1
|
Yeo JJ, Chew QH, Sim K. Resilience and its inter-relationship with symptomatology, illness course, psychosocial functioning, and mediational roles in schizophrenia: A systematic review. Asia Pac Psychiatry 2022; 14:e12486. [PMID: 34431616 DOI: 10.1111/appy.12486] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/26/2021] [Accepted: 08/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter-relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors. METHODS A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020. RESULTS Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self-esteem), and psychosocial functioning (better overall, real-life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions. DISCUSSION Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter-relationships with carer resilience, and evaluate the efficacy of suitable resilience-targeted interventions in schizophrenia.
Collapse
Affiliation(s)
- Jerry Jay Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qian Hui Chew
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| |
Collapse
|
2
|
Shikimoto R, Noda Y, Kida H, Nakajima S, Tsugawa S, Mimura Y, Ochi R, Takayama M, Niimura H, Mimura M. Association between resilience and cortical thickness in the posterior cingulate cortex and the temporal pole in Japanese older people: A population-based cross-sectional study. J Psychiatr Res 2021; 142:89-100. [PMID: 34330025 DOI: 10.1016/j.jpsychires.2021.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/06/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Resilience is a crucial factor preventing the onset of mental illness and contributing to the well-being and healthy longevity, whose neural bases are not fully elucidated in older people. The present study aimed to identify the cortical thickness associating with resilience in older adults. METHODS This is a part of the cross-sectional Arakawa geriatric cohort study for people aged 65 years or older, consisting of 1001 individuals. A Self-Reported Resilience Scale (RS), neuropsychological batteries, face-to-face interviews for diagnosis, and a three-dimensional T1-weighted magnetic resonance imaging were conducted. Cortical thickness was computed by the FreeSurfer. The relationships among cortical thickness, total RS score, and clinico-demographic data were investigated using univariate and multivariable regression analyses. RESULTS The total RS score was correlated with age, education, and scores of the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) in univariate analyses. The total RS score was associated with cortical thicknesses in the left posterior cingulate (β [95 % CI of B] = 0.07 [0.16-14.84]) and the left temporal pole (β [95 % CI of B] = 0.08 [0.63-9.93]) after adjusting sex, age, imaging acquisition site, education, MMSE and GDS scores, hypertension, hyperlipidemia, diabetes mellitus, Barthel index, BMI, and living situation in multivariable regression analyses. CONCLUSION The present analyses suggest that the resilience capacity may be related to the cortical thickness in the posterior cingulate and temporal cortices in older adults. Our findings warrant further longitudinal studies to confirm the causal relationship between stress events, resilience, and brain structures.
Collapse
Affiliation(s)
- Ryo Shikimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Sakuragaoka Memorial Hospital, Tokyo, Japan.
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Yu Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Ryo Ochi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Midori Takayama
- Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, Japan.
| | - Hidehito Niimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| |
Collapse
|
3
|
Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia. Qual Life Res 2021; 31:507-516. [PMID: 34173172 DOI: 10.1007/s11136-021-02920-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life. METHODS Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). RESULTS Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; rs = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience. CONCLUSION Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.
Collapse
|
4
|
Wambua GN, Kilian S, Ntlantsana V, Chiliza B. The association between resilience and psychosocial functioning in schizophrenia: A systematic review and meta-analysis. Psychiatry Res 2020; 293:113374. [PMID: 32795771 DOI: 10.1016/j.psychres.2020.113374] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
The exploration of resilience in schizophrenia is recent and poorly understood. Literature suggests that exploration of the construct will help with the understanding of not only risk but also protective factors in individuals living with psychosis. We performed a systematic review and meta-analysis with the primary aim of synthesizing the evidence of an existing relationship between resilience and schizophrenia-spectrum disorders (SSD). We searched electronic databases for relevant articles that evaluated resilience and psychosocial functioning in participants with schizophrenia-spectrum disorders. Sixteen studies were deemed eligible for review. We also conducted a random-effects meta-analysis to explore resilience levels of study participants. Our findings highlight lower levels of resilience in SSD cohorts and poorer psychosocial functioning among those with low levels of resilience. Evidence also suggests that the presence of resilience in individuals with schizophrenia-spectrum disorders is associated with improved psychosocial functioning.
Collapse
Affiliation(s)
- G Nduku Wambua
- Department of Psychiatry, University of Kwa-Zulu Natal, Durban, South Africa.
| | - Sanja Kilian
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Vuyokazi Ntlantsana
- Department of Psychiatry, University of Kwa-Zulu Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, University of Kwa-Zulu Natal, Durban, South Africa
| |
Collapse
|
5
|
Shahar G. The Nature of the Beast: Commentary on “Can There Be a Recovery-Oriented Diagnostic Practice?”. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818777653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pavlo, Flanagam, Leither, and Davidson attempt to reconcile the recovery movement in mental health service with a formal diagnostic practice is as courageous as it is timely. Acknowledging this, I note several points of convergence and divergence with the authors’ views. Points of convergence include (1) the inevitability of a diagnostic system when working with (severe) mental illness, (2) the importance of going beyond signs and symptoms in capturing the unique characteristics of the person, (3) the focus on humanistic values, particularly the emphasis on a collaborative assessment and on human strengths, in the diagnostic process, and (4) the role of future-oriented thinking in diagnosis. Divergence with the authors concerns (1) my own reliance on descriptive psychiatry, with its focus on signs and symptoms, as a part and parcel of an effective diagnosis, (2) the potential benefits of psychological tests, for example, self-report questionnaires and projective procedures over and above the clinical interview, and (3) my emphasis on mental representations of self-with-others, termed here and elsewhere as “agents in relations,” as the building blocks of personality and psychopathology.
Collapse
Affiliation(s)
- Golan Shahar
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
6
|
Mizuno Y, Hofer A, Frajo-Apor B, Wartelsteiner F, Kemmler G, Pardeller S, Suzuki T, Mimura M, Fleischhacker WW, Uchida H. Religiosity and psychological resilience in patients with schizophrenia and bipolar disorder: an international cross-sectional study. Acta Psychiatr Scand 2018; 137:316-327. [PMID: 29141100 DOI: 10.1111/acps.12838] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The impact of religious/spiritual activities on clinical outcomes in patients with serious mental illnesses remains controversial, which was addressed in this international cross-sectional study. METHOD Three-hundred sixty-nine subjects were recruited from Austria (n = 189) and Japan (n = 180), consisting of 112 outpatients with paranoid schizophrenia, 120 with bipolar I disorder (DSM-IV), and 137 healthy controls. Religiosity was assessed in terms of attendance and importance of religious/spiritual activities, while resilience was assessed using the 25-item Resilience Scale. General linear models were used to test whether higher religiosity will be associated with higher resilience, higher social functioning, and lower psychopathology. The association between levels of spiritual well-being and resilience was also examined. RESULTS Attendance of religious services (F[4,365] = 0.827, P = 0.509) and importance of religion/spirituality (F[3,365] = 1.513, P = 0.211) did not show significant associations with resilience. Regarding clinical measures, a modest association between higher importance of religion/spirituality and residual manic symptoms was observed in bipolar patients (F[3,118] = 3.120, P = 0.029). In contrast to the findings regarding religiosity, spiritual well-being showed a strong positive correlation with resilience (r = 0.584, P < 0.001). CONCLUSION The protective effect of religiosity in terms of resilience, social functioning, and psychopathology was not evident in our sample. Spiritual well-being appears more relevant to resilience than religiosity.
Collapse
Affiliation(s)
- Y Mizuno
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - B Frajo-Apor
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - F Wartelsteiner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - G Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - S Pardeller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - T Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry and Clinical Ethics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - M Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - W W Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
7
|
Personal resources and depression in schizophrenia: The role of self-esteem, resilience and internalized stigma. Psychiatry Res 2017; 256:359-364. [PMID: 28686933 DOI: 10.1016/j.psychres.2017.06.079] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 05/03/2017] [Accepted: 06/25/2017] [Indexed: 11/22/2022]
Abstract
Depression in schizophrenia represents a challenge from a diagnostic, psychopathological and therapeutic perspective. The objective of this study is to test the hypothesis that resilience and self-stigma affect depression severity and to evaluate the strength of their relations in 921 patients with schizophrenia. A structural equation model was tested where depression is hypothesized as affected by resilience, internalized stigma, gender and negative symptoms, with the latter two variables used as exogenous covariates and the former two as mediators. The analysis reveals that low resilience, high negative symptoms, female gender were directly associated with depression severity, and internalized stigma acted only as a mediator between avolition and resilience, with similar magnitude. The cross-sectional study design and the variable selection limit the generalizability of the study results. The model supports a complex interaction between personal resources and negative symptoms in predicting depression in schizophrenia. The clinical implication of these findings is that personal resources could be a significant target of psychosocial treatments.
Collapse
|