Concepts of Resilience in Adolescent Mental Health Research

Inconsistency in psychological resilience and social support with mental health in early adolescents: A multilevel response surface analysis approach

BACKGROUND

Given the high prevalence of adolescent mental health problems, promoting understanding and implementation of protective factors is crucial for prevention and intervention efforts addressing adolescent mental health problems. This study aims to investigate whether consistency and inconsistency in protective factors are associated with adolescent mental health problems and to inform adolescent mental health interventions that target the unique needs of adolescents and promote adolescent mental health.

METHODS

We used multistage cluster sampling to conduct psychological resilience, social support, and mental health questionnaires from April to June 2023 among 10,653 Chinese adolescents (52.3 % were boys). Data were analyzed using polynomial regressions with response surface analysis.

RESULTS

The higher levels of psychological resilience and social support in adolescents were associated with fewer mental health problems (anxiety: a1 = -1.83, P < 0.001; depression: a1 = -2.44, P < 0.001; and perceived stress: a1 = -1.20, P < 0.001). When the level of psychological resilience was greater than social support, the greater the discrepancy the higher the perceived stress among adolescents (a3 = 1.19, P < 0.001). Moreover, the consistency of psychological resilience and social support had a greater impact on girls' mental health (anxiety: a1 = -1.97, P < 0.001; depression: a1 = -2.71, P < 0.001; perceived stress: a1 = -1.23, P < 0.001).

LIMITATIONS

The cross-sectional study design limited the inference of causal relationships between variables.

CONCLUSIONS

These results emphasize that adolescents need a balanced development of protective factors and targeted intervention programs for different mental health problems.

Multi-level factors associated with psychological resilience in the face of adverse childhood experiences among Chinese early adolescents

BACKGROUND

Adverse childhood experiences (ACEs) are pervasive and exert enduring negative effects on health throughout one's life. A better understanding of resilience among adolescents with ACEs exposure is crucial to enhance their mental health; however, comprehensive and multifaceted analyses of its associated factors are limited.

OBJECTIVE

This study aimed to investigate multi-level correlates of psychological resilience in Chinese early adolescents exposed to ACEs.

PARTICIPANTS AND SETTING

In a sample of 5724 middle school students, 65.5 % (n = 3749; 49.1 % females; Mage = 13.57, SD = 0.96) reported ACEs during their primary school period and were finally included in this study.

METHOD

Both linear regression and network models were conducted to explore correlates of capacity- and outcome-oriented resilience at the individual (i.e., five personality traits, emotional release, and loneliness), family (i.e., family support and relationships with the mother and father), and school levels (i.e., peer support, teacher support, and relationships with classmates and teachers).

RESULTS

Linear regression analysis revealed that all correlates were associated with capacity- (β ranged from -0.271 to 0.503, PFDR < 0.001 for all) and outcome-oriented resilience (β ranged from -0.516 to 0.229, PFDR < 0.001 for all). Similarly, network analysis revealed that neuroticism, conscientiousness, loneliness, emotional release, extraversion, and the relationship with the mother were directly associated with both capacity- (weights ranged from 0.029 to 0.179) and outcome-oriented resilience (weights ranged from 0.024 to 0.396). However, openness, peer and family support, and relationships with classmates and teachers were directly associated with capacity-oriented resilience (weights ranged from 0.020 to 0.201).

CONCLUSIONS

This study identified the shared and unique associated factors for capacity- and outcome-oriented resilience in the face of ACEs and demonstrated the complex interactions between these factors, which can guide tailored interventions to enhance resilience among Chinese early adolescents with ACEs exposure. Further longitudinal studies may endeavor to confirm our results.

One-year recovery rates for young people with depression and/or anxiety not receiving treatment: a systematic review and meta-analysis

OBJECTIVES

To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022.

ELIGIBILITY CRITERIA

Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10-24 years without specific treatment.

DATA EXTRACTION AND SYNTHESIS

Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale.

RESULTS

Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63).

CONCLUSIONS

The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety.

PROSPERO REGISTRATION NUMBER

CRD42021251556.

How does social media use influence the mental health of pancreatic cancer patients: a chain mediating effect of online social support and psychological resilience

Background

Pancreatic cancer is an extremely malignant disease that poses a serious threat to the mental health of patients. Many cancer patients now use social media for online social support. However, the impact of social media on mental health is currently inconsistent in the academic community. Therefore, this study aimed to examine the mediating effects of online social support and psychological resilience in the relationship between social media use and mental health of pancreatic cancer patients.

Methods

Four hundred and twenty-five valid questionnaires were collected through convenience sampling. All data were processed using SPSS 26.0 and AMOS 26.0. We examine the influence relationships among latent variables by constructing a structural equation model. Then SPSS Process Macro was used to test the chain mediating effect of the model.

Results

The results showed that (1) anxiety situations occurred in 22.2% of participants (N = 94), while the incidence of depression was 20.2% (N = 86). (2) Social media use positively influenced online social support (β = 0.990, p < 0.001), psychological resilience (β = 0.504, p < 0.001), and mental health (β = 0.330, p < 0.001); online social support positively influenced psychological resilience (β = 0.535, p < 0.001) and mental health (β = 0.354, p < 0.001); psychological resilience significantly and positively influenced mental health (β = 0.243, p < 0.001). (3) The chain mediating effect of online social support and psychological resilience was significant at 0.253 with a confidence interval of [0.178, 0.340].

Conclusion

Pancreatic cancer patients in China are exposed to a high burden of anxiety and depression, which requires urgent attention. Meanwhile, online social support and psychological resilience played a chain mediating role between social media use and mental health (anxiety and depression), and our results provide new insights and ways to support the mental health improvement of pancreatic cancer patients.

Association of Child Sexual Abuse Victimization and Murderous Behaviors and the Mediating Role of Psychological Adjustment among College Students in China

A history of child sexual abuse (CSA) is associated with a variety of psychological issues and conduct disorders in adolescents. However, little is known about the association between CSA and its characteristics and murderous behaviors in young adults. The purpose of this study was to examine this relationship and explore the mediating effect of psychological adjustment (PA). A cross-sectional study was conducted with 4034 college students in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding the history of CSA, self-perceived PA and murderous behaviors. PA was evaluated by two of the most important indicators: resilience and emotional release. Mediation analyses were computed via parallel mediation models. Of the participants, 14.1% reported experiencing CSA. After controlling for potential confounders, CSA victimization was robustly and positively associated with murderous ideation (OR: 2.36, 95% CI: 1.77-3.14), murderous plans (OR: 4.02, 95% CI: 2.63-6.12), murderous preparation (OR: 3.87, 95% CI: 2.37-6.31), and murderous attempts (OR: 5.35, 95% CI: 3.11-9.21). CSA victimization that was persistent and of the combined contact or noncontact types greatly increased the risk of murderous behaviors. A dose-response relationship was observed between the duration of experienced CSA and murderous behaviors. Furthermore, the results of the mediation analysis revealed that PA partially mediated the relationship between CSA victimization and murderous behaviors. Therefore, PA protects against the development of murderous behaviors in abused individuals. These findings have important implications for the prevention and intervention of murderous behaviors in adolescents who experienced CSA, highlighting the importance of considering PA as a protective role in this relationship.

Role of the arts in the life and mental health of young people that participate in artistic organizations in Colombia: a qualitative study

BACKGROUND

Adolescents and young adults are vulnerable to developing mental distress. However, evidence suggests that more than half of the young people with symptoms of depression and anxiety overcome their distress within a year. However, there is little research on the exact resources that young people use and help them to recover. The aim of this study was to explore how arts activities can support the recovery of young people engaged with arts organizations in Bogota.

METHODS

We recruited 38 participants from two arts organizations in Bogotá and conducted six focus groups embedded within artistic workshops. The type of activities in the workshops varied reflecting the different teaching methods of the two organizations. The focus group discussions were recorded and analyzed using thematic analysis.

RESULTS

Five themes explained how arts activities can help young people participating in artistic organizations to overcome mental distress: i) allowing the expression of emotions; ii) helping to manage and transform emotions; iii) distracting from problems; iv) facilitating social support and relationships; and v) contributing to the identity of young people.

CONCLUSIONS

For young people who participate in artistic organizations, the arts are a resource for overcoming negative emotions such as anxiety, depression, and sadness. The beneficial role of arts activities includes different process of managing, expressing, and distracting from distress, and it differs depending on whether arts are perceived as a professional vocation or a hobby.

“Flying over the crisis”: A study on interdisciplinary metaphors of resilience

Background/Aim: Metaphors on theoretical concepts may be congruent or divergent from their explicit definitions. We carried out a secondary qualitative analysis on metaphors of members of an interdisciplinary research group on resilience and investigated: (A) Which metaphors do experts in different disciplines use to describe people showing resilience? (B) Do these (implicit) metaphors support the (explicit) theses of the research group on resilience? (C) Do we find differences between experts from different disciplines in the use of metaphors on resilience? Method: Nine guideline-based interviews with experts from medicine, psychology, philosophy, and theology were studied using a systematic metaphor analysis, basing on inductive and deductive categorizations. Results: Eight metaphor sources were identified, for example, battle, path. Experts used similar metaphors to describe resilience that often overarched the concepts of resilience as a trait, process, and outcome. Moments of vulnerability within the resilience trajectory were found. Conclusions: The analysis revealed high concordance of metaphors across different disciplines, reflecting both the ideas of the group as well as the mainstream view of resilience. This supports that implicit concepts may be more difficult to reframe than explicit theories. Few differences between disciplines may point to the impact of an overarching Western concept of individual resilience.

Psychological adjustment mediating the relationship between childhood maltreatment and borderline personality features among Chinese early adolescents

BACKGROUND

A strong link between childhood maltreatment (CM) and borderline personality features (BPF) has been consistently demonstrated. However, little is known about the role of psychological adjustment (PA) as a mediator of this relationship. The purpose of the study was to explore the mediating role of PA in the CM-BPF linkage in a large sample of early adolescents.

METHODS

A total of 5724 students (mean age = 13.5, SD = 1.0) were recruited from three middle schools by using the multistage random cluster sampling method in Anhui Province, China. Participants were required to complete self-report questionnaires regarding CM experience, self-perceived PA and BPF. Mediation analyses were computed via structural equation modelling.

RESULTS

CM victimization was positively associated with BPF, and individuals with lower levels of PA were more likely to present with BPF. Mediation analysis showed a significant indirect effect of CM on BPF via PA (effect = 0.047, 95 % CI: 0.035, 0.058).

LIMITATION

The cross-sectional design of this study did not allow testing causality. The retrospective investigation of CM history could cause recall bias.

CONCLUSIONS

PA partially mediates the relationship between CM and BPF. These findings have important implications for considering PA as a protective factor in this relationship.

Resilience in Web-Based Mental Health Communities: Building a Resilience Dictionary With Semiautomatic Text Analysis

Background

Resilience is an accepted strengths-based concept that responds to change, adversity, and crises. This concept underpins both personal and community-based preventive approaches to mental health issues and shapes digital interventions. Online mental health peer-support forums have played a prominent role in enhancing resilience by providing accessible places for sharing lived experiences of mental issues and finding support. However, little research has been conducted on whether and how resilience is realized, hindering service providers’ ability to optimize resilience outcomes.

Objective

This study aimed to create a resilience dictionary that reflects the characteristics and realization of resilience within online mental health peer-support forums. The findings can be used to guide further analysis and improve resilience outcomes in mental health forums through targeted moderation and management.

Methods

A semiautomatic approach to creating a resilience dictionary was proposed using topic modeling and qualitative content analysis. We present a systematic 4-phase analysis pipeline that preprocesses raw forum posts, discovers core themes, conceptualizes resilience indicators, and generates a resilience dictionary. Our approach was applied to a mental health forum run by SANE (Schizophrenia: A National Emergency) Australia, with 70,179 forum posts between 2018 and 2020 by 2357 users being analyzed.

Results

The resilience dictionary and taxonomy developed in this study, reveal how resilience indicators (ie, “social capital,” “belonging,” “learning,” “adaptive capacity,” and “self-efficacy”) are characterized by themes commonly discussed in the forums; each theme’s top 10 most relevant descriptive terms and their synonyms; and the relatedness of resilience, reflecting a taxonomy of indicators that are more comprehensive (or compound) and more likely to facilitate the realization of others. The study showed that the resilience indicators “learning,” “belonging,” and “social capital” were more commonly realized, and “belonging” and “learning” served as foundations for “social capital” and “adaptive capacity” across the 2-year study period.

Conclusions

This study presents a resilience dictionary that improves our understanding of how aspects of resilience are realized in web-based mental health forums. The dictionary provides novel guidance on how to improve training to support and enhance automated systems for moderating mental health forum discussions.

Identifying resources used by young people to overcome mental distress in three Latin American cities: a qualitative study

OBJECTIVE

To explore which resources and activities help young people living in deprived urban environments in Latin America to recover from depression and/or anxiety.

DESIGN

A multimethod, qualitative study with 18 online focus groups and 12 online structured group conversations embedded into arts workshops.

SETTING

This study was conducted in Bogotá (Colombia), Buenos Aires (Argentina) and Lima (Peru).

PARTICIPANTS

Adolescents (15-16 years old) and young adults (20-24 years old) with capacity to provide assent/consent and professionals (older than 18 years of age) that had experience of professionally working with young people were willing to share personal experience within a group, and had capacity to provide consent.

RESULTS

A total of 185 participants took part in this study: 111 participants (36 adolescents, 35 young adults and 40 professionals) attended the 18 focus groups and 74 young people (29 adolescents and 45 young adults) took part in the 12 arts workshops. Eight categories captured the resources and activities that were reported by young people as helpful to overcome mental distress: (1) personal resources, (2) personal development, (3) spirituality and religion, (4) social resources, (5) social media, (6) community resources, (7) activities (subcategorised into artistic, leisure, sports and outdoor activities) and (8) mental health professionals. Personal and social resources as well as artistic activities and sports were the most common resources identified that help adolescents and young adults to overcome depression and anxiety.

CONCLUSION

Despite the different contexts of the three cities, young people appear to use similar resources to overcome mental distress. Policies to improve the mental health of young people in deprived urban settings should address the need of community spaces, where young people can play sports, meet and engage in groups, and support community organisations that can enable and facilitate a range of social activities.

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.

Which resources help young people to prevent and overcome mental distress in deprived urban areas in Latin America? A protocol for a prospective cohort study

INTRODUCTION

Improving the mental health of young people is a global public health priority. In Latin America, young people living in deprived urban areas face various risk factors for mental distress. However, most either do not develop mental distress in the form of depression and anxiety, or recover within a year without treatment from mental health services. This research programme seeks to identify the personal and social resources that help young people to prevent and recover from mental distress.

METHODS AND ANALYSIS

A cross-sectional study will compare personal and social resources used by 1020 young people (aged 15-16 and 20-24 years) with symptoms of depression and/or anxiety and 1020 without. A longitudinal cohort study will follow-up young people with mental distress after 6 months and 1 year and compare resource use in those who do and do not recover. An experience sampling method study will intensively assess activities, experiences and mental distress in subgroups over short time periods. Finally, we will develop case studies highlighting existing initiatives that effectively support young people to prevent and recover from mental distress. The analysis will assess differences between young people with and without distress at baseline using t-tests and χ² tests. Within the groups with mental distress, multivariate logistic regression analyses using a random effects model will assess the relationship between predictor variables and recovery.

ETHICS AND DISSEMINATION

Ethics approvals are received from Ethics Committee in Biomedical Research, Faculty of Medicine, University of Buenos Aires; Faculty of Medicine-Research and Ethics Committee of the Pontificia Universidad Javeriana, Bogotá; Institutional Ethics Committee of Research of the Universidad Peruana Cayetano Heredia and Queen Mary Ethics of Research Committee. Dissemination will include arts-based methods and target different audiences such as national stakeholders, researchers from different disciplines and the general public.

TRIAL REGISTRATION NUMBER

ISRCTN72241383.