from the network analysis was alienation by people (Strength = 1.213, Betweenness = 13, Closeness = 0.00211). The core symptom for sleep quality were the sleep quality (Str = 1.114, Bet = 17, Clo = 0.01586). Regarding the combination network, results showed that self-isolation and daytime dysfunction were the bridge nodes and that daytime dysfunction was positively associated with feeling less capable than before (according to self) (r = 0.15).

CONCLUSION

Our study demonstrates the core symptoms in different symptomatic networks, which can be targeted for treatment personalization and aid in the improvement of sleep quality and stigma in breast cancer patients.

Association between stigma and sleep quality in patients with breast cancer: A latent profile and mediation analysis

PURPOSE

This study aims to identify the heterogeneity in the stigma experienced by patients with breast cancer and examine the mediation effect of resilience on the relation between stigma and sleep quality.

METHOD

A total of 396 patients with breast cancer were enrolled from Be Resilient to Breast Cancer (BRBC) program between January and April 2023. Participants completed the Social Impact Scale, the 10-item Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index Scale. Latent profile analysis (LPA) and mediation analysis were conducted to analyze the data.

RESULTS

LPA categorized stigma into three subgroups, namely low-stigma (21.9%), moderate-stigma (64.9%), and high-stigma (13.2%). Mediation analysis revealed a fully mediated effect in the comparison between low-stigma and moderate-stigma groups (standard error [SE] = 0.13, 95%CI = 0.06,0.56), whereas a partially mediated effect was observed in the comparison between low-stigma and high-stigma groups (SE = 0.18, 95%CI = 0.39,1.10).

CONCLUSIONS

Stigma is a significant factor to sleep quality in breast cancer and resilience could act as a robust buffer against stigma resulting in improved sleep quality. Resilience-based interventions might be helpful in this population.

Feasibility and acceptability of CRiSOL: A pilot peer-based intervention to address syndemic health issues afflicting Latino immigrants in the U.S

Substance use, HIV/AIDS, domestic violence and mental health (SAVAME) are syndemic health issues that disproportionately burden Latinos in the U.S. Yet, there are limited evidence-based interventions to address these interrelated syndemic issues and their shared socio-ecological determinants. This study sought to test the feasibility and acceptability of CRiSOL, a peer-based, resilience-focused intervention to reduce the impact of the SAVAME syndemic on Latino immigrants. Fifteen Latino immigrant community leaders were recruited and trained to serve as health promotion agents in their naturally existing social networks. The training was implemented with high fidelity, received with high satisfaction by the peer leaders, and associated with significant improvements in their knowledge, leadership skills, and social capital. During an 8-month outreach phase, nine leaders remained active in the program and documented 825 one-on-one interactions with community members, during which they provided advice/counseling (52.2% of interactions), health information/education (32.5%), referrals to health and social services (38.5%), food aid (39.9%), and service navigation/assistance (10.2%). While future research must be conducted to establish the effectiveness of CRiSOL, findings from this pilot evaluation indicate the feasibility, acceptability, and high level of reach of this intervention and suggest significant potential to reduce the SAVAME syndemic burden in Latino communities.

Heterogeneity in resilience patterns and its prediction of 1-year quality of life outcomes among patients with newly diagnosed cancer: An exploratory piecewise growth mixture model analysis

PURPOSE

This study was designed to explore the impact of a new cancer diagnosis on resilience of patients and whether the resilience patterns could predict Quality of Life (QoL) in the first year.

METHODS

An exploratory linear piecewise growth mixture modeling (PGMM) with one hypothetical dot (3 months since diagnosis, T1) was employed to identify different resilience patterns and growth in 289 patients with different cancer diagnoses at five assessment occasions (T0-T4). Logistic regression analysis was performed to select potential predictors and receiver operating characteristic (ROC) curve analysis was utilized to test PGMM's discriminative ability against 1-year QoL.

RESULTS

Five discrete resilience trajectories with two growing trends were identified, including "Transcendence" (7.3%), "Resilient" (47.4%), "Recovery" (18.7%), "Damaged" (14.9%) and "Maladaption" (11.8%). Advanced stage, colorectal cancer, and receiving surgery therapy were significant predictors of negative resilience trajectories ("Damaged" or "Maladaption"). Discriminative ability was good for PGMM (AUC = 0.81, 95%CI, 0.76-0.85, P < 0.0001).

CONCLUSION

Heterogeneity is identified in resilience growth before and after 3 months since diagnosis. 26.7% newly diagnosed patients need additional attention especially for those with advanced colorectal cancer and receiving surgery therapy.

The role of the oxytocin system in the resilience of patients with breast cancer

Breast cancer is a grave traumatic experience that can profoundly compromise patients' psychological resilience, impacting their overall quality of life. The oxytocin system represents one of the essential neurobiological bases of psychological resilience and plays a critical role in regulating resilience in response to social or traumatic events during adulthood. Oxytocin, through its direct interaction with peripheral or central oxytocin receptors, has been found to have a significant impact on regulating social behavior. However, the precise mechanism by which the activation of peripheral oxytocin receptors leads to improved social is still not completely comprehended and requires additional research. Its activation can modulate psychological resilience by influencing estrogen and its receptors, the hypothalamic-pituitary-adrenal axis, thyroid function, 5-hydroxytryptamine metabolism levels, and arginine pressure release in breast cancer patients. Various interventions, including psychotherapy and behavioral measures, have been employed to improve the psychological resilience of breast cancer patients. The potential effectiveness of such interventions may be underpinned by their ability to modulate oxytocin release levels. This review provides an overview of the oxytocin system and resilience in breast cancer patients and identifies possible future research directions and interventions.

Revision and psychometric evaluation of a fertility intention scale for young women with breast cancer in Chinese Mainland

Objective

Neglected fertility intentions affect the quality of life of young women with breast cancer. The purpose of this study was to revise the Taiwanese version of the Fertility Intention Scale and validate its psychometric properties among young women with breast cancer in Chinese Mainland.

Methods

We performed a cross-sectional survey with young women with breast cancer at a Chinese cancer hospital to evaluate the psychometric properties of the Revised Fertility Intention Scale. A two-phase study was conducted: (1) revision of the scale and (2) evaluation of the scale's reliability and validity.

Results

Six new items and one new dimension were added to the original 15 items and four dimensions, reliability and validity of the 21-item Revised Fertility Intention Scale were verified in a sample of 436 women in Chineses Mainland with breast cancer who were aged 18-40 years. The content validity index, results of factor analysis, convergent validity, and known-groups validity were acceptable, and the Cronbach's alpha and intraclass correlation coefficients supported the revised scale.

Conclusions

The 21-item Revised Fertility Intention Scale has satisfactory reliability and validity for assessing fertility intentions among young women with breast cancer in Chinese Mainland. In clinical practice, nurses can use the scale to identify fertility intentions and associated factors in young women with breast cancer and develop feasible and effective oncofertility care measures.

Associations between Adverse Childhood Experiences (ACEs) and Prenatal Mental Health and Substance Use

Adverse childhood experiences (ACEs) are common and increase the risk of poor health outcomes. Resilience may offer protection against the impacts of ACEs. This study examined the association between maternal ACEs and mental/behavioral health outcomes during pregnancy overall and by resilience. The sample comprised pregnant patients in two pilot studies screened for eight ACEs and resilience during standard prenatal care in Kaiser Permanente Northern California from 1 March 2016 to 30 July 2016 (Study 1, medical centers A, B) and from 1 April 2018 to 31 March 2019 (Study 2, medical centers A, C). Early pregnancy outcomes included anxiety and depressive disorders, depression symptoms, intimate partner violence (IPV), and substance use. Multivariable logistic regression was used in this cross-sectional study to examine associations between maternal ACEs (0, 1-2, ≥3) and mental/behavioral health outcomes overall and among those with low and high resilience. Patients (n = 1084) averaged 30.8 years (SD 5.1); 41.7% were non-Hispanic White; 41.7% experienced ≥1 ACE, and 40.3% had low resilience. Patients with 1-2 ACEs or ≥3 ACEs (versus 0 ACEs) had higher odds of anxiety and depressive disorders, depressive symptoms, IPV, and any prenatal substance use (OR 1.44-4.40, p < 0.05). Each individual ACE was associated with ≥2 mental/behavioral health outcomes. In stratified analyses, having ≥1 ACE (vs. 0) was associated with a greater number of mental/behavioral health outcomes among patients with low versus high resilience. ACEs were associated with prenatal mental/behavioral health conditions, particularly in the context of low resilience, highlighting the importance of trauma-informed prenatal care and the need to study resilience-building interventions during pregnancy.

Learning From Cancer Patients Who Push on With Tenacity

Cancer survivors have unique life challenges that threaten their well-being. Concept building has identified fearless tenacity as a process that is critical to meaningful survival, by expanding understanding of how cancer survivors get along day by day as they transcend the course of cancer treatment and move beyond to pursue life purpose. This work establishes a foundation for nurses wishing to promote self-worth through fostering fearless tenacity. It sets a direction for research and practice grounded in the discipline through a specific nursing theory and solid footing from both extant literature and the real life experiences.

The development and validation of a new resilience inventory based on inner strength

There are a number of resilience scales with good psychometric properties. However, the various scales differ in their item content in accordance with the model of resilience the developer had in mind. Culture is one of the reasons for the difference. Thailand, one of the Buddhist cultures, has a different view on resilience compared with Western culture. This study aimed to develop and validate a resilience inventory created based on the inner strength concept using a confirmatory factor analysis (CFA) and Rasch measurement model. The resilience inventory (RI) was developed by creating new items representing inner strengths attributed to resilience. The inner strength was adopted to form the resilience construct, including perseverance, wisdom, patience, mindfulness, loving-kindness and equanimity. In addition, face and content validity were examined by experts in both mental health and Buddhism. The final RI comprised nine items with a 5-point Likert-type scale. The RI-9 was completed by 243 medical students who participated in the study, along with other measurements, i.e., Inner Strength-Based Inventory (iSBI), measuring the ten characteristics of perfection or inner strength, and the Core Symptom Index, measuring anxiety, depression and somatization symptoms. CFA, internal consistency and the Polytomous Rasch rating model were used to investigate the RI-9 construct validity. The mean age of the participants was 22.7 years (SD, 0.8); one-half were male (50%). The RI-9 construct demonstrated item hierarchy as follows: perseverance, patience (tolerance), mindfulness and equanimity, wisdom and loving-kindness. CFA showed that the unidimensional model fitted the data well. Rasch analysis showed no misfitting items and local dependence. The reliability of the person and item was good, and no disordered threshold was observed. Two items were found to exhibit differential item functioning due to sex. RI-9 scores were significantly related to all ten strengths from the iSBI, whereas they were negatively related to depression, anxiety, somatization and interpersonal difficulties. The RI-9 demonstrated validity and reliability. It constitutes a promising tool for outcome assessment in nonclinical populations. Further investigation on external validity as well as psychometric validation in other different cultures, should be encouraged.

Validation of the Chinese version of the resilience scale for the oldest-old

Background

Resilience is one of the most important variables associated with adaptive ability. The resilience scale for the oldest-old age (RSO) has been designed to measure the resilience among the oldest-old people. Originally developed in Japan, this scale has not been used in China. The objective of this study was to translate the RSO into Chinese and investigate its validity and reliability among the community's oldest-old adults aged ≥80 years.

Methods

A total of 473 oldest-old people who came from communities were recruited by convenience sampling for the assessment of construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). In addition, internal consistency reliability, test-retest reliability, face validity, and content validity were used to evaluate the psychometric characteristics of RSO.

Results

The RSO demonstrated good face validity and content validity. The content validity index of the Chinese version of the RSO was 0.890. Moreover, one factor was extracted by exploratory factor analysis, which accounted for 61.26% of the variance. The RSO had high internal consistency with a Cronbach's alpha = 0.927. The test-retest reliability was 0.785. The item-total correlations ranged from 0.752 to 0.832.

Conclusion

The results of the study indicate that the Chinese version of the RSO questionnaire has good reliability and validity and can be recommended for use by health and social service agencies as a method for assessing the resilience of the oldest-old in the community.

Measuring resilience by cognitive diagnosis models and its prediction of 6-month quality of life in Be Resilient to Breast Cancer (BRBC)

Objective

The application of advanced Cognitive Diagnosis Models (CDMs) in the Patient Reported Outcome (PRO) is limited due to its complex statistics. This study was designed to measure resilience using CDMs and its prediction of 6-month Quality of Life (QoL) in breast cancer.

Methods

A total of 492 patients were longitudinally enrolled from Be Resilient to Breast Cancer (BRBC) and administered with 10-item Resilience Scale Specific to Cancer (RS-SC-10) and Functional Assessment of Cancer Therapy-Breast (FACT-B). Generalized Deterministic Input, Noisy "And" Gate (G-DINA) was performed to measure cognitive diagnostic probabilities (CDPs) of resilience. Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were utilized to estimate the incremental prediction value of cognitive diagnostic probabilities over total score.

Results

CDPs of resilience improved prediction of 6-month QoL above conventional total score. AUC increased from 82.6-88.8% to 95.2-96.5% in four cohorts (all P < 0.001). The NRI ranged from 15.13 to 54.01% and IDI ranged from 24.69 to 47.55% (all P < 0.001).

Conclusion

CDPs of resilience contribute to a more accurate prediction of 6-month QoL above conventional total score. CDMs could help optimize Patient Reported Outcomes (PROs) measurement in breast cancer.

Examining the underlying latent structure of the sports emotion questionnaire: Insights from the bifactor multidimensional item response theory

Background

Despite the widespread use of the sports emotion questionnaire (SEQ) in several studies, it is surprising that only a few have explicitly tested the validity and utility of the instrument in non-western populations. Besides, the issue of dimensionality and the latent structure of the instrument remain inconclusive given that several authors have revealed different factor structures across diverse populations. The central concern is whether the items on the various dimensions, proposed for the original SEQ, offer adequate information to their respective expected subscale or otherwise. This study assessed the underlying latent structure of the SEQ using confirmatory and bifactor multidimensional item response (MIRT) models.

Methods

Through a well-designed validation study 300 athletes from three West African countries, participating in the 2018 West African University Games were surveyed to respond to the SEQ. The data were analyzed using first, a 5-factor confirmatory factor analysis (CFA) via the MIRT model and second, a bifactor MIRT analysis.

Results

The results revealed that items on the SEQ were fairly good in measuring the construct under the respective domains of the instrument. However, the outcome of the bifactor model showed that the majority of the items on the SEQ explained common variance in relation to the general factor other than the specific domains (5-dimensions).

Conclusion

Findings of the bifactor model question whether the sub-dimensions of the SEQ are needed since most of the items on the SEQ explained larger variances in the general factor than any of the five domains. It is concluded that instruments like SEQ should be scored for a general factor and not as sub-dimensions. Further investigations are encouraged by scholars within the area to probe the dimensionality of the SEQ.

Resilience as a Factor Influencing Psychological Distress Experience in Patients with Neuro-Oncological Disease

Cancer causes psychological distress. Approximately one-third of all patients with cancer suffer from distress requiring psycho-oncological treatment. Examining factors contributing to their distress can inform approaches to counteracting them. Among such factors, resilience is considered to be a psychological adaptive capacity resulting from complex genetic, epigenetic, psychological, and environmental influences. For that reason, we investigated resilience as a factor of psychological distress experience among patients with neuro-oncological disease. To assess distress among patients with neuro-oncological diseases, we performed electronic psycho-oncological screening in the Department of Neurosurgery at Tübingen University Hospital (n = 100) following tumor surgery (T₀) using the Resilience Scale 13, the Hornheider Screening Instrument, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder Scale-2, and the Distress Thermometer, all administered on tablets. Follow-up was done 6 months after (T₁). The distress of patients with neuro-oncological disease decreased significantly after 6 months (p < 0.01). Most patients (87%) showed moderate to high resilience. Although significant correlations with distress are measurable at the T₀ time point (ρ = -0.318 **, p < 0.01), no significant correlations were observed at T₁. Thus, resilience seems to significantly impact distress in the acute phase of the neuro-oncological disease. For clinical practice, our findings suggest that resilience-focused screening can provide useful information about patients at risk of experiencing distress.

Psychometric properties of the Turkish version of the Patient Health Engagement Scale

BACKGROUND

The Patient Health Engagement Scale was designed to assess the emotional and psychological attitudes of patients' engagement along their healthcare management journey.

AIM

This study aimed to conduct psychometric testing of the Turkish version of the Patient Health Engagement Scale among patients with chronic diseases.

DESIGN

A cross-sectional validation study was conducted and reported according to the STROBE checklist.

METHODS

There were 520 patients who completed the scale between March 2017 and February 2018. The content, construct and concurrent validity were evaluated. The reliability of the scale was measured using internal consistency and construct reliability. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis.

RESULTS

The scale's validity was enabled by the translation and back translation method. The content validity index of the scale was 0.88. Construct validity determined one factor. The total variance was calculated at 85.29%. The factor loads ranged between 0.86 and 0.95. The results of the confirmatory factor analysis showed goodness-of-fit indices in the excellent range according to the literature. The reliability of the scale was calculated at 0.95.

CONCLUSION

The scale was found to be a valid and reliable measurement tool to be used in identifying the engagement with health levels of patients with chronic diseases.

Resilience index improves prediction of 1-year decreased quality of life in breast cancer

BACKGROUND

Resilience is important in cancer survivorship and has great potential to predict long-term quality of life (QoL) in breast cancer. The study was designed to develop a new prediction model to estimate pretest probability (PTP) of 1-year decreased QoL combing Resilience Index (RI) and conventional risk factors.

METHODS

RI was extracted from 10-item Resilience Scale Specific to Cancer (RS-SC-10) based on the Principal Component Analysis (PCA). Patients were enrolled from Be Resilient to Breast Cancer (BRBC) and the prediction model was developed based on a sample of 506 consecutive patients and validated in an internal cohort (N1 = 314) and two external cohorts (N2 = 223 and N3 = 189). Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were utilized to estimate the incremental value of RI.

RESULTS

RI improved prediction above conventional risk factors. AUC increased from 0.745 to 0.862 while IDI and NRI were 8.39% and 18.44% respectively (P < 0.0001 for all). Five predictors were included in the final model: RI, age, N stage, M stage, and baseline QoL. The new model demonstrated good calibration ability in the internal and external cohorts resulting in C-indexes of 0.862 (95%CI, 0.815-0.909), 0.828 (95%CI, 0.745-0.910), 0.880 (95%CI, 0.816-0.944), and 0.869 (95%CI, 0.796-0.941).

CONCLUSION

RI contributed to a more accurate estimation for PTP of 1-year decreased QoL above conventional risk factors and could help optimize decision making of treatment for breast cancer.

IMPLICATIONS FOR CANCER SURVIVORS

A promising prognostic indicator of RI could improve QoL-related management in Chinese patients with breast cancer.

Gen Z during the COVID-19 crisis: a comparative analysis of the differences between Gen Z and Gen X in resilience, values and attitudes

In the current study we seek to examine the difference between Generation Z and Generation X in terms of coping with a global crisis (COVID-19), specifically regarding resilience in times of crisis, personal values ​​and attitudes during that time. Based on the theory of generations, we aimed to explore whether different generations have different levels of resilience, values and attitudes during the global crisis. Data were gathered in a cross-sectional study; 958 participants participated, divided into two age-groups: 508 participants of Generation Z (ages ranged between 18-24; 53.9% males [Age: M = 21.05, SD = 1.96]; 46.1% females [Age: M = 21.14, SD = 1.83]), and 205 participants of Generation X (ages ranged between 40-50; 54.2% males [Age: M = 45.16, SD = 3.15]; 45.8% females [Age: M = 45.23, SD = 3.01]). It was found that members of Generation Z (Gen Z) were less resilient. Also, Gen Z members had higher levels of openness to change, and self-enhancement as compared to Generation X (Gen X). In addition, Gen Z were found to be more positive in their attitudes toward flexible learning but no differences between the generations were found as for flexible work. Both generation members had the similar attitudes towards online consumption. Despite the magnitude and significance of the crisis, the main values of each generation remained unchanged in many respects, but attitudes of both generations are positive towards hybrid work and consumption.

Associations among neuroticism, self-efficacy, resilience and psychological distress in freshman nursing students: a cross-sectional study in China

OBJECTIVES

The current study examines the mediating roles of resilience and self-efficacy and the moderating role of gender in the association between neuroticism and psychological distress in Chinese freshman nursing students (FNSs).

METHODS

A total of 1220 FNSs were enrolled from the Be Resilient to Nursing Career (ChiCTR2000038693) Programme and the following instruments were administered to them: NEO Five-Factor Inventory, General Self-Efficacy Scale, Connor-Davidson Resilience Scale and Kessler Psychological Distress Scale. A moderated mediation analysis and a generalised additive model analysis were performed.

RESULTS

The direct and indirect effects of neuroticism on psychological distress were significantly mediated by self-efficacy (B = 0.200, 95% CI 0.001 to 0.039), resilience (B = 0.021, 95% CI 0.007 to 0.038) and the interaction between self-efficacy and resilience (B = 0.016, 95% CI 0.005 to 0.028). The interactions between neuroticism and gender (β = 0.102, 95% CI 0.001 to 0.203, p<0.05) and between resilience and gender were significant (β = 0.160, 95% CI 0.045 to 0.275, p<0.01). A non-linear and positive association was confirmed between neuroticism and psychological distress.

CONCLUSIONS

Self-efficacy and resilience significantly mediate the relationship between neuroticism and psychological distress. Gender moderates the relationships between neuroticism and resilience and between resilience and psychological distress.

Development and testing of an instrument to measure contextual factors influencing self-care decisions among adults with chronic illness

Background

Decisions about how to manage bothersome symptoms of chronic illness are complex and influenced by factors related to the patient, their illness, and their environment. Naturalistic decision-making describes decision-making when conditions are dynamically evolving, and the decision maker may be uncertain because the situation is ambiguous and missing information. Contextual factors, including time stress, the perception of high stakes, and input from others may facilitate or complicate decisions about the self-care of symptoms. There is no valid instrument to measure these contextual factors. The purpose of this study was to develop and test a self-report instrument measuring the contextual factors that influence self-care decisions about symptoms.

Methods

Items were drafted from the literature and refined with patient input. Content validity of the instrument was evaluated using a Delphi survey of expert clinicians and researchers, and cognitive interviews with adults with chronic illness. Psychometric testing included exploratory factor analysis to test dimensionality, item response theory-based approaches for item recalibration, confirmatory factor analysis to generate factor determinacy scores, and evaluation of construct validity.

Results

Ten contextual factors influencing decision-making were identified and multiple items per factor were generated. Items were refined based on cognitive interviews with five adults with chronic illness. After a two round Delphi survey of expert clinicians (n = 12) all items had a content validity index of > 0.78. Five additional adults with chronic illness endorsed the relevance, comprehensiveness, and comprehensibility of the inventory during cognitive interviews. Initial psychometric testing (n = 431) revealed a 6-factor multidimensional structure that was further refined for precision, and high multidimensional reliability (0.864). In construct validity testing, there were modest associations with some scales of the Melbourne Decision Making Questionnaire and the Self-Care of Chronic Illness Inventory.

Conclusion

The Self-Care Decisions Inventory is a 27-item self-report instrument that measures the extent to which contextual factors influence decisions about symptoms of chronic illness. The six scales (external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment) reflect naturalistic decision making, have excellent content validity, and demonstrate high multidimensional reliability. Additional testing of the instrument is needed to evaluate clinical utility.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01990-2.

Re-assessing the Psychometric Properties of Stress Appraisal Measure in Ghana Using Multidimensional Graded Response Model

Despite the widespread use of the stress appraisal measure questionnaire in sport psychology literature, information on the psychometric properties of this survey instrument across different cultures and samples is still lacking. This study sought to validate the stress appraisal measure among male football players in the Ghana’s Premier League using the multidimensional item response theory. The descriptive cross-sectional survey design was adopted to recruit 424 footballers from the 2020/2021 Ghana Premier League season using the census approach. The 28-item Stress Appraisal Measure was used to assess six (6) appraisal mechanisms under primary and secondary cognitive appraisals. The ordered polytomous item response theory was used for analyzing the data. The study found that although some items were problematic, the majority of them were found to have good item parameters, effective scale option functioning, and provided adequate empirical information in the measurement of stress appraisal. This research concluded that the stress appraisal measure has promising applicability among male footballers who participated in the premier league in Ghana. Future researchers are encouraged to re-validate the stress appraisal measure with a different sample to contribute to the understanding of the applicability of the instrument in non-western populations.

The Associations Between Psychological Distress and Academic Burnout: A Mediation and Moderation Analysis

Background

Psychological distress is reported to be associated with academic burnout in students while the mediation and moderation effect of resilience and personality are less explored.

Purpose

The current study was designed to estimate the mediating effect of resilience and the moderation effect of personality between psychological distress and academic burnout.

Participants and methods

A total of 613 students were enrolled from two medical universities between December 2020 and January 2021. They were administered with Academic Burnout Scale, 10-item Kessler Psychological Distress Scale (K10), Connor-Davidson Resilience Scale (CD-RISC-10) and NEO Five-Factor Inventory (NEO-FFI). Latent profile analysis and moderated mediation analysis were performed.

Results

Three personalities were identified and named as resilient (13.4%), over-controlled (50.2%) and under-controlled (36.4%). Resilience significantly mediated the relationship between psychological distress and academic burnout while personality significantly moderated the relationship between psychological distress and resilience.

Conclusion

Resilience and personality may be two important mediators between psychological distress and academic burnout. More attentions should be paid to students with under-controlled personality and resilience-enhancing interventions could be developed to prevent or alleviate academic burnout in future research.

Heterogeneity in Psychological Resilience and Mental Health among Newly Graduated Nursing Students: A Latent Profile and Generalized Additive Model Analysis

Background

Psychological resilience is important to mental health and professional development in newly graduated nursing students (NGNSs). However, the association between psychological resilience and mental health in NGNSs is less explored.

Purpose

The current study was designed to determine mental health profiles measured by the Kessler 10 scale (K10) and evaluate the non-linear association between psychological resilience and mental health in NGNSs.

Methods

A total of 472 NGNSs from the Be Resilient to Nursing Career program were assessed using the K10 and ten-item Connor–Davidson Resilience Scale (CD-RISC 10). Latent profile analysis and generalized additive model analysis were performed.

Results

A four-class model based on the K10 was identified: lowest (28.0%), lower-middle (36.4%), upper-middle (26.1%), and highest (9.5%) subgroups. Academic degree and psychological resilience were significant indicators of mental health profiles. Psychological resilience was negatively and nonlinearly correlated with mental health when the CD-RISC 10 score was >17.

Conclusion

There exists heterogeneity in NGNSs’ mental health. The negative and nonlinear association between psychological resilience and mental health can only be confirmed in NGNSs with moderate and high resilience levels.

Assessing the psychometric properties of the Chinese return-to-work self-efficacy questionnaire using Rasch model analysis

Background

Self-efficacy is a significant predictor of return to work and affects the confidence of survivors to return to work after illness. The Return-to-work self-efficacy (RTW-SE) questionnaire is a self-report questionnaire to assess confidence in returning to work with good reliability and validity. The aim of this study was to translate and cross-culturally adapt the RTW-SE questionnaire into Chinese and examine the psychometric properties among young and middle-aged stroke survivors using Rasch model analysis.

Methods

The cross-cultural adaptation and translation procedures followed a dual-translation approach. The psychometric properties of the RTW-SE questionnaire were examined using Rasch model analysis by Winsteps software. The unidimensionality and local independence were analyzed by principal component analysis of the residuals (PCAR) and standardized residual correlations.Category diagnostics were performed for scale function, and the item fit, reliability, and separation were also validated. Item-person maps were used to examine the distribution and matching of item’s location and person ability. Finally, the differential item functioning (DIF) was used to measure gender-related group equivalence.

Results

A total of 366 participants aged 23–59 years were recruited from three communities in Zhengzhou. The RTW-SE questionnaire demonstrated unidimensionality and a 5-point Likert rating scale was more appropriate to investigate young and middle-aged stroke survivors’self-efficacy. There was a good fit for the items with both person and item reliabilities greater than 0.8 and separation indices of 3.75 and 3.94, respectively. The item location was identified from the item-person map as not covering person ability, but the scale did not have an age-related DIF.

Conclusions

The results confirm evidence of appropriate psychometric properties of the RTW-SE questionnaire and can be used as a reliable and validated instrument for measuring self-efficacy to return to work in young and middle-aged Chinese patients with stroke.

Clinical investigation of dynamic and enduring aspects of global cognition in aged population

BACKGROUND

A major issue in evaluating the cognitive status of ageing populations is a clear distinction between enduring and dynamic aspects of global cognition necessary for evaluating risks of dementia and effectiveness of preventive interventions.

MATERIALS AND METHODS

Generalizability Theory was applied to investigate dynamic and enduring aspects of global cognition using longitudinal data over 10 years of follow-up. Measures included the Mini-Mental Status Examination (MMSE) and the Telephone Interview for Cognitive Status-modified (TICS-M). The sample (N = 238) included 154 females, mean age = 76.54 years, SD = 3.94 from the Sydney Memory and Ageing Study.

RESULTS

The MMSE measured dynamic and enduring aspects of cognition to a comparable degree with 56% of variance explained by enduring aspects and 44% by dynamic aspects and showed low sensitivity/high specificity in detecting dementia. A shortened version of the MMSE (MMSE-D8) better captured dynamic aspects of cognition after removing three items less sensitive to change. The TICS-M predominantly measured enduring aspects of cognition (72%) with the remaining 28% due to dynamic aspects and displayed high sensitivity/high specificity for dementia screening.

CONCLUSIONS

The MMSE measures both dynamic and enduring cognitive aspects and is suitable for general clinical assessments, while the MMSE-D8 can be used to monitor transitory changes of global cognition over time. The TICS-M is more useful for measuring enduring features of cognition and screening for dementia. Our findings highlight the value of generalizability theory to distinguish dynamic and enduring features of cognition, which may contribute to preventive interventions and monitoring cognitive ability over time.

Associations among fear of childbirth, resilience and psychological distress in pregnant women: A response surface analysis and moderated mediation model

INTRODUCTION

Prenatal psychological distress is prevalent during pregnancy. This study aimed to estimate the associations among fear of childbirth, resilience and psychological distress.

METHODS

A total of 1,060 Chinese pregnant women were enrolled from Be Resilient to Postpartum Depression (ChiCTR2100048465) and the following instruments were administered to them: Childbirth Attitudes Questionnaire, Connor-Davidson Resilience Scale, Perceived Social Support Scale, General Self-Efficacy Scale, Adverse Childhood Experience scale and Hospital Anxiety and Depression Scale. A dominance, a response surface analysis and a moderated mediation analysis were performed.

RESULTS

In terms of psychological distress, resilience and fear of childbirth could explain 41.6% (0.148/0.356) and 33.1% (0.118/0.356), respectively. Pregnant women with high resilience-low fear of childbirth had significantly lower levels of psychological distress than those with low resilience-high fear of childbirth. The indirect effects of fear of childbirth on psychological distress through resilience was significantly (B = 0.054, 95% CI 0.038 to 0.070). The interactions between fear of childbirth and adverse childhood experiences (β = 0.114, 95% CI -0.002 to 0.231, p = 0.054) and between resilience and adverse childhood experiences (β = -0.118, 95% CI -0.222 to -0.012, p < 0.05) were significant.

CONCLUSION

Resilience, fear of childbirth and adverse childhood experiences may be three important factors to psychological distress in Chinese pregnant women.

Individualised Care Scale-Nurse: Construct validity and internal consistency of the Spanish version

BACKGROUND

Individualising the provided care is mandatory in nursing and is essential in clinical practice. Therefore, there is a need to develop accurate instruments to evaluate the quality of care. Moreover, there is no validated instrument to assess nurses' views of individualised care in Spanish-speaking countries.

AIM

To assess the construct validity and internal consistency of the Spanish version of the Individualised Care Scale-Nurse.

METHODS

A cross-sectional study including 108 nursing professionals (40.84 ± 9.51 years old, 86.1% female) was used to validate the Spanish Individualised Care Scale-Nurse version. A forward-back translation method with an expert panel and a cross-sectional study was used for transcultural adaptation and psychometric validation purposes. Psychometric properties of feasibility, reliability and validity were assessed. Construct validity was examined through a confirmatory factor analysis and fit indices of the overall model were computed. Internal consistency was explored through McDonald's omega and Cronbach's alpha coefficients among other correlation measures.

RESULTS

The back-translation concluded both Spanish and English Individualised Care Scale-Nurse versions to be equivalent. The original structure of the Individualised Care Scale-Nurse was verified in the Spanish version through the confirmatory factor analysis (factor loadings >0.3; acceptable fit indices: SRMR ≈ 0.08, CFI ≈ 0.9, RMSEA ≈ 0.09 after posteriori modifications). McDonald's omega exceeded 0.7 for both subscales and complete scales revealing an adequate internal consistency.

CONCLUSIONS

The Spanish version of the Individualised Care Scale-Nurse has exhibited good properties of homogeneity and construct validity for its use in practice and research in health care systems.

New resilience instrument for family caregivers in cancer: a multidimensional item response theory analysis

OBJECTIVE

Resilience instruments specific to family caregivers (FCs) in cancer are limited. This study was designed to validate the 10-item Resilience Scale Specific to Cancer (RS-SC-10) in FCs using multidimensional item response theory (MIRT) analysis.

METHODS

382 FCs were enrolled from Be Resilient to Cancer Program (BRCP) and administered with RS-SC-10 and 36-item Short Form Health Survey (SF-36). MIRT was performed to evaluate item parameters while Generalized Additive Model (GAM) and Latent Profile Analysis (LPA) were performed to test the non-linear relationship between resilience (RS-SC-10) and Quality of Life (QoL, SF-36).

RESULTS

RS-SC-10 retained 10 items with high multidimensional discrimination, monotonous thresholds and its original two-factor structure (Generic and Shift-Persist). Four latent resilience subgroups were identified and a non-linear dose-response pattern between resilience and QoL was confirmed (per-SD increase OR = 1.62, 95% CI 1.16-2.13, p = 0.0019).

CONCLUSION

RS-SC-10 is a brief and suitable resilience instrument for FCs in cancer. The resilience screening of patients and FCs can be performed simultaneously in clinical practice.

COPEWithME: The Role of Parental Ability to Support and Promote Child Resilient Behaviors During the COVID-19 Emergency

The COVID-19 pandemic has led to lockdown in many countries and Italy was the first one interested in Europe. The lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, but it is very demanding for the population involved and especially for children and their families. The aims of the present study are: (a) to explore the psychometric properties of the COPEWithME questionnaire, a new tool to evaluate parents' ability to support and promote child resilient behaviors, (b) to investigate the relation between parents' resilience and their ability to support and promote child resilient behaviors with child resilience and child stress-related behaviors assessed during the COVID-19 outbreak. Participants (N = 158 mothers, with 6- to 11-years-old children, 53% female), who were volunteers and anonymous, filled out an online questionnaire composed by CD-RISC 25, PMK-CYRM-R, and COPEWithME. With regard to the COPEWithME, validation exploratory factor analyses revealed a one-factor solution of 18 items. The COPEWithME positively correlates both with mothers' resilience and with children's resilience. Mediation analysis showed that the association between mothers' resilience and children's stress-related behaviors was mediated by the mothers' ability to support and promote child resilient behaviors. The COPEWithME, to our knowledge, is the first measure of parents' ability to support and promote resilient behaviors in school-age children, a key parenting skill that may help children in dealing with stressful situations such as the COVID-19 outbreak. These findings represent useful insights to advance mental health interventions in the post-pandemic phases suggesting focusing on a family's resources and resilience processes.

Assessment of Participation within the International Classification of Functioning, Disability, and Health (ICF): The Turkish Validity and Reliability of the Participation Scale

Objective

The aim of the study was to investigate the reliability and validity of the Turkish version of the Participation Scale (P-Scale).

Methods

A total of 152 students, with a mean age of 20.27 ± 2.19, participated in the study. Sociodemographic information (age, gender, and family income) was recorded; all participants completed the P-Scale twice with a 15-day interval. Translation and cross-cultural adaptation were performed to analyze the validity and reliability of the P-Scale. Cronbach's alpha and McDonald's alpha were used for scale reliability statistics and explanatory (EFA) and confirmatory (CFA) factor analysis; Mardia's multivariate normality and assumption tests were used for the validity of the scale. The factor extraction methods were minimum rank factor analysis in EFA and weighted least squares mean and variance adjusted estimator polychoric correlation matrix in CFA.

Results

Internal consistency of the scale was found good with Cronbach's alpha (0.852) and excellent with McDonald's alpha (0.924). The EFA and CFA resulted in two-factored structure, with the explained variance found to be higher than 30%.

Conclusions

Analysis demonstrated that the P-Scale had a satisfactory level of reliability and validity in Turkish university students.

The Role of Resilience for Migrants and Refugees' Mental Health in Times of COVID-19

Migrants and refugees need international protection, particularly during a crisis such as the current health pandemic. The aim of this research was to examine the mental health and attitudes towards COVID-19 in migrants and refugees compared to the general Spanish population. Moreover, the nature of resilience was examined as a mixed component though life experiences. For this proposal, an interview was carried out in a sample of 245 participants who volunteered to participate in the study. The sample was divided into Spanish non-migrants, Spanish migrants, non-Spanish migrants and refugees. Attitudes towards COVID-19, resilience (based on BRCS) and mental health (based on DASS-21) were measured. The results obtained can be described as follows: (i) Migrant participants indicated worse mental health than non-migrants, and within the migrant group, refugees presented worse scores; (ii) No differences were found in attitudes towards COVID-19 in any of the subgroups; (iii) A moderating effect of group was found for the relationship between resilience and mental health but not between resilience and fear of COVID-19. These results might be of great interest in making visible the vulnerability of migrants and specifically refugees, and the proposal of intervention programs based on resilience training.

Initial Validation of the Mindful Presence Scale: The Issue of the Construal Level of Scale Items

Our research has two main aims. It undertakes the validation of a six-item trait mindfulness scale called Mindful Presence Scale (MPS), which measures central aspects of mindfulness. For the first time in mindfulness literature, the construal level of scale items is also examined. Four questionnaire-based online studies were conducted. Study 1 drew three samples (n n = 391, n p = 215, and n b = 235) from the students at the University of Debrecen. It examined the factor structure, reliability, and internal consistency of the three differently worded scale versions. The positively worded scale version (MPSp) yielded a stable two-factor structure and demonstrated the best psychometric properties. Study 2 performed a confirmatory factor analysis on a sample drawn from public employees across the country (n cfa = 420). The two-factor solution in Study 1 was confirmed. χ2 tests were not significant, and fit indices were excellent. There was no significant difference between the high-level construal subscale (Fhlc) and the low-level construal subscale (Fllc) in terms of factorial stability. Participant of Study 3 were students who did not take part in Study 1. The sample (n inv = 250) was tested for measurement invariance across gender. The scaled results supported strong/threshold invariance. Study 4 tested concurrent validity with 10 concurrent instruments. A sample of secondary school teachers (n con = 128) was tested by examining Spearman's rank order correlations. There was a significant difference in how the Fhlc and Fllc subscales predicted scores of some of the concurrent instruments. Further research is warranted into how the construal level of mindfulness scale items affects the recollection of the mindful experience. Overall, MPSp proved to be a valid short mindfulness measure.

Integrative psycho-biophysiological markers in predicting psychological resilience

The hypothalamic-pituitary-adrenal (HPA) and parasympathetic nervous systems have been reported to play important roles in emotion regulation and stress coping. Yet, their direct relationship with psychological resilience remains unclear. These biophysiological features should be considered together with the traditional psychometric properties in studying resilience more comprehensively. The current study aimed to examine the role of these systems during a laboratory stress task and to determine the prediction power of resilience by combining psychological and biophysiological features. One hundred and seven (52 females) university students without psychiatric disorders underwent the Trier Social Stress Task (TSST). Psychometric properties of resilience were measured at rest; vagal heart rate variability (HRV), salivary cortisol, and dehydroepiandrosterone (DHEA) levels were captured at baseline, during, and after TSST. Multivariate linear regression as well as support vector regression machine-learning analyses were performed to investigate significant predictors and the prediction power of resilience. Results showed that positive and negative affects, HRV during the anticipatory phase of stress, and the ratio of cortisol/DHEA at the first recovery time point were significant predictors of resilience. The addition of biophysiological features increased the prediction power of resilience by 1.2-fold compared to psychological features alone. Results from machine learning analyses further demonstrated that the increased prediction power of resilience by adding the ratio of cortisol/DHEA was significant in "cortisol responders"; whereas a trend level was observed in "cortisol non-responders". Our findings extend the knowledge from the literature that high vagal activity during the anticipating phase of stress and the ability to restore the balance between cortisol and DHEA after a stress event could be an important feature in predicting resilience. Our findings also further support the need of combining psychological and biophysiological features in studying/predicting resilience.

Mental Health, resilience, and religiosity in the elderly under COVID-19 quarantine in Qatar

INTRODUCTION

Corona Virus Disease 2019 (COVID-19) quarantine has been associated with depression, anxiety, and stress symptoms. We hypothesize these symptoms might even be more pronounced in the elderly, who may be particularly sensitive to social isolation. However, certain individuals might be more resilient than others due to their coping mechanisms, including religious coping.

OBJECTIVES

We aimed to examine the levels of perceived stress, depressive, and anxiety symptoms in older adults under COVID-19 quarantine in Qatar; and to identify the sociodemographic, psychological, and clinical factors associated with mental health outcomes, with a focus on the role of resilience, and religiosity.

METHODS

A cross-sectional study assessing depressive, anxiety, and stress symptoms as well as resilience, and religiosity through a phone survey in adults aged 60 years or more under COVID-19 quarantine in the State of Qatar, in comparison to age and gender-matched controls.

RESULTS

The prevalence of depressive, anxiety, and stress symptoms in elderly subjects under COVID-19 quarantine in Qatar was not significantly different from the prevalence in gender and age-matched controls. In the quarantined group, higher depressive, anxiety, and stress scores were associated with the female gender and with lower resilience scores but were not linked to age, psychiatric history, medical history, duration of quarantine, or religiosity.

CONCLUSION

The elderly population does not seem to develop significant COVID-19 quarantine-related psychological distress, possibly thanks to high resilience and effective coping strategies developed through the years.

Association between change in sleep duration and posttraumatic stress symptoms in natural disaster victims: the mediating role of resilience

OBJECTIVE

This study investigated the association between changes in sleep duration after disaster and post-traumatic stress disorder (PTSD) symptoms and the mediating role of resilience on the association.

METHODS

Data were collected from 2951 Korean adults who were victims of a natural disaster and did not have any mental or medical illnesses before the event. They completed a long-term survey on changes in life for disaster victims using computer-aided personal interviews. Changes in sleep duration before and one month after experiencing a disaster were assessed using a self-reported questionnaire. Resilience levels and PTSD symptoms were measured using the Brief Resilience Scale and the Impact of Event Scale - Revised, respectively, and more than 33 of the IES-R score items were defined as significant PTSD symptoms. Multivariate logistic regression was used to examine the associations between changes in sleep duration and PTSD symptoms. Additionally, mediating studies were conducted to identify the role of resilience on the association.

RESULTS

Compared with participants without significant PTSD symptoms, those with PTSD symptoms were more likely to be older and female (group without significant PTSD symptom: mean age = 56.12 ± 18.70 years, female sex = 49.24%; group with significant PTSD symptoms: mean age = 60.88 ± 15.66 years, female sex = 59.52%). Compared with disaster victims without changes in sleep duration, those who had shorter sleep duration after disaster had a higher risk of significant PTSD symptoms (OR = 2.89, 95% Cl = 2.31-3.62, p < 0.001). In the mediating study, resilience level significantly mediated the relationship between reduced sleep duration and PTSD symptoms (direct effect: β = 0.208, 95% Cl = 0.166-0.250, p < 0.001; indirect effect: β = 0.007, 95% Cl = 0.002-0.011, p < 0.001; total effect: β = 0.215, 95% Cl = 0.173-0.257, p < 0.001).

CONCLUSION

This study revealed that individuals with reduced sleep duration after disaster had a higher risk of PTSD symptoms, while those with increased sleep duration did not. In addition, mediating effects of resilience level on the relationship between reduced sleep duration and significant PTSD symptoms were observed.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

OBJECTIVE

We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic.

METHODS

We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores.

RESULTS

Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers.

CONCLUSION

Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Resilience patterns and transitions in the Be Resilient To Breast Cancer trial: an exploratory latent profile transition analysis

OBJECTIVE

Be Resilient to Breast Cancer (BRBC), a theoretically-derived, resilience-based, culturally-tailored, supportive-expressive group therapy (SEGT), has been developed to help promote patients' resilience in breast cancer. Data from patients receiving BRBC intervention was utilized to explore and define characteristics of resilience patterns and their transitions over time.

METHODS

Resilience was used as a primary outcome and 391 patients completed Resilience Scale Specific to Cancer at enrollment (T0), 2 months (T1), 6 months(T2), and 12 months (T3) after intervention. latent profile transition analysis was performed to model the change in resilience and predict positive transitioning probabilities between resilience patterns (from one pattern to another pattern with a higher level) over time.

RESULTS

One hundred and forty four resilience patterns were identified after BRBC intervention. 33.1%, 50.3%, and 40.5% of patients experienced positive resilience transitions from T0 to T1, T1 to T2, and T2 to T3, respectively. Patients with middle age, unmarried status, higher education level, and less advanced tumor stage were more likely to experience positive resilience transitions.

CONCLUSION

Different transitions of resilience patterns are observed after BRBC intervention. Age, marital status, education, and tumor stage may be four factors affecting the efficacy of SEGT intervention in breast cancer.

Validation of Death and Dying Distress Scale-Chinese Version and Prevalence of Death Anxiety Among Patients With Advanced Cancer

Purpose: Death anxiety is commonly experienced by individuals with advanced cancer who have a limited life expectancy. The Death and Dying Distress Scale (DADDS) is a validated measure that was created to capture this experience; but no Chinese version is available to date. We conducted a cross-sectional study to explore the psychometric properties of a Chinese version DADDS (DADDS-C) and address prevalence of death anxiety among patients with advanced cancer. Methods: Patients with advanced cancer were recruited from Peking University Cancer Hospital. Measures administered included: DADDS-C, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder-7(GAD-7), Quality of Life at End of Life in Cancer (QUAL-EC), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-sp). McDonald's Omega, Cronbach's alpha, Exploratory Factor Analysis and Confirmatory Factor Analysis were used to test DADDS-C's reliability and validity. Logistic regression analysis was used to identify risk factors for death anxiety. Results: Of 300 patients approached, 256 (85%) provided informed consent and completed the questionnaires. Of these participants, 43 (16.8%) had moderate death anxiety based on scores of ≥45 on the DADDS-C. Three factors (feeling shortness of time, dying and death distress, being a burden to others) explained 71.643% of shared variation with factor loadings ranging from 0.629 to 0.822. Cronbach's alpha was 0.939; Omega total was 0.959. DADDS-C had acceptable convergent and discriminant validity. Logistic regression analysis indicated that two factors (better relationship with healthcare providers and preparation for end of life) protected patients from death anxiety. Conclusion: DADDS-C is a valid tool for measuring death anxiety in Chinese patients with advanced cancer. The presence of at least moderate death anxiety in a substantial minority of these patients calls for screening for this symptom and for more routine psychological interventions to alleviate and prevent such distress in this population.

Minimum clinical important difference for resilience scale specific to cancer: a prospective analysis

BACKGROUND

The minimum clinical important differences (MCIDs) of resilience instruments in patients with cancer have not been comprehensively described. This study was designed to evaluate MCIDs of 10-item and 25-item resilience scales specific to cancer (RS-SC-10 and RS-SC-25).

METHODS

From June 2015 to December 2018, RS-SCs were longitudinally measured in 765 patients with different cancer diagnoses at baseline (T0) and 3 months later (T1). The EORTC QLQ-C30, Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Allostatic Load Index were measured concurrently as anchors. Anchor-based methods (linear regression, within-group), distribution-based methods(within-group), and receiver operating characteristic curves (ROCs, within-subject) were performed to evaluate the MCIDs.

RESULTS

623 of 765 (84.1%) patients had paired RS-SCs scores. Moderate correlations were identified between the change in RS-SCs and change in anchors (r = 0.38-0.44, all p < 0.001). Linear regression estimated + 8.9 and - 6.7 as the MCIDs of RS-SC-25, and + 3.4 and - 2.5 for RS-SC-10. Distribution-based methods estimated + 9.9 and - 9.9 as the MCIDs of RS-SC-25, and + 4.0 and - 4.0 for RS-SC-10. ROC estimated + 5.5 and - 4.5 as the MCIDs of RS-SC-25, and + 2.0 and - 1.5 for RS-SC-10.

CONCLUSIONS

The most reliable MCID is around 5 points for RS-SC-25 and 2 points for RS-SC-10. RS-SCs are more responsive to the worsening status of resilience in patients with cancer and these estimates could be useful in future resilience-based intervention trials.

Sources of perceived social support on resilience amongst parents raising children with special needs in Ghana

BACKGROUND

While parenting a child with special needs is burdensome, some parents do overcome through protective resources. Social support has been widely linked to this unique ability to overcome the challenges of raising a child with special needs. In spite of this, there is still paucity of research about the influence of the sources of perceived social support on this ability, known as resilience.

AIM

This study examined three sources of perceived social support-family, friends and significant other-on the resilience of Ghanaian parents raising children with special needs while adjusting for covariates (parental gender, marital status and educational level).

METHODS

One hundred and seven (107) biological parents were recruited from special schools and parents support groups in Accra, Ghana. They completed paper-and-pencil or online questionnaires on resilience and perceived social support.

RESULTS

Output from hierarchical multiple regression after adjusting for covariates showed that only support from significant others predicted resilience. Additionally, being married was positively and holding a higher education was inversely associated with resilience.

CONCLUSION AND IMPLICATION

These findings indicate the importance of support from significant others in the resiliency of parents but underscore the need to fully integrate and emphasize support from the other sources in resilience enhancing interventions.

Prevalence of Prenatal Depression Among Pregnant Women and the Importance of Resilience: A Multi-Site Questionnaire-Based Survey in Mainland China

BACKGROUND

Prenatal depression is associated with adverse maternal and fetal health consequences, yet it has not raised sufficient concerns in China. Psychological worries and stress may lead to prenatal depression, but resilience could relieve some of the negative effects of worries and stress and mitigate prenatal depression.

AIMS

This study aimed to assess the prevalence of prenatal depression and explore its associated factors.

METHOD

A multisite cross-sectional study was conducted that included 605 pregnant women from three hospitals in two provincial capitals (Shenyang and Zhengzhou) and one municipality (Chongqing). A smartphone questionnaire was employed to assess prenatal depression using the Center for Epidemiologic Studies Depression Scale (CES-D). Multivariate logistic regression analysis was performed to explore factors associated with prenatal depression.

RESULTS

The prevalence of prenatal depression (CES-D≥16) among Chinese pregnant women was 28.4%. Logistic regression analyses revealed that prenatal depression was positively associated with worries about appearance (odds ratio [OR] 1.666, 95% confidence interval [CI] 1.043-2.661) and perceived stress (OR 1.156, 95% CI 1.104-1.211) and negatively associated with monthly income, relationship with mother (OR 0.287, 95% CI 0.103-0.796), and resilience (OR 0.935, 95% CI 0.918-0.953).

CONCLUSION

These findings revealed that Chinese pregnant women suffered from high levels of prenatal depression (28.4%). Worries about appearance and perceived stress were risk factors for prenatal depression, whereas a pregnant woman's harmonious relationship with her own mother and resilience could relieve the negative impacts of pregnancy that can lead to prenatal depression. Improving resilience and maintaining harmonious relationships with mothers should be emphasized in order to reduce the detrimental effects of pregnancy and improve the mental well-being of pregnant women.