Recent advances in the understanding and treatment of anxiety disorders. Resilience: determinants, measurement, and treatment responsiveness

Fostering resilience in young people with intellectual disabilities using a 'settings' approach

The need to foster resilience amongst young people with intellectual disabilities is increasingly recognised within policy. Critically, understanding of the actual means by which this aspiration might be most sensitively and effectively met is considered weak. This paper reports on an exploratory case-study of a social enterprise community café - The Usual Place - that through the promotion of employability, seeks to promote resilience amongst its young 'trainees' with intellectual disabilities. Two research questions were set: "how is 'resilience' conceptualized within the organisation" and "what features within the organisation are significant in fostering resilience"? We identify a range of significant features associated with being able to successfully foster resilience - the need for a foundational 'whole organisation'(settings) approach based on high levels of participation and choice; the negotiation of a constructive dynamic tension between 'support' and 'exposure'; and the embedding of these actions in embodied actions and day-to-day organisational activities.

Sex differences in the relationship between brain gray matter volume and psychological resilience in late adolescence

Psychological resilience reflects an individual's ability to adapt and cope successfully in adverse environments and situations, making it a crucial trait in resisting stress-linked mental disorders and physical diseases. Although prior literature has consistently shown that males are more resilient than females, the sex-linked neuroanatomical correlates of psychological resilience are largely unknown. This study aims to explore the sex-specific relation between psychological resilience and brain gray matter volume (GMV) in adolescents via structural magnetic resonance imaging (s-MRI). A cohort of 231 healthy adolescents (121/110 females/males), aged 16 to 20 completed brain s-MRI scanning and Connor-Davidson Resilience Scale (CD-RISC) and other controlling behavioral tests. With s-MRI data, an optimized voxel-based morphometry method was used to estimate regional GMV, and a whole-brain condition-by-covariate interaction analysis was performed to identify the brain regions showing sex effects on the relation between psychological resilience and GMV. Male adolescents scored significantly higher than females on the CD-RISC. The association of psychological resilience with GMV differed between the two sex groups in the left ventrolateral prefrontal cortex extending to the adjacent anterior insula, with a positive correlation among males and a negative correlation among females. The sex-specific association between psychological resilience and GMV might be linked to sex differences in the hypothalamic-pituitary-adrenal axis and brain maturation during adolescence. This study may be novel in revealing the sex-linked neuroanatomical basis of psychological resilience, highlighting the need for a more thorough investigation of the role of sex in future studies of psychological resilience and stress-related illness.

Positive effects of parent-child group emotional regulation and resilience training on nonsuicidal self-injury behavior in adolescents: a quasi-experimental study

Background

Nonsuicidal self-injury (NSSI) among adolescents is a growing global concern. However, effective interventions for treating NSSI are limited.

Method

A 36-week quasi-experimental study design of parent-child group resilience training (intervention group) for adolescents aged 12-17 years was used and compared with treatment-as-usual (control group). The primary endpoint was the frequency of NSSI assessed with the Ottawa Self-Injury Inventory (OSI), and the secondary endpoints were the levels of depression, hope, resilience, and family adaptability and cohesion as assessed by the 24-item Hamilton depression rating scale (HAMD-24), Herth Hope Scale (HHS), Connor-Davidson Resilience Scale (CD-RISC), and Family Adaptability and Cohesion Evaluation Scale, second edition (FACES-II-CV), respectively.

Result

A total of 118 participants completed the trial. Both groups showed a significant reduction in NSSI frequency after 12, 24, and 36 weeks of intervention (p< 0.05), although the intervention group did not differ significantly from the control group. After 12, 24, and 36 weeks of intervention, the CD-RISC, HHS, HAMD-24, and FACES-II-CV scores in the intervention and control groups improved over baseline (p< 0.05). Furthermore, the intervention group had higher scores on the CD-RISC, HHS, and FACES-II-CV and lower scores on the HAMD-24 than the control group after 12, 24, and 36 weeks of intervention (p  < 0.05).

Conclusion

Parent-child group emotional regulation and resilience training showed promise as treatment options for NSSI among adolescents, leading to increased hope, resilience, and improved family dynamics among NSSI teens. Moreover, NSSI frequency significantly decreased in the intervention group compared to baseline.

Can Resilience Buffer the Effects of Loneliness on Mental Distress Among Working-Age Adults in the United States During the COVID-19 Pandemic? A Latent Moderated Structural Modeling Analysis

BACKGROUND

The profound health consequences of loneliness are well-established. However, less is known about the protective factors which may alleviate the effects of loneliness on mental health especially among working-age adults amidst the COVID-19 pandemic. We draw on the social ecology of resilience and examine whether resilience factors can buffer the effects of loneliness on mental distress.

METHODS

Data came from the National Well-being Survey-a national study of a demographically representative sample of U.S. working-age adults (N = 4014). We used (a) structural equation models with latent variables to examine the main effects of loneliness, psychological resilience, and perceived social support on mental distress, and (b) latent moderated structural equations to estimate the latent interaction effects.

RESULTS

Results revealed that (a) loneliness was positively associated with mental distress and psychological resilience was negatively related to mental distress, and (b) psychological resilience and perceived social support moderated the strength of the relationship between loneliness and mental distress.

CONCLUSIONS

Our study highlights the importance of psychological resilience and perceived social support as two protective factors in the relationship between loneliness and mental distress. Given that loneliness significantly predicts worse mental and physical health and higher mortality, identifying protective factors that might disrupt these connections is vital. As such, public health efforts to strengthen and expand familial and community social support networks and foster psychological resilience are urgently needed to support mental health among working-age adults during additional waves of the pandemic or future similar stressors.

Changes in stress, burnout, and resilience associated with an 8-week intervention with relational agent "Woebot"

Background

Research investigating the potential for digital mental health interventions with integrated relational agents to improve mental health outcomes is in its infancy. By delivering evidence-based mental health interventions through tailored, empathic conversations, relational agents have the potential to help individuals manage their stress and mood, and increase positive mental health.

Aims

The aims of this study were twofold: 1) to assess whether a smartphone app delivering mental health support through a relational agent, Woebot, is associated with changes in stress, burnout, and resilience over 8 weeks, and 2) to identify demographic and clinical factors associated with changes in these outcomes.

Method

This exploratory, non-randomized, single-armed, open-labeled trial was conducted from May to July 2022. A total of 256 adults (mean age 39 ± 13.35; 72 % females) recruited through social media advertising enrolled in the study. Participants completed an 8-week intervention period during which they were invited to use a smartphone app called Woebot-LIFE that delivers cognitive behavioral therapy through a relational agent called "Woebot". Participant-reported measures of stress, burnout, and resilience were collected at Baseline, and Week 8. Changes in these outcomes during the study period were assessed. Bivariate and stepwise multiple regression modeling was used to identify sociodemographic and clinical factors associated with observed changes over the 8-week study period.

Results

Exposure to Woebot-LIFE was associated with significant reductions in perceived stress and burnout and significantly increased resilience over the 8-week study period. A greater reduction in stress was observed among those with clinically elevated mood symptoms (i.e., Patient Health Questionnaire-8 or Generalized Anxiety Disorder 7-item scores ≥10) at baseline compared to those without; however, the differences in the improvements in resilience scores and burnout between the two groups were not statistically significant. Although a difference in the magnitude of change in stress was observed for participants with and without clinically elevated mood symptoms at baseline, significant improvements in stress, burnout, and resilience over the 8-week study period were observed for both groups. Bivariate analyses showed that race, insurance type, and baseline level of resilience were associated with changes in each of the outcomes, though baseline resilience was the only factor that remained significantly associated with changes in the outcomes in the stepwise multiple regression analyses.

Conclusion

Results of this single-arm, exploratory study suggest that conversational agent-guided mental health interventions such as Woebot-LIFE may be associated with reduced stress and burnout and increased resilience in both clinical and non-clinical populations.

The impact of labour market shocks on mental health: evidence from the Covid-19 first wave

In this study, we estimate the effect of a negative labour market shock on individuals' levels of stress, anxiety, and depression. We use a dataset collected during the first wave of the Covid-19 pandemic, on a representative sample of citizens from Italy, Spain, and the United Kingdom, interviewed on three occasions. We measure stress, anxiety and depression and labour shocks using validated scales. Our research design is a standard difference-in-differences model: we leverage the differential timing of shocks to identify the impact on mental health. In our estimations, a negative labour shock increases the measure of stress, anxiety, and depression by 16% of a standard deviation computed from the baseline.

The promotion of sleep wellness: Resilience as a protective factor

Objectives

To evaluate the association between resilience, sleep quality, and health.

Methods

This cross-sectional study included 190 patients (Mean age = 51, SD = 15.57) recruited from the Johns Hopkins Center for Sleep and Wellness. Patients completed a modified version of the brief resilience scale (BRS) to assess characteristics of resilience and questions to assess aspects of mental health, physical health, sleep quality, and daytime functioning.

Results

Participants' average score on the BRS was 4.67 (SD = 1.32, range = 1.17-7), reflecting a high level of resilience. There was a significant gender difference in resilience levels for men (Mean = 5.04, SD = 1.14) and women (Mean = 4.30, SD = 1.38), such that men reported significantly higher levels of resilience compared to women (t (188) = 4.02, p < 0.001) [lower levels of resilience were significantly associated with higher levels of (current) fatigue and tiredness after adjusting for demographic, physical, and mental covariates. In those reporting between one and three mental health symptoms, high levels of resilience minimized the negative influence that these symptoms had on sleep quality. This minimizing effect was no longer evident in those experiencing >3 mental health symptoms, who also reported significantly higher symptoms of fatigue despite their high resilience scores.

Conclusions

This study emphasizes how resilience may affect the relationship between mental health and sleep quality in sleep patients. Resilience may further our understanding of the inter-relationships between sleep and the manifestation of physical health symptoms, a relationship that will likely heighten in relevance during personal and global crisis. An awareness of this interaction could be used as a proactive prevention and treatment strategy. In other words, incorporating methods to evaluate resilience in patients with mental illnesses regularly can be useful for predicting the potential manifestation and severity of sleep disturbance. Therefore, strategies that focus on promoting resilience could improve health and wellness.

Development and validation of a prediction model for intrapartum cesarean delivery based on the artificial neural networks approach: a protocol for a prospective nested case-control study

INTRODUCTION

Although intrapartum caesarean delivery can resolve dystocia, it would still lead to several adverse outcomes for mothers and children. The obstetric care professionals need effective tools that can help them to identify the possibility and risk factors of intrapartum caesarean delivery, and further implement interventions to avoid unnecessary caesarean birth. This study aims to develop a prediction model for intrapartum caesarean delivery with real-life data based on the artificial neural networks approach.

METHODS AND ANALYSIS

This study is a prospective nested case-control design. Pregnant women who plan to deliver vaginally will be recruited in a tertiary hospital in Southwest China from March 2022 to March 2024. The clinical data of prelabour, intrapartum period and psychosocial information will be collected. The case group will be the women who finally have a baby with intrapartum caesarean deliveries, and the control group will be those who deliver a baby vaginally. An artificial neural networks approach with the backpropagation algorithm multilayer perceptron topology will be performed to construct the prediction model.

ETHICS AND DISSEMINATION

Ethical approval for data collection was granted by the Ethics Committee of West China Second University Hospital, Sichuan University, and the ethical number is 2021 (204). Written informed consent will be obtained from all participants and they can withdraw from the study at any time. The results of this study will be published in peer-review journal.

Fostering Resilience in Adolescents at Risk: Study protocol for a cluster randomized controlled trial within the resilience school-based intervention

Introduction

Resilience is considered of high relevance when developing interventions to cope with stressful situations. Schools are one of the key settings to promote resilience among adolescents. The purpose of this cluster randomized controlled trial is to assess the effectiveness of an intervention in adolescents at risk, aged 12-to-15 years old, to increase resilience and emotional regulation strategies.

Methods

The recruitment period started in January 2022. Schools will be randomly allocated to control and intervention groups by an external researcher using computer-generated random numbers. The minimum sample size was estimated to be 70 participants per group. Primary health care nurses will carry out the intervention during the school period (January to June 2022). Students will follow a specific training consisting of six 55-min sessions, for 6 weeks. Each session will consist of 5 min of mindfulness, followed by 45 min of the corresponding activity: introducing resilience, self-esteem, emotional regulation strategies, social skills, problem-solving, community resources, social and peer support, and 5 min to explain the activity to do at home. Data will be collected at baseline, 6 weeks, and 24 weeks after the intervention. The child youth resilience measure-32 (CYRM-32) scale will be used to assess the effectiveness of the intervention. This study received a grant in June 2021.

Discussion

The intervention is intended to improve mental health through resilience. Different factors related to resilience will be promoted, such as self-esteem, emotional regulation, social and communication skills, problem-solving and peer support, among others. As it has been designed as a cluster-randomized school-based intervention, we will directly ameliorate the participation and engagement of the target population. With the present intervention, we expect to improve coping skills in adolescents by enhancing resilience capacities.

Assessing perceptions of resilience: The understanding from network analysis

Introduction

Previous studies have yet to reach a consensus on the construct of resilience perception, and how to enhance the effect of resilience intervention remains an urgent issue. In this consideration, this study examines the fundamental construct of resilience. It provides insight into the critical prevention goal for resilience intervention by utilizing the latest methods of psychological network analysis.

Methods

The sample is the graduate students enrolled in September 2021. Participants completed (1) the Connor-Davidson Resilience Scale, (2) the University of Washington Resilience Scale-8 Item, (3) the Brief Resilience Scale, and (4) the Resilience Scale for Adults, each representing different orientations of resilience.

Results

The network analysis grants greater clarity to the resilience perception as a dynamic system that interacts between an individual's tendency to intrinsic capacity and response to external resources. This study has shown that a positive perception of external social resources is the most important for individuals' resilience cognition; the effect of resilience intervention can be achieved more quickly by changing the individual's sense of hope.

Discussion

Based on the results, a psychometric instrument that integrates different orientations of resilience concepts and is based on time-varying needs to be developed.

Low Resilience Was a Risk Factor of Mental Health Problems during the COVID-19 Pandemic but Not in Individuals Exposed to COVID-19: A Cohort Study in Spanish Adult General Population

BACKGROUND

The aim is to analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults.

METHODS

a longitudinal cohort study was carried out. Resilience was measured with the CD-RISC. Mental health problems that were assessed included: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms.

RESULTS

we found statistically significant differences between groups and resilience scores in MDE [F (3; 48.40) = 19.55], GAD [F (3; 19.63) = 6.45] and STB [F (3; 111.74) = 31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 were not at higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95% CI) = -3.25 (-3.969 to -2.54)], but not for individuals with COVID-19.

CONCLUSIONS

in the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, and not in the population with COVID-19.

Resilience in cancer patients and how it correlates with demographics, psychological factors, and lifestyle

Background

Being diagnosed with cancer is challenging. Many patients wish to be actively involved in treatment and contribute to therapy, but the patients’ coping abilities and desire for involvement differ. The individual level of resilience seems to play a major role. Our study aims to learn more about the associations of resilience and factors as demographics and psychological factors.

Methods

This multicentric cross-sectional study was conducted in ten oncological centers in Germany in summer 2021. The questionnaire collected information on demographics, resilience, self-efficacy, general satisfaction with life, and sense of coherence. Considered lifestyle-aspects were diet and physical activity. 416 patients were included in the analyses.

Results

A moderate mean resilience score was achieved (M = 69). Significant correlations in demographics were found for resilience and education (r = 0.146, p = 0.003), income (r = 0.205, p = 0.001), and time since receiving diagnosis (r = − 0.115, p = 0.021). Resilience and self-efficacy correlated on a high level (r = 0.595, p < 0.001), resilience and sense of coherence, and resilience and general satisfaction with life in a moderate way (r = 0.339, p < 0.001; r = 0.461, p = 0.001).

Conclusions

Resilience portrays an important aspect in cancer treatment. Detecting patients at risk, stabilizing, or improving resilience are important to focus on and strengthen them accordingly. Possible negatively influencing factors (e.g., low self-efficacy) need to be considered. Factors affecting resilience but difficult to influence, as educational background, should be screened for. Also, the combination of low resilience and low income seems to describe a vulnerable patient group.

“We are pests, we have no future”: The prediction of anxiety by perceived discrimination in patients with coronavirus: Mediating role of psychological resilience

In a short amount of time, the COVID-19 pandemic has played havoc on social security, and people infected with coronavirus may have suffered from both physical and mental health issues requiring treatment. The purpose of our study was to examine the effect of perceived discrimination on anxiety in patients with coronavirus and to observe the role of psychological resilience as a mediator in this process. 376 patients with coronavirus were given a questionnaire, and 26 of them participated in in-depth interviews. Our results demonstrated that perceived discrimination in patients with coronavirus was predictive of anxiety and that strong perceptions of discrimination reduced patients’ psychological resilience levels, thereby triggering severe anxiety. Furthermore, psychological resilience was demonstrated to be a significant predictor of anxiety severity. Psychological resilience has been shown to act as a mediator between perceived discrimination and anxiety. As a response to COVID-19, the government, the media, and the general public should treat patients with coronavirus scientifically and rationally, minimize the secondary psychological damage caused by the perception of discrimination to the special groups of society represented by patients with coronavirus during the pandemic, correct the erroneous stigma generated by the traditional communication process, and prevent the spread of the psychosocial virus.

Overexposure to COVID-19 information amplifies emotional distress: a latent moderated mediation model

An infodemic has accompanied the COVID-19 pandemic. This study explores whether overexposure to COVID-19-related information amplifies emotional distress. A cross-sectional online survey was conducted in China during the outbreak and after the peak of the pandemic (N = 1313). A latent moderated mediation model was built to analyze this relationship. COVID-19 information exposure was found to relate positively with emotional distress, and risk perception mediated the association between them. Additionally, psychological resilience moderated the mediating effects of risk perception. However, five factors of resilience differed in their moderating effects. This study offers theoretical and practical implications apropos clinical intervention and public health management.

Promoting resilience in healthcare students through psychological interventions

Given the impact of well-known chronic stressors on health and social care students, the concept of resilience has gained importance in the field of health professional education. Many interventions have been tested that are aimed at fostering students’ resilience, but the underlying evidence has not been rigorously assessed. This was the aim of the review in this issue's Cochrane Corner. In this Round the Corner section, we discuss those findings and put them into further context.

Effects of resilience on impulsivity, cognition and depression during protracted withdrawal among Chinese male methamphetamine users

BACKGROUND

Methamphetamine (METH) dependence is a complex and dynamic public health problem. Long-term abuse of METH can increase numerous risks of mental and physical problems. Currently, the methods to reduce METH dependence and improve the withdrawal symptoms are limited and ineffective. Resilience is seen as a multidimensional and dynamic capability to recover or bounce back from stressful events and is also generally considered as a protective factor against mental dysfunction.

METHODS

One hundred thirty-four males with METH dependence were consecutively recruited from Huanglong Compulsory Isolated Detoxification Center between 2019 and 2021, of whom 112 were into the group. The Connor-Davidson Resilience Scale (CD-RISC), Self-rating depression scale (SDS), Self-rating anxiety scale (SAS), Barratt Impulsiveness Scale-11(BIS-11), and the Repeatable Battery for the Assessment of Neuropsychological Status (Rbans) were used to evaluate resilience, depression, anxiety, impulsivity, and cognition respectively.

RESULTS

The results mainly indicated that high resilience group showed lower SDS, SAS and BIS-11 scores than low resilience group (all p < 0.05). Besides, the total scores of Rbans were higher in high resilience groups than low resilience group (both p < 0.05). Moreover, linear regression results showed that resilience may be influenced by the scores of SDS and SAS.

CONCLUSIONS

Resilience is negatively correlated with impulsivity and depression. Besides, it is also positively associated with cognitive function. Drug users with higher resilience may have a strong ability to mobilize psychological resources to create a good psychological environment, which may have a positive effect on the relief or improvement of symptoms.

Emotion, Well-Being, and Resilience-Theoretical Perspectives and Practical Applications

Resources are required to minimize the daily threats in life; thus, discussions about the role of emotions, well-being, and resilience become imperative for human survival. The book reviewed here attempts to highlight the associations among human well-being, emotions, and resilience. The book showcases resilience as a conceptually and empirically robust construct useful for research and practice, and takes a comprehensive endeavour to provide the importance of resilience in various contexts by presenting suitable empirical evidences and applications. The book is deeply rooted in positive psychology and would be meaningful for scholars, leaders of organizations, and health professionals working in the areas of counselling, well-being, and community development.

Dispositional Optimism and Disaster Resilience: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami

OBJECTIVE

Dispositional optimism - the general belief that good things will happen - is considered a key asset for the preservation of mental health after a traumatic life event. However, it has been hypothesized that in extreme situations such as major disasters where positive expectations cannot overcome the grim reality on the ground, being optimistic might be a disadvantage. To test this mismatch hypothesis, this study explores whether higher pre-disaster dispositional optimism is associated with higher posttraumatic stress (PTS) and depressive symptoms among individuals who experienced the 2011 Great East Japan Earthquake and Tsunami.

METHODS

Information on optimism was collected from community-dwelling residents aged ≥65 years seven months before the 2011 Earthquake/Tsunami in Iwanuma, a Japanese city located 80-km from the epicenter. Data on disaster-related personal experiences (e.g., loss of relatives or friends/housing damage), as well as depressive and PTS symptoms, were collected during a follow-up survey in 2013, 2.5 years after the earthquake and tsunami. Multiple logistic regression models were utilized to evaluate the associations between disaster experiences, optimism, and depressive/PTS symptoms among 962 participants.

RESULTS

Higher pre-disaster dispositional optimism was associated with lower odds of developing depressive symptoms (OR = 0.78, 95% CI: 0.65 to 0.95) and PTS symptoms (OR = 0.83, 95% CI: 0.69 to 0.99) after the earthquake. Contrary to the mismatch hypothesis, high dispositional optimism buffered the adverse impact of housing damage on depressive symptoms (interaction term coefficient = -0.63, p = 0.0431), but not on PTS symptoms.

CONCLUSIONS

In contrast to the mismatch hypothesis, the results suggest that dispositional optimism is a resilience resource among survivors of a disaster.

Burnout and Depression in Portuguese Healthcare Workers during the COVID-19 Pandemic-The Mediating Role of Psychological Resilience

During the COVID-19 pandemic, healthcare workers (HCW) have been exposed to multiple psychosocial stressors. Resilience might protect employees from the negative consequences of chronic stress. The aim of this study was to explore the mediating role of resilience in the relationship between depression and burnout (personal, work-related, and client-related). A cross-sectional study was performed using an online questionnaire distributed via social networks. A survey was conducted comprising standardized measures of resilience (Resilience Scale-25 items), depression (subscale of Depression Anxiety Stress Scales-21 items), and burnout (Copenhagen Burnout Inventory Scale-19 items). A total of 2008 subjects completed the survey, and a hierarchical regression model was estimated for each burnout dimension. The results revealed that depression had not only a directed effect on personal, work- and client-related burnout, but also an indirect small effect on it through resilience. Psychological resilience played a partial mediating role between depression and all burnout dimensions. This partial mediation suggests that there may be other possible variables (e.g., social connection, self-compassion, gratitude, sense of purpose) that further explain the associations.

How anxious did you feel during lockdown? The roles resilience, living environment, and gender play on the level of anxiety state during pandemic isolation

In the unique context of the coronavirus disease 2019 (COVID-19) pandemic, researchers and clinicians alike drew attention to the risks involved by physical and social isolation for mental health. Factors like resilience, gender, urban/rural environment, or preexisting anxiety can impact anxious states produced by home forced isolation. Based on these, we assumed that: i) there are significant differences in the level of anxiety (state) during the pandemic, depending on the living area of the subjects; ii) gender plays a moderating role in the relationship between resilience and anxiety; and iii) anxiety (trait), experiential avoidance, resilience, and family connectedness, determine the level of anxiety (state). The MemoryLab team conducted the present study on 495 subjects (n=411 women, age between 18 and 65). Of these, 350 live in large and medium urban areas, 63 in small urban areas, and 82 in rural areas. As instruments, we used The State-Trait Anxiety Inventory (STAI 2.0), The Acceptance and Action Questionnaire 2 (AAQ-2), The Aggression Questionnaire (AQ), The Family Connectedness Questionnaire, and Connor-Davidson Resilience Scale 10 (CD-RISC-10), as well as the standard division of living areas according to community size. Data collection took place online during the spring peak of the pandemic. According to ANOVA analysis, people living in small urban areas have a higher level of anxiety. The difference is significant compared to those living in large and medium cities and villages. Gender has no moderating role in the relationship between resilience and the anxiety state. Also, experiential avoidance, anxiety (trait), and resilience play a significant role on the level of anxiety (state), measured during social isolation. The results could be an important indicator for understanding psychological mechanisms guiding interventions to support the communities effectively.

The association between resilience and psychosocial functioning in schizophrenia: A systematic review and meta-analysis

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.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

The design and psychometric evaluation of the Adolescents' Resilience in Disaster Tool (ARDT-Q37): A mixed method study

Adolescent resilience after a disaster has been shown to be a protective factor against loss, trauma, and psychological distress. Its importance for successful disaster recovery is widely accepted by disaster risk management professionals, yet very few tools are available to assess adolescent resilience during an emergency or after a natural disaster has occurred. The aim of this study was to develop and evaluate the psychometric properties of a questionnaire designed to measure adolescents' resilience before, during or after a natural disaster. This mixed method study was carried out in three phases involving item generation, systematic review (phase one), qualitative analysis (phase two) and the reduction of items (phase three). The psychometric evaluation of the Adolescents' Resilience in Disaster Tool (ARDT) was conducted using the data from 599 high school students North of Iran (Golestan Province). The initial item pool included 80 items that were reduced to 37 after assessment of validity (face, content and structure) and reliability. Exploratory Factor Analysis found five factors that affect adolescents' resilience which included helping, trusting in God and hopefulness, adaptability, self-confidence and social support. The internal consistency was desirable (α = .86 and ICC = .91; 95% CI: .849 to .948). The psychometric support for the 37-item version of the ARDT in this study indicates strong support for the ARDT-Q37 as a rapid assessment tool to evaluate resilience in adolescents aged 12–18 years old. Identifying the status of adolescents’ resilience and determining their level of need for intervention during and after a natural disaster is critical for long- and short-term outcomes. Implications for policy makers and professionals involved in the preparedness, response and recovery from natural disasters are discussed.

Psychiatry trainee welfare - from words to action

OBJECTIVE

To review selected literature available on trainee welfare and reflect on our own experiences to provide practical advice to our colleagues and suggest strategies to enhance trainee welfare.

CONCLUSIONS

Promoting the welfare of psychiatry trainees requires a three-pronged approach. We must care for ourselves through individual strategies; we must advocate for optimization of the systems we work in to minimize modifiable factors associated with burnout; and we must continue on the perennial challenge of culture change to reduce stigma around stress and mental illness and promote a healthier workplace.

Domains and Indicators of Resilient Children in Natural Disasters: A Systematic Literature Review

Resilience has received increased attention among both practitioners and scholars in recent years. Child resilience has received notable attention in disaster risk reduction (DRR) during the creation of the Sendai Framework 2015-2030 to improve child protection in the event of disasters. As resilience is a subjective concept with a variety of definitions, this study evaluates its different factors and determinates in the existing research to clarify the path for the near future and objective research. A systematic literature review was conducted by searching and selecting the peer-reviewed papers published in four main international electronic databases including PubMed, SCOPUS, WEB OF SCIENCE, and PsycINFO to answer the research question: "What are the criteria, factors or indicators for child resilience in the context of a natural disaster?" The process was based on PRISMA guidelines. In total, 28 papers out of 1838 were selected and evaluated using thematic analysis. The results are shown in two separate tables: one descriptive and the other analytical. Two main themes and five subthemes for criteria for child resilience in a disaster have been found. The factors found cover the following areas: mental health, spiritual health, physical, social behavior, and ecological, and as well as environmental. The majority of the included studies mentioned the scattered criteria about children resilience without any organized category. Although this concept is multifactorial, additional research is needed to develop this study and also observe other kinds of disasters such as human-made disasters.

Factors Associated With Caregivers' Resilience in a Terminal Cancer Care Setting

BACKGROUND

Resilience implies characteristics such as self-efficacy, adaptability to change, optimism, and the ability to recover from traumatic stress. Studies on resilience in family caregivers (FCs) of patients with terminal cancer are rare. This study aims to examine the factors associated with FCs' resilience in a terminal cancer care setting.

METHODS

This is a cross-sectional study of 273 FCs from 7 hospice and palliative care units in Korea. Resilience was categorized as high and low, and factors associated with resilience were grouped or categorized into subscales. A multivariate logistic regression analysis was used to examine relevant factors.

RESULTS

High FCs' resilience was significantly associated with FCs' health status, depression, and social support. In a multivariate regression model, FCs' perception of good health (adjusted odds ratio [aOR] = 2.26, 95% confidence interval [CI] = 1.16-4.40), positive social support (aOR = 3.70, 95% CI = 1.07-12.87), and absence of depression (aOR = 3.12, 95% CI = 1.59-6.13) remained significantly associated with high FCs' resilience.

CONCLUSION

Lack of family support is associated with and may be a cause of diminished resilience. And more concern should be paid to FCs to improve FCs' health and emotional status. Education programs might be effective for improving caregivers' resilience. Further research with supportive interventions is indicated.

Loneliness, Resilience, Mental Health, and Quality of Life in Old Age: A Structural Equation Model

Objectives: In the scientific literature on aging, a recent core issue has been the role of individuals' internal and external resources, which are considered intrinsically connected, in contributing synergistically to physical and psychological quality of life (QoL). The current study investigates the way in which psychological factors-such as, loneliness, resilience, and mental states, in terms of depression and anxiety symptoms-affect the perceived QoL among elderly individuals. Method: Data from 290 elderly Italian participants were used to study the mediation effects of both mental health and resilience to elucidate the relationship between loneliness and psychophysical QoL. Results: The best model we obtained supports the mediation effect of both resilience and mental health between loneliness and mental and physical QoL. These results highlight that loneliness influences mental and physical QoL via two pathways, with the impact of loneliness mediated by mental health and resilience dimensions. Conclusions: The findings suggest the importance of the support that elderly people receive from social relationships. In terms of clinical interventions, the reduction of loneliness could be an important factor in primary prevention or the recovery process. A way to reduce levels of mental distress could be represented by the increasing of resilience and self-efficacy and reduction of loneliness dissatisfaction. A high degree of resiliency contributes to increasing perceived life quality at the physical and psychological levels, and at the same time, reducing anxiety and depressive symptoms.

Self-reported Health Status Predicting Resilience and Burnout in Longitudinal Study

OBJECTIVE

The study examined the links between health-related indicators, adult resilience, and burnout.

METHOD

The data were collected during two waves of the longitudinal study (in 2004-05, N=98, and 2011-12, N=88, respectively). Health behaviour, self-rated health (SRH), Sense of Coherence Scale (SOC), and Shirom-Melamed Burnout Measure (SMBM) were measured.

RESULTS

The comprehensibility of SOC and physical fatigue of SMBM as measured in wave 2 were determined by SRH as measured in wave 1. In the cross-sectional part, the meaningfulness of SOC was related to SRH, and alcohol consumption in wave 1. The comprehensibility of SOC was related to SRH in wave 2.

CONCLUSION

SOC is well known to have effect on health. However, the results show that self-reported health had effect on the comprehensibility of SOC. Our data also support the finding that the effect of SRH on burnout is stronger than the effect of burnout on SRH.

A Cross-Cultural Study in Germany, Russia, and China: Are Resilient and Social Supported Students Protected Against Depression, Anxiety, and Stress?

This study cross-culturally investigated resilience and social support as possible protective factors for mental health. The values of depression, anxiety, and stress symptoms, resilience and social support were collected from German (N = 4433), Russian (N = 3774), and Chinese students (N = 4982). The samples were split (two-thirds vs. one-third) to cross-validate the results. In all samples, resilience and social support were significantly negatively associated with depression, anxiety, and stress symptoms. While in Germany those associations were stronger for social support, in Russia and in China stronger associations were found for resilience. Furthermore, in all samples, resilience was found to mediate the association between social support and the negative mental health variables significantly. In conclusion, resilience and social support are universal interrelated protective factors for mental health independently of historical, cultural, social, and geographical conditions of a country.

Relationship between psychological distress and resilience in rescue workers

Objectives:

To assess the relationship between psychological distress and resilience in rescue workers. Following hypothesis was formulated; there would be negative correlation between psychological distress and resilience in rescue workers.

Method:

A correlational study was conducted from June-August 2015 in Rahim Yar Khan, Punjab, Pakistan. The sample of the present study consisted of 100 rescue workers. The age of the participants ranged from 23 to 40 year old with the mean age of 27.4±3.9 years. Demographic information form, Kessler psychological distress scale and adult resilience measure were administered on the participants to assess the level of psychological distress and resilience.

Results:

Pearson product moment coefficient of correlation was applied to analyze the relationship of psychological distress and resilience. Analysis of the result indicated that there is negative relationship between psychological distress and resilience (r= -0.203, p<0.01) in rescue workers. Further, contextual factors (r= -0.292, p<0.05) and its subcomponents including spiritual beliefs (r= -0.239, p<0.05) and cultural resources (r= -0.287, p<0.01) were also found to be inversely correlated with psychological distress.

Conclusion:

The research evidenced that rescue workers were experiencing psychological distress Resilience factors should be considered while designing trainings to preserve mental health and to enhance the psychological well-being of rescue workers.

Factors related to self-reported social anxiety symptoms among incoming university students

AIM

The aim of this study was to explore the lifestyle/social, personality trait and mental factors among incoming university students with higher self-reported social anxiety symptoms (SAS).

METHODS

A total of 5126 incoming university students were recruited. The test battery included a self-administered questionnaire that examined personal lifestyle, the Measurement of Support Functions, the Chinese Internet Addiction Scale-Revision, the Organizational Citizenship Behaviour Scale, the Social Phobia Inventory, the suicide ideation from the Brief Symptoms Rating Scale and the Pittsburgh Sleep Questionnaire.

RESULTS

SAS (23.7%) were prevalent. Using logistic regression analysis, we found that the significant predictors of higher levels of SAS were being an undergraduate student and a non-smoker, having lower Measurement of Support Functions score (poorer social support), having higher Chinese Internet Addiction Scale-Revision score (Internet addiction), having lower Organizational Citizenship Behaviour Scale score (less altruistic behaviour), having suicide ideation and having higher Pittsburgh Sleep Questionnaire score (poorer sleeper).

CONCLUSIONS

Given the high prevalence of SAS among university students, it is necessary to build a better strategy to detect students with potential social anxiety-related problems/disorders or other mental problems early on.

Personal resilience and coping with implications for work. Part I: A review

BACKGROUND

Interest in resilience has increased in recent years. The U.S. military focus is on personal health and adaptation following exposure to battle, while the civilian interest centers on adjustments subsequent to disastrous events. Coping skills are also relevant, yet the relationships between coping and resilience are unclear.

OBJECTIVE

This brief review examines personal resilience and individual coping strategies, exploring definitions of each, along with their potential relationships to one another. Their potential contributions within a work setting are described.

METHODS

A literature review was conducted using search terms of resilience, resiliency, personal resilience, coping and resilient coping.

RESULTS

Coping refers to one's using purposeful actions to handle life situations. Coping techniques can be functional or dysfunctional and the situations one copes with may be acute or long term, severe or minor. Resilience refers to positive and functional handling of oneself and ones' life, referring to the ability to recover, recuperate, and regenerate following tragic events.

CONCLUSIONS

While coping and resilience are related to one another, they are distinct concepts. Positive coping techniques may contribute to resilience. However, which coping techniques improve resilience, and in what circumstances, are questions for future research.

Comparing Facebook Users and Facebook Non-Users: Relationship between Personality Traits and Mental Health Variables - An Exploratory Study

Over one billion people use Facebook as a platform for social interaction and self-presentation making it one of the most popular online sites. The aim of the present study was to investigate differences in various personality traits and mental health variables between Facebook users and people who do not use this platform. The data of 945 participants (790 Facebook users, 155 Facebook non-users) were collected. Results indicate that Facebook users score significantly higher on narcissism, self-esteem and extraversion than Facebook non-users. Furthermore, they have significantly higher values of social support, life satisfaction and subjective happiness. Facebook non-users have (marginally) significantly higher values of depression symptoms than Facebook users. In both groups, extraversion, self-esteem, happiness, life satisfaction, resilience and social support, on the one hand, and depression, anxiety and stress symptoms, on the other hand, are negatively correlated. Neuroticism is positively associated with depression, anxiety and stress symptoms. However, significant differences exist between Facebook users and Facebook non-users regarding some associations of personality traits and mental health variables. Compared to Facebook non-users, the present results indicate that Facebook users have higher values of certain personality traits and positive variables protecting mental health. These findings are of particular interest considering the high importance of social online-platforms in the daily life of many people.

Resilience in lesbians and gay men: A review and key findings from a nationwide Australian survey

Rates of depression and anxiety are disproportionately high among lesbians and gay men, and stigma-related stress is thought to be a major factor. While reducing stigma remains a priority, developing ways to assist lesbians and gay men to build resilience to stigma-related stress is also a growing priority among policymakers and health professionals. This article summarizes major conceptual work and research on resilience among lesbians and gay men, including key findings from a nationwide online survey involving 2,793 Australian lesbians and gay men aged 16 years and older that examined demographic and psychosocial factors related to resilience. Research on resilience in gay and lesbian populations is currently a small field but appears to be growing. As recommended in this article, further work is needed to identify circumstances in which lesbians and gay men display resilience to stigma-related stress and to systematically test resilience training programmes that help to prevent depression and anxiety in these at-risk populations.

Resilience and hope during advanced disease: a pilot study with metastatic colorectal cancer patients

Background

The balance between hope-hopelessness plays an important role in the way terminally ill patients report quality of life, and personal resilience may be related to hope at the end of life. The objective of this study was to explore associations between personal resilience, hope, and other possible predictors of hope in advanced cancer patients.

Methods

A cross-sectional pilot study was carried out with metastatic colorectal cancer patients in a tertiary hospital. The patients answered the Connor-Davidson Resilience Scale, Herth Hope Index, Barthel Index, an instrument addressing family and social support, visual-numeric scales for pain and suffering, a two-item screening for depression, socio-demographic and socio-economic information about the family.

Results

Forty-four patients were interviewed (mean age 56 years; range 29-86). A strong correlation was noted between resilience and hope (0.63; p < 0.05). No correlation was found between hope and independence for activities of daily living, support from family and community, and pain and suffering levels. Of the 44 patients, 20 presented with depressive symptoms. These depressive patients had lower resilience (p = 0.005) and hope (p = 0.003), and higher scores of suffering (p < 0.001). The association between resilience and hope kept stable after adjusting for age, gender, and presence of depression (p < 0.001).

Conclusion

Given that resilience is a dynamic, changeable path that can improve hope, resilience-fostering interventions should be most valued in palliative care settings and should be commenced as soon as possible with cancer patients. Patients with advanced stages of non-malignant conditions would also probably benefit from such interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12904-016-0139-y) contains supplementary material, which is available to authorized users.

Psychosocial Factors Associated with Resilience in a National Community-Based Cohort of Australian Gay Men Living with HIV

HIV-positive gay men may experience multiple sources of adversity and stress, related both to their HIV diagnosis and sexual identity. Most of these men, however, do not experience mental health problems. Little is known about factors that help them achieve resilience in the face of life challenges. This study examined psychosocial factors associated with resilience in a national community-based sample of 357 Australian HIV-positive gay men. Resilience was measured using the Connor-Davidson Resilience Scale. Higher levels of resilience were linked with experiencing low or no internalized HIV-related stigma, having no previous history of mental health problems, and a number of socioeconomic indicators. In addition to providing a more complete picture of the mental health of HIV-positive gay men, findings from this study can be used to inform strength-based approaches to mental health prevention and support.

Perceived social support disparities among children affected by HIV/AIDS in Ghana: a cross-sectional survey

BACKGROUND

The study investigated whether perceived social support varied among children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families (comparison group).

METHOD

This study employed cross-sectional, quantitative survey that involved 291 children aged 10-18 years in the Lower Manya Krobo District of Ghana and examined their social support disparities.

RESULTS

Multivariate linear regressions indicate that children living with HIV/AIDS-infected caregivers reported significantly lower levels of social support compared with AIDS-orphaned children, other-orphaned children and non-orphaned children independent of socio-demographic covariates. Children who have lost their parents to other causes and other-orphaned children reported similar levels of social support. In terms of sources of support, all children orphans and vulnerable children were more likely to draw support from friends and significant others rather than from the family.

CONCLUSION

The findings indicate a need to develop interventions that can increase levels of social support for orphaned and vulnerable children within the context of HIV/AIDS in Ghana, particularly networks that include the family.

Predictors of depression among a sample of South African mortuary workers

Mortuary workers are at high risk of developing depression and other psychiatric disorders owing to the nature of their work and exposure to deceased victims of violent deaths. Few studies have investigated mental health among mortuary workers in low- and middle-income countries. Participants (N = 45) were recruited from mortuaries in South Africa and completed a battery of questionnaires measuring depression, physical health, perceived stress, fear of blood/injury/mutilation, and resilience. Participants with self-reported depression and posttraumatic stress disorder (PTSD) comprised 13.3% and 4.4% of the sample, respectively. Inexperienced mortuary workers had a higher prevalence rate of depression (16.7%) compared with experienced workers (9.5%). Prevalence of PTSD did not differ significantly between inexperienced (4.2%) and experienced (4.8%) workers. Physical health, perceived stress, fear of blood/injury/mutilation, and resilience were significant predictors of depression in the combined group (experienced and inexperienced). However, perceived stress was the only significant predictor of depression, in multiple regression, in the combined group. Inexperienced workers had significantly higher levels of blood/injury/mutation fear and depression. Mortuary workers seem to be at increased risk of depression, especially inexperienced workers. Perceived poor health, lower levels of resilience, and blood/injury/mutilation fears may lead to increased perceived stress among mortuary workers, which may, in turn, lead to depression. Interventions focused on promoting mental health may be beneficial to all mortuary workers, and preparatory training related to mental health may be beneficial to inexperienced mortuary workers before occupational uptake.

The effects of anxiety and depression on stress-related growth among Chinese army recruits: Resilience and coping as mediators

Stress-related growth can occur after various traumas or stressful events. In order to investigate how anxiety and depression relate to stress-related growth, this study was conducted with 443 Chinese army recruits who had just finished a 3-month recruit training program. Path analyses revealed that resilience and positive/negative coping partially mediated the effect of anxiety on perceived stress-related growth, while negative coping fully mediated the relationship between depression and perceived stress-related growth. Moreover, positive coping partially carried the influence of resilience on perceived stress-related growth. Anxiety and depression may be potential targets for intervention to enhance the development of stress-related growth among Chinese army recruits.

The Chinese Mental Resilience Scale and its psychometric properties

This study aimed to develop a Chinese Mental Resilience Scale. A total of 2500 healthy participants, in two representative samples of the Chinese population, were administered the scale. Exploratory factor analysis, confirmatory factor analysis, and correlation analysis were used to obtain the relevant coefficients and verify the reliability and validity of the scale. Five factors were extracted: willpower, family support, optimism and self-confidence, problem solving, and interpersonal interaction, plus a lying subscale, which together accounted for 54 percent of the total variance. The Chinese Mental Resilience Scale demonstrated good psychometric properties. It can be used to evaluate the mental resilience level of general Chinese population.

The efficacy of resilience training programs: a systematic review protocol

BACKGROUND

Resilience has been defined as the ability of individuals to manage and adapt to stress and life challenges. Training programs that develop and/or enhance resilience may have efficacy in improving health, well-being, and quality of life. Because patients with chronic conditions must reliably self-manage their health, strategies to bolster resilience in this population may be of particular value. The objectives of this systematic review are to synthesize the evidence of resilience training program efficacy in improving outcomes related to quality of life, self-efficacy and activation, and resilience and coping ability in: 1) diverse adult populations; and 2) patients with chronic conditions.

METHODS/DESIGN

We will conduct a systematic review of randomized controlled trials assessing the efficacy of any program designed to enhance resilience in adults that measure any outcome against any comparator. We will search multiple electronic databases, trial registries, bibliographies, and will contact authors and experts to identify studies. We will use systematic review software to independently and in duplicate screen reports and extract data. We will extract characteristics of the study populations, interventions, comparators, outcomes, and quality/risk of bias. Primary, patient reported outcomes will be categorized into domains of quality of life, self-efficacy, and resilience. Secondary outcomes will be considered based on findings of the review. We will attempt meta-analysis by pooling standardized mean differences and minimally important differences (MIDs), when possible. Planned trial subgroup analyses are: 1) studies of patients with chronic conditions; 2) studies with placebo controls; 3) studies with similar intervention characteristics; and 4) studies with common lengths of follow-up.

DISCUSSION

This study is intended to accumulate the evidence for resilience training programs in improving quality of life, resilience, and self-efficacy for care management, particularly among adult patients with chronic conditions. Its findings will be valuable to policy-makers, funding agencies, clinicians, and patients seeking innovative and effective ways to achieve patient-centered care.

TRIAL REGISTRATION

PROSPERO registration number: CRD42014007185.

Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders

OBJECTIVE

Research suggests that resilience is associated with favorable treatment outcome in patients with depression and/or anxiety disorders. In this regard, the identification of specific characteristics related to resilience that could provide targets for resilience-enhancement interventions is needed. Since the type of cognitive coping strategies is a possible marker of resilience, we investigated adaptive and maladaptive cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders.

METHODS

A total of 230 outpatients with depression and anxiety disorders were consecutively recruited and completed the Cognitive Emotion Regulation Questionnaire, the Connor-Davidson Resilience Scale, the Beck Depression Inventory, and the State Anxiety Inventory. A linear regression model was used to determine which cognitive emotion regulation strategies predicted resilience after controlling for relevant covariates. Additionally, this model of resilience was compared with those of depression and anxiety symptoms.

RESULTS

Adaptive strategies were more strongly correlated with resilience than maladaptive strategies. In the regression model, more use of refocus on planning and positive reappraisal as well as less use of rumination predicted high resilience after controlling for age, gender, marital status, depression, and anxiety. Among these strategies, refocus on planning was the common strategy contributing to resilience and depression.

CONCLUSION

These results suggested that the cognitive emotion regulation strategies of refocus on planning, positive reappraisal, and less rumination contribute to resilience in patients with depression and anxiety disorders. It might provide potential targets for psychotherapeutic intervention to improve resilience in these patients.

Influence of personal and environmental factors on mental health in a sample of Austrian survivors of World War II with regard to PTSD: is it resilience?

BACKGROUND

War-related traumata in childhood and young-adulthood may have long-lasting negative effects on mental health. The focus of recent research has shifted to examine positive adaption despite traumatic experiences, i.e. resilience. We investigated personal and environmental factors associated with resilience in a sample of elderly Austrians (N = 293) who reported traumatic experiences in early life during World War II and subsequent occupation (1945-1955).

METHODS

After reviewing different concepts of resilience, we analysed our data in a 3-phased approach: Following previous research approaches, we first investigated correlates of PTSD and non-PTSD. Secondly, we compared a PTSD positive sample (sub-threshold and full PTSD, n = 42) with a matched control sample regarding correlates of resilience and psychometrically assessed resilience (CD-RISC). Thirdly, we examined factors of resilience, discriminating between psychologically healthy participants who were exposed to a specific environmental stressor (having lived in the Soviet zone of occupation during 1945-1955) from those who were not.

RESULTS

A smaller number of life-time traumata (OR = 0.73) and a medium level of education (OR = 2.46) were associated with better outcome. Matched PTSD and non-PTSD participants differed in psychometrically assessed resilience mainly in aspects that were directly related to symptoms of PTSD. Psychologically healthy participants with an environmental stressor in the past were characterized by a challenge-oriented and humorous attitude towards stress.

CONCLUSIONS

Our results show no clear picture of factors constituting resilience. Instead, most aspects of resilience rather appeared to be concomitants or consequences of PTSD and non-PTSD. However, special attention should be placed on a challenge-oriented and humorous attitude towards stress in future definitions of resilience.

The Korean version of the Connor-Davidson Resilience Scale: an extended validation

The Connor-Davidson Resilience Scale (CD-RISC) is a brief self-rating questionnaire for measuring resilience. The aims of the present study were to describe the development of a Korean version of the CD-RISC (K-CD-RISC) and to more firmly establish its psychometric properties in terms of reliability and validity. The participants consisted of a general population sample (n=194) and psychiatric outpatients (n=127) with non-psychotic mood or anxiety disorders. The K-CD-RISC score means (standard deviation) were 65.9 (13.6) in the general population and 50.4 (20.5) in the psychiatric outpatients. The mean score of the general population was significantly higher than that of the psychiatric outpatients. Exploratory factor analysis revealed five factors, and the obtained factor structure was verified through confirmatory factor analysis. In the general population, the Cronbach's α coefficient of the K-CD-RISC was found to be 0.92. Greater resilience was found to be associated with less perceived stress, anxiety and depression and with higher levels of positive affect and purpose in life. Taken together, our findings suggest that the K-CD-RISC has good psychometric properties and is a valid and reliable tool for assessing resilience.

Measuring resilience in adult women using the 10-items Connor-Davidson Resilience Scale (CD-RISC). Role of trauma exposure and anxiety disorders

PURPOSE

Resilience is the ability of individuals to adapt positively in the face of trauma. Little is known, however, about lifetime factors affecting resilience.

METHODS

We assessed the effects of psychiatric disorder and lifetime trauma history on the resilience self-evaluation using the Connor-Davidson Resilience Scale (CD-RISC-10) in a high-risk-women sample. Two hundred and thirty eight community-dwelling women, including 122 participants in a study of breast cancer survivors and 116 participants without previous history of cancer completed the CD-RISC-10. Lifetime psychiatric symptoms were assessed retrospectively using two standardized psychiatric examinations (Mini International Neuropsychiatric Interview and Watson's Post-Traumatic Stress Disorder Inventory).

RESULTS

Multivariate logistic regression adjusted for age, education, trauma history, cancer, current psychiatric diagnoses, and psychoactive treatment indicated a negative association between current psychiatric disorder and high resilience compared to low resilience level (OR = 0.44, 95% CI [0.21-0.93]). This was related to anxiety and not mood disorder. A positive and independent association with a trauma history was also observed (OR = 3.18, 95% CI [1.44-7.01]).

CONCLUSION

Self-evaluation of resilience is influenced by both current anxiety disorder and trauma history. The independent positive association between resilience and trauma exposure may indicate a "vaccination" effect. This finding need to be taken into account in future studies evaluating resilience in general or clinical populations.