Brief interventions for young adults who use drugs: The moderating effects of resilience and trauma

Measuring Resilience in the Context of Conflict-Related Sexual Violence: A Novel Application of the Adult Resilience Measure (ARM)

There is a rich body of research addressing the issues of conflict-related sexual violence, and a similar wealth of scholarship focused on resilience. To date, however, these literatures have rarely engaged with each other. This article developed from an ongoing research project that seeks to address this gap, by exploring how victims-/survivors of conflict-related sexual violence in three highly diverse settings - Bosnia-Herzegovina, Colombia and Uganda - demonstrate resilience. This research is the first to apply the Adult Resilience Measure (ARM), a 28-item scale that seeks to measure protective resources across individual, relational, and contextual subscales, to the context of conflict-related sexual violence. A total of 449 female and male participants in the three aforementioned countries completed the ARM (in the framework of the study questionnaire) as part of this research. This article presents some of the results of the analyses. Specifically, we first sought to establish through Confirmatory Factor Analysis whether the ARM was actually measuring the same construct in all three countries, by confirming the invariance (or otherwise) of the factor structure. The second aim was to explore how different resources function and cluster in different cultural contexts, to arrive at a more nuanced understanding of the different protective factors in the lives of study participants. We generated different factor structures for BiH, Colombia, and Uganda respectively, suggesting that a single factor structure does not sufficiently capture the diverse groupings of protective factors linked to the particularities of each country, including the dynamics of the conflicts themselves. Ultimately, we use the findings to underscore the need for policy approaches that move away from a deficit model and give greater attention to strengthening and investing in the (often overlooked) protective resources that victims-/survivors may already have in their everyday lives.

Personality Disorders, Risky Behaviors, and Adversity: The Moderating Role of Resilience

Individuals with personality disorders (PDs) comprise 30% to 40% of individuals receiving mental health treatment. Treatment of PDs is exceedingly difficult; therefore, research has focused on PD etiology and preventative factors. One known influence on PD etiology is adverse childhood experiences (ACEs). ACEs are associated with increased prevalence of several health risk behaviors (HRBs), including engagement in substance use, criminal, and risky sexual behavior. One protective factor, childhood resiliency, predicts lower prevalence of PDs and engagement in HRBs. We hypothesized that increased prevalence of ACEs would predict higher levels of PD symptoms and HRBs engagement. Furthermore, we predicted that childhood resiliency would moderate the relation between ACEs, PD symptoms, and HRBs. In the present study, students (N = 531) completed the Adverse Childhood Experiences survey, the Self-Administered - Standardized Assessment of Personality Abbreviated Scale, and the Childhood Youth and Resiliency Measure-28. They also responded to questions about substance use, criminal, and sexual behavior which were used to define a latent HRB variable. Structural equation modeling was conducted to examine study hypotheses. As hypothesized, we found positive relations between ACEs, PD symptoms, and our HRB latent variable. Childhood resiliency moderated both ACE and PD symptom paths. At lower levels of reported ACEs, individuals high in childhood resiliency reported fewer PD symptoms and HRBs than individuals low in childhood resiliency. At high levels of ACEs, childhood resiliency did not serve as a protective factor. Additionally, study findings suggest that childhood resiliency factors are integral for protecting against the development of these disorders.

Changes in young adult substance use during COVID-19 as a function of ACEs, depression, prior substance use and resilience

Background: Given the potential for increased substance use during COVID-19, we examined (1) young adults' changes in cigarette, e-cigarette, marijuana, and alcohol use from pre- to during COVID-19; and (2) related risk/protective factors. These findings could inform intervention efforts aimed at curbing increases in substance use during periods of societal stress. Methods: We analyzed Wave 3 (W3; September-December 2019) and Wave 4 (W4; March-May 2020) from the Vape shop Advertising, Place characteristics and Effects Surveillance (VAPES), a 2-year, five-wave longitudinal study of young adults across six metropolitan areas. We examined risk/protective factors (i.e. adverse childhood experiences [ACEs], depressive symptoms, resilience) in relation to changes in past 30-day substance use frequency. Results: In this sample (N = 1084, Mage=24.76, SD = 4.70; 51.8% female; 73.6% White; 12.5% Hispanic), W3/W4 past 30-day use prevalence was: 29.1% cigarettes (19.4% increased/26.4% decreased), 36.5% e-cigarettes (23.2% increased/28.6% decreased), 49.4% marijuana (27.2% increased/21.2% decreased), and 84.8% alcohol (32.9% increased/20.7% decreased). Multivariate regressions indicated that, greater increases were predicted by: for e-cigarettes, greater ACEs; and for alcohol, greater depression. Among those with low resilience, predictors included: for e-cigarettes, greater depression; and for marijuana, greater ACEs. Conclusions: Interventions to reduce substance use during societal stressors should target both risk and protective factors, particularly resilience.

Retrospective development of a novel resilience indicator using existing cohort data: The adolescent to adult health resilience instrument

Background

Cohort studies represent rich sources of data that can be used to link components of resilience to a variety of health-related outcomes. The Adolescent to Adult Health (Add Health) cohort study represents one of the largest data sets of the health and social context of adolescents transitioning into adulthood. It did not however use validated resilience scales in its data collection process. This study aimed to retrospectively create and validate a resilience indicator using existing data from the cohort to better understand the resilience of its participants.

Methods

Questions asked of participants during one Add Health data collection time period (N = 15,701) were matched to items on a well-known and widely validated resilience scale called the Connor Davidson Resilience Scale. Factor analysis and psychometric analyses were used to refine and validate this novel Adolescent to Adult Health Resilience Instrument. Construct validity utilized participants’ answers to the 10 item Center for Epidemiologic Studies Depression Scale, which has been used to validate other resilience scales.

Results

Factor analysis yielded an instrument with 13 items that showed appropriate internal consistency statistics. Resilience scores in our study were normally distributed with no ceiling or floor effects. Our instrument had appropriate construct validity, negatively correlating to answers on the depression scale (r = -0.64, p<0.001). We also found demographic differences in mean resilience scores: lower resilience scores were seen among women and those who reported lower levels of education and household income.

Conclusions

It is possible to retrospectively construct a resilience indicator from existing cohort data and achieve good psychometric properties. The Adolescent to Adult Health Resilience Instrument can be used to better understand the relationship between resilience, social determinants of health and health outcomes among young adults using existing data, much of which is publicly available.

Resilience During Pregnancy by Race, Ethnicity and Nativity: Evidence of a Hispanic Immigrant Advantage

The similar socioeconomic position of black and Hispanic women coupled with better birth outcomes among Hispanic women is termed the "Hispanic Paradox." However, birth outcome disparities among Hispanic women exist by maternal nativity. Persistent unequal exposure over time to stressors contributes to these disparities. We hypothesized that variation in maternal resilience to stressors also exists by race, ethnicity, and nativity. We utilized data from the Spontaneous Prematurity and Epigenetics of the Cervix study in Boston, MA (n = 771) where resilience was measured mid-pregnancy using the Connor Davidson Resilience Scale 25. We assessed resilience differences by race/ethnicity, by nativity then by race, ethnicity, and nativity together. We also assessed the risk of low resilience among foreign-born women by region of origin. We used Poisson regression to calculate risk ratios for low resilience, adjusting for maternal age, education, and insurance. Resilience did not differ significantly across race/ethnicity or by foreign-born status in the overall cohort. US-born Hispanic women were more likely to be in the low resilience tertile compared with their foreign-born Hispanic counterparts (adjusted RR 3.52, 95% CI 1.18-10.49). Foreign-born Hispanic women also had the lowest risk of being in the low resilience tertile compared with US-born non-Hispanic white women (aRR 0.33, 95% CI 0.11-0.98). Resilience did not differ significantly among immigrant women by continent of birth. Overall, foreign-born Hispanic women appear to possess a resilience advantage. Given that this group often exhibits the lowest rates of adverse birth outcomes, our findings suggest a deeper exploration of resilience among immigrant Hispanic women.