Hardiness: an examination of its relationship with positive and negative long term changes following trauma

Psychometric Properties of the Greek Version of the Connor-Davidson Resilience Scale (CD-RISC-10) in a Sample of Nurses

Resilience has been defined as one's ability to maintain a mental health state and overall well-being when undergoing grave stress or facing significant adversity. Numerous resilience-investigating research tools have been developed over the years, with the Connor-Davidson Resilience Scale (CD-RISC), a self-rated tool presenting valuable psychometric properties, remaining one of the most prominent. We aimed to translate and validate the brief CD-RISC-10 in a convenience sample of 584 nurses in Greece's secondary and tertiary health care system. We conducted a confirmatory factor analysis and known-groups validity test and estimated the reliability of the CD-RISC-10. Our confirmatory factor analysis revealed that the scale had a unifactorial structure since all the model fit indices were very good. Moreover, the reliability of the CD-RISC-10 was very good since the acquired Cronbach's alpha and McDonald's omega were 0.924 and 0.925, respectively. Therefore, the Greek version of the CD-RISC-10 confirmed the factor structure of the original scale and had very good validity and reliability.

The roles of adaptability and school climate in first-year teachers' developing perceptions of themselves, their classroom relationships, and the career

The teaching career, and especially the transition from pre-service to in-service teaching, is uniquely characterized by change. Adaptability is an internal characteristic that has been shown to benefit teachers and may be especially relevant as they begin developing initial perceptions of themselves as educators, of their relationships with students, and of the teaching career at large. Importantly though, it is likely that the impacts of adaptability depend in part on the broader context. One such contextual factor that is highly relevant to teachers is their school's climate. The present study explored direct and indirect (moderated) relations among first-year teachers' (N = 133) adaptability and perceived school climate and their teaching self-efficacy, perceptions of the classroom relational climate, and career optimism. Path analysis revealed positive main effects of adaptability on self-efficacy and perceptions of classroom relational climate, as well as positive main effects of school climate on self-efficacy and career optimism. In addition, an interaction effect was detected whereby relations among adaptability and self-efficacy were strongest among participants who reported high and average levels of school climate. Results can inform future research on teacher adaptability and can also be used to inform interventions and supports provided to new teachers by school psychologists and other school personnel.

COVID-related stress, risk for suicidal behavior, and protective factors in a national sample of college students

Objective: This study's purpose was to determine if COVID-related stress predicted suicide risk among college students and if this risk was attenuated by higher levels of social and psychological resources. Participants: The sample included 65,142 college students who participated in the National College Health Assessment survey in Spring 2021. Methods: SPSS PROCESS was used to test the association between COVID-related stress and suicide risk while controlling for demographic covariates and to determine the potential stress-buffering roles of social connectedness, resiliency, and psychological well-being. Results: Higher levels of COVID-related stress predicted increased suicide risk yet this risk was attenuated when social connectedness, resiliency, and psychological flourishing were greater. Conclusions: Findings indicate that efforts to increase social connectedness, resiliency, and psychological flourishing could help reduce the risk of college students' suicidality under conditions of high COVID-related stress.

The examination of stress symptoms and posttraumatic growth in the patients diagnosed with Covid-19

OBJECTIVE

COVID-19 infection can profoundly affect patients' lives. Coping with difficult life crises can also lead to increased stress or positive psychological change called post-traumatic growth. This research was conducted to examine the symptoms of stress and post-traumatic growth symptoms in the patients diagnosed with COVID-19 (Coronavirus).

METHOD

The present study, which is in a descriptive design, was conducted with 175 patients who were discharged after being treated in the intensive care units with the diagnosis of COVID-19. The personal information form, the Posttraumatic Diagnostic Scale (PTDS), and the Posttraumatic Growth Inventory (PTGI) were used to collect data.

RESULTS

The mean score for Posttraumatic Stress Symptoms of the participants was 19.18 ± 9.53, and the mean score for Posttraumatic Growth Inventory was 0.86 ± 0.47. In addition, a significant positive correlation was found between PTDS and PTGI mean scores (p < 0.001). As the degree of being affected by covid 19 increases, posttraumatic growth and traumatic stress symptom levels increase (p < 0.05). The posttraumatic growth levels increase as the time elapsed after the treatment of COVID-19 increases (p < 0.001).

CONCLUSION

It was determined that after the traumatic experience (COVID-19), the participants had moderate traumatic stress symptoms, and they overcame this situation by experiencing growth. It is recommended to take preventive measures against the symptoms of stress and support the patients in terms of overcoming this process by getting stronger.

Self-Handicapping in Chinese Medical Students During the COVID-19 Pandemic: The Role of Academic Anxiety, Procrastination and Hardiness

Background: In the face of the 2019 Coronavirus Disease (COVID-19) outbreak, Chinese medical students worried about their future studies which might make them more susceptible to academic anxiety. Previous studies have shown that academic anxiety is an important risk factor for self-handicapping, but there are few studies to explore the relationship between the two which may be mediated or moderated by other variables. Therefore, this study investigated how Chinese medical students' academic anxiety is correlated to their self-handicapping in time of COVID-19 epidemic, and explored the moderating and mediating effects of hardiness and procrastination. Methods: In this study, 320 Chinese medical students' psychological traits were measured with Academic Anxiety Questionnaire, Self-Handicapping Scale, General Procrastination Scale and Hardiness Scale to explore the potential associations between these variables. Results: The most obvious finding to emerge from this study was that self- handicapping had a positive correlation with academic anxiety and procrastination, but had a negative correlation with hardiness; hardiness had a negative association with academic anxiety and procrastination; and academic anxiety and procrastination were positively correlated. In addition, the relationship between academic anxiety and self-handicapping of Chinese medical students was not only partially mediated by procrastination, but also moderated by hardiness. Furthermore, medical students who had lower hardiness had stronger direct effect, while the indirect effect was strong at high and low conditions of hardiness. Conclusion: In time of the COVID-19 epidemic, the academic anxiety and self-handicapping of medical students are influenced by procrastination and hardiness to a great extent. Thus, in addition to suggesting that more attention should be paid to the academic anxiety and procrastination of medical students, in the future, more attention should be paid to cultivating the hardiness of medical students and exerting its interventional role in self-handicapping.

The Role of Coping Strategies in Post-Traumatic Growth among Syrian Refugees: A Structural Equation Model

The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18-77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees' traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.

Development and validation of the Lo's Healthy and Happy Lifestyle Scale (LHHLS): The resilience in general population facing COVID-19 in Taiwan

BACKGROUND

This article explores the effectiveness of development of the Lo's Healthy and Happy Lifestyle Scale (LHHLS), which is an evaluative tool that monitors the resilience of the Taiwan population in times of such COVID-19 epidemic. Also, to verify factors of resilience, namely the reliability and validity of self-efficacy and positive thinking, and establishment of a prospective norm analysis.

METHOD

The study mainly applied Explorative Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to develop LHHLS and establish the reliability and validity of the tool's structure, verify norm analysis and the reliability of data from each question using Cronbach's alpha.

RESULTS

According to statistics, LHHLS has a good factorial effectiveness and relatively high reliability, with factor reliability analyses where Cronbach's alpha lies between 0.83 to 0.94. The 14 questions in the LHHLS has a total variance of 67.04%. The tool includes two sub-assessments that are theoretically and statistically appropriate: mental health/self-efficacy and positive thinking.

CONCLUSION

The tool LHHLS can be applied to populations affected by COVID-19. With participants' self-awareness of mental health state and state of happy living, this tool is valid and reliable in assessing and evaluating the resilience of such participants against times of COVID-19. This study can become future use for epidemic prevention communities in monitoring residents' healthy living and changes in their resilience. Also, can become a reference standard for interventions to reduce the impacts populations' happy and healthy living, in times of biological disasters.

Posttraumatic stress disorder and growth: Examination of joint trajectories in children and adolescents

Positive health endpoints are not the opposite of negative endpoints. Previous studies examining posttraumatic stress disorders (PTSD) and posttraumatic growth (PTG) trajectories have overlooked the co-existence of PTSD and PTG, making it difficult to accurately distinguish individuals with various posttraumatic presentations, causing the effects of targeted interventions to be discounted. To fill this gap, the current study sought to examine joint PTSD and PTG trajectories in children and adolescents. Eight hundred and seventy-six Chinese children and adolescents were recruited to complete self-report questionnaires 6, 12, and 18 months after the Ya'an earthquake. Multiple-process growth mixture modeling analysis was used to test the study proposal. Five distinct joint PTSD and PTG trajectory types were found: recovery, growth, struggling, resistant, and delayed symptoms. Female students and students who felt trapped or fearful were more likely to be in the struggling group, and students who experienced injury to themselves or family members were more likely to belong to the delayed symptom group. These findings suggest that postdisaster psychological services should be provided to relieve delayed symptoms in individuals who experience injury to themselves or their family members, and individuals in the struggling group should be supported to achieve growth.

Hardiness Predicts Post-Traumatic Growth and Well-Being in Severely Wounded Servicemen and Their Spouses

INTRODUCTION

Thousands of military personnel have suffered severe wounds and traumatic amputations in recent overseas conflicts. They face multiple surgeries and long, painful rehabilitation. Despite the tremendous stress for these servicemen and families, many appear to cope quite well and even thrive despite their devastating wounds. Hardiness is a world view or mindset marked by high levels of commitment and engagement in the world, a strong sense of control, and the tendency to see change as a challenge and opportunity to learn and improve. Previous research has shown that military personnel high in hardiness are at lower risk for post-traumatic stress disorder, depression, and other psychiatric symptoms following combat exposure. This study evaluated the impact of personality hardiness on post-traumatic growth (PTG) and psychological well-being in severely wounded service members and their spouses.

MATERIALS AND METHODS

Male volunteers were surveyed while in hospital for severe battle wounds including loss of limbs. All were married, and all spouses also agreed to participate. Participants (N = 44) completed measures of hardiness, PTG, well-being, and neuroticism, and answered a question regarding potential benefits of their experience.

RESULTS

Hierarchical multiple regression showed that hardiness significantly predicted both PTG and well-being, while controlling for age, education, family income, and neuroticism. Both service members and spouses indicated they experienced benefits in the following areas: strengthened family ties and connections; greater appreciation for and perspective on life; new career and educational opportunities; stronger, more resilient as a person; and formed new relationships, friends, and connections.

CONCLUSION

These results suggest that seriously wounded military members and their spouses who are high in hardiness are more likely to experience PTG and psychological well-being following extremely stressful experiences. Hardiness entails positive reframing of negative experiences as opportunities and challenges to overcome, and taking action to solve problems. Training programs to increase hardiness attitudes and related coping skills may thus be beneficial in facilitating healthy adaptation for severely injured patients.

A Public Mental Health Study Among Iraqi Refugees in Sweden: Social Determinants, Resilience, Gender, and Cultural Context

This public mental health study highlights the interactions among social determinants and resilience on mental health, PTSD and acculturation among Iraqi refugees in Sweden 2012-2013. Objectives: The study aims to understand participants' health, resilience and acculturation, paying specific attention to gender differences. Design: The study, using a convenience sampling survey design (N = 4010, 53.2% men), included measures on social determinants, general health, coping, CD-RISC, selected questions from the EMIC, PC-PTSD, and acculturation. Results: Gender differences and reported differences between life experiences in Iraq and Sweden were strong. In Sweden, religious activity was more widespread among women, whereas activity reflecting religion and spirituality as a coping mechanism decreased significantly among men. A sense of belonging both to a Swedish and an Iraqi ethnic identity was frequent. Positive self-evaluation in personal and social areas and goals in life was strong. The strongest perceived source of social support was from parents and siblings, while support from authorities generally was perceived as low. Self-rated health was high and the incidence of PTSD was low. A clear majority identified multiple social determinants contributing to mental health problems. Social or situational and emotional or developmental explanations were the most common. In general, resilience (as measured with CD-RISC) was low, with women's scores lower than that of men. Conclusions: Vulnerability manifested itself in unemployment after a long period in Sweden, weak social networks outside the family, unsupportive authorities, gender differences in acculturation, and women showing more mental health problems. Though low socially determined personal scores of resilience were found, we also identified a strong level of resilience, when using a culture-sensitive approach and appraising resilience as expressed in coping, meaning, and goals in life. Clinicians need to be aware of the risks of poorer mental health among refugees in general and women in particular, although mental health problems should not be presumed in the individual patient. Instead clinicians need to find ways of exploring the cultural and social worlds and needs of refugee patients. Authorities need to address the described post-migration problems and unmet needs of social support, together comprising the well-established area of the social determinants of health.

Compassion Fatigue and Burnout: What Managers Should Know

Most health care employees experience and are bolstered by compassion satisfaction as they deal with patients in need. However, the more empathetic a health care provider is, the more likely he or she will experience compassion fatigue. Compassion fatigue is a negative syndrome that occurs when dealing with the traumatic experiences of patients, and examples of symptoms include intrusive thoughts, sleeping problems, and depression. Compassion fatigue is different from burnout. Compassion fatigue is a rapidly occurring disorder for primary health care workers who work with suffering patients, whereas burnout, a larger construct, is a slowly progressing disorder for employees who typically are working in burdensome organizational environments. Managers can mitigate problems associated with compassion fatigue with a number of interventions including patient reassignments, formal mentoring programs, employee training, and a compassionate organizational culture. With burnout, health care managers will want to focus primarily on chronic organizational problems.

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.

Influence of hardiness, avoidance coping, and combat exposure on depression in returning war veterans: A moderated-mediation study

BACKGROUND

Depression is a serious problem among military personnel returning from combat deployments, and is related to a range of adverse outcomes including alcohol and drug abuse, family violence and suicide. The present study explores how psychological hardiness, avoidance coping, and combat stress exposure may influence depression in U.S. Army soldiers returning from a one-year deployment to Afghanistan.

METHODS

National Guard soldiers (N = 357) completed surveys upon their return to home station, including measures of hardiness, avoidance coping, combat exposure, and depression. Path analysis with ordinary least squares regression procedures (PROCESS program; Hayes, 2013) were applied to test for mediation and moderation effects among the study variables.

RESULTS

Results showed a pattern of moderated-mediation. In the mediation model, hardiness had a significant effect on depression, which was mediated by avoidance coping. Soldiers low in hardiness reported using more avoidance coping strategies, which was related to increased depression. This effect in turn was seen to be conditional, moderated by level of combat exposure such that the effect was stronger at high levels of exposure.

LIMITATIONS

Data are cross-sectional, and the sample consisted of male soldiers only, which may limit generalizability.

CONCLUSIONS

Depression and related problems among combat veterans may be diminished by applying training programs and policies aimed at increasing hardiness attitudes and active coping skills.

Resilience as a moderating factor between stress and alcohol-related consequences in the Army National Guard

Due to the current prolonged conflicts in Iraq and Afghanistan, members of the United States National Guard and Reserve have shifted from a historically support-based role to an integral segment of combat efforts. Clinical and epidemiological research studies conducted on both civilian and military populations have documented high rates of comorbidity of stress disorders and substance use disorders. It is widely understood that excessive alcohol use is an issue among military personnel. The aim of this paper is to describe risk factors for alcohol-related serious consequences in a study of Army National Guard service members, as well as the role of resilience in protecting against these risks. Members of the National Guard (N=320) participated in the survey. We conducted a multiple regression to predict alcohol-related serious consequences and a simple moderation analysis was performed. After controlling for race, education, and deployment history, several variables emerged as significant predictors of alcohol-related consequences. Higher stressors, lower resilience, younger age, being unmarried and not living as married, being male, and identifying as non-Hispanic were associated with higher levels of serious alcohol-related consequences. Results revealed that resilience significantly moderated the relationship between stress and alcohol-related consequences. This study furthers our understanding of the alcohol-stress relationship by contextualizing it in terms of behaviors related to alcohol, as opposed to measuring consumption only. Most importantly, our work extends prior research in its examination of resilience as a moderator of the relationship between stress and serious alcohol-related consequences.

Posttraumatic growth in a heterogeneous sample of traumatically injured patients 1 year postinjury

OBJECTIVE

Posttraumatic growth (PTG) describes positive change resulting from challenging life events. The current study examined factors associated with PTG in traumatically injured patients 1 year postinjury.

METHOD

Participants (N = 221) in this prospective cohort study included adults admitted to a Level I trauma center. Over half the participants (60%) were male, with a mean age of 47. Participants completed baseline measures during hospitalization. PTG was assessed at 12-month follow-up.

RESULTS

Greater PTG was associated with minority race/ethnicity, lower income, automotive collision, and premorbid psychological disorder other than depression or posttraumatic stress (PTS). These variables are also known to predict PTS in trauma patients. Analysis confirmed that greater PTS at follow-up was associated with more growth.

CONCLUSION

Participants with the most growth also experienced the most distress. This finding demonstrates the importance of implementing psychological screening and intervention for trauma patients in the acute care setting to reduce PTS and facilitate growth.

A Longitudinal Study of Hardiness as a Buffer for Posttraumatic Stress Symptoms in Mothers of Children with Cancer

Mothers of children diagnosed with cancer have been found to be at a heightened risk for post-traumatic stress symptoms (PTSS). In an effort to identify a potential buffer, hardiness was examined as a protective factor for PTSS among mothers of children that were diagnosed with cancer in the past 2 weeks. Using a prospective design, mothers completed measures of PTSS and hardiness at the time of their child's cancer diagnosis and then again at 6- and 12-months post-diagnosis. Random effects regression analyses revealed that mothers who scored high on hardiness were less likely to experience PTSS after controlling for the effect of time. PTSS cluster-specific relations with hardiness were also examined, which revealed that mothers who scored high on hardiness experienced fewer avoidance/numbing symptoms at the time of their child's diagnosis of cancer and across 12 months; whereas mothers who scored low on hardiness tended to experience more avoidance/numbing symptoms at the time of their child's diagnosis. However, these symptoms declined gradually over the course of 12 months. The present findings support examining hardiness further as a buffer against specific PTSS clusters and exploring options for identifying and treating mothers of children with cancer that may be at risk for PTSS.

Post-Traumatic Growth Following Politically Motivated Acts of Violence: 10 Years Post Injury

The study explored posttraumatic growth (PTG) and its relationship with the quality of life (QOL), posttraumatic stress, and resilience among survivors of terror attacks over 10 years post-injury. Participants were patients of Hadassah Medical Center, Israel, who were injured in terror attacks between 2000 and 2004 during the second Intifada. Variables of interest were obtained from a survey and patients' medical files. In total, 42 patients participated, 66% were men, and the average age was 41.4 years. Multivariate analysis was utilized to predict PTG from a variety of demographic variables including gender, ethnicity, relationship status, age, education, income, religiosity, and injury/disability type. Additional primary variables of study included current levels of QOL, posttraumatic stress, and resilience. Results revealed that married/partnered individuals had higher levels of PTG than divorced or single individuals. Findings suggest that social support following trauma is important for PTG and should be prioritized in recovery interventions with trauma survivors.

Meaning and Posttraumatic Growth Among Survivors of the September 2013 Colorado Floods

In the wake of significant adversity, a range of recovery outcomes are possible, from prolonged distress to minimal effects on functioning and even psychological growth. Finding meaning in one's life is thought to facilitate optimal recovery from such adversity. Research on psychological growth and recovery often focuses on the daily hassles or significant traumas of convenience samples or on people's psychological recovery from medical illness. A small body of research is developing to test theories of growth among survivors of natural disasters. The present study of 57 survivors of the 2013 Colorado floods tested the incremental relations between posttraumatic growth (PTG) and dimensions of meaning in life, vitality, and perceived social support. The most consistent relations observed were among the one dimension of meaning-search for meaning-perceived social support, and PTG. Despite the limitations of this study, we conclude that search for meaning in life may be an important part of recovery from natural disasters, floods being one example.

Hardiness, History of Abuse and Women's Health

This study examined hardiness and health in women with and without histories of physical and/or sexual abuse. Patients ( N= 201) from a major Midwestern hospital gynecology clinic completed measures of hardiness, physical health, psychological health and neuroticism. The following findings were obtained: (a) the proposed three-factor structure of hardiness was not confirmed, and a different model was suggested; (b) evidence for convergent (adjustment and neuroticism) validity was found; (c) hardiness was significantly associated with physical and psychological health; (d) hardiness was not found to moderate the effects of an abusive past; and (e) the constructs of neuroticism and hardiness appear to overlap to a certain extent. Implications of these findings for theory, research and practice are discussed.

Post-traumatic growth following acquired brain injury: a systematic review and meta-analysis

The idea that acquired brain injury (ABI) caused by stroke, hemorrhage, infection or traumatic insult to the brain can result in post-traumatic growth (PTG) for individuals is increasingly attracting psychological attention. However, PTG also attracts controversy as a result of ambiguous empirical findings. The extent that demographic variables, injury factors, subjective beliefs, and psychological health are associated with PTG following ABI is not clear. Consequently, this systematic review and meta-analysis explores the correlates of variables within these four broad areas and PTG. From a total of 744 published studies addressing PTG in people with ABI, eight studies met inclusion criteria for detailed examination. Meta-analysis of these studies indicated that growth was related to employment, longer education, subjective beliefs about change post-injury, relationship status, older age, longer time since injury, and lower levels of depression. Results from homogeneity analyses indicated significant inter-study heterogeneity across variables. There is general support for the idea that people with ABI can experience growth, and that various demographics, injury-related variables, subjective beliefs and psychological health are related to growth. The contribution of social integration and the forming of new identities post-ABI to the experience of PTG is explored. These meta-analytic findings are however constrained by methodological limitations prevalent in the literature. Clinical and research implications are discussed with specific reference to community and collective factors that enable PTG.

Centrality of positive and negative deployment memories predicts posttraumatic growth in danish veterans

OBJECTIVE

The purpose of the present study was to examine theoretically motivated predictors for the development of positive changes following potentially traumatic experiences (i.e., posttraumatic growth). Specifically, we wanted to examine the prediction that memories of highly negative and positive deployment events predict subsequent posttraumatic growth.

METHOD

A total of 251 Danish soldiers (7% female, mean age 26.4) deployed to forward operating bases in Afghanistan filled out questionnaires before, during, and after deployment. This allowed us to perform prospective as well as cross-sectional analyses of the data.

RESULTS

The main findings were that the centrality of highly emotional memories from deployment predicted growth alongside openness to experience, combat exposure, and social support. Importantly, the centrality of both positive and negative memories predicted growth equally well.

CONCLUSION

The perceived importance of both negative and positive events may play an important part in the development of posttraumatic growth.

[Personal resilience and post-traumatic stress symptoms of local government employees: six months after the 2011 magnitude 9.0 East Japan Earthquake]

OBJECTIVES

The Great East Japan Earthquake caused severe infrastructure damage in the Kanto and Tohoku regions, but the psychological stress of public sector employees in the Kanto region where tsunami damage was small has received little attention. This study examined the association between personal resilience and post-traumatic stress symptoms of local government employees in the Kanto region.

METHODS

In this cross-sectional study, all employees (N=2,069) of a single municipality in the Kanto region were recruited in September 2011, six months after the earthquake, and 991 completed the questionnaire (response rate, 47.9%). After excluding respondents who had missing values, the data from 825 respondents (607 males and 218 females) were analyzed. Post-traumatic stress symptoms were measured using the Impact Event Scale-Revised. Resilience was measured using the Connor-Davidson Resilience Scale and divided into three groups on the basis of scores; low, moderate, and high. House damage and respondents or their families' experience of injury that were caused by the earthquake were assessed using single-item questions. Participants who reported house damage or injury were defined as being affected. Using multiple logistic regression analysis, the odds ratio of post-traumatic stress symptoms (IES-R score ≥25) was calculated for the upper, middle, and low resilience score groups.

RESULTS

Among the respondents, 4.6% experienced injuries within their families, 82.3% reported house damage, and thus 83.3% were affected by the Great East Japan Earthquake. Post-traumatic stress symptoms were significantly higher among the affected group and those with chronic diseases. After adjusting for the demographic and occupational characteristics, the likelihood of post-traumatic stress symptoms was greater in the low resilience group (Odds ratio: 2.10 [95% confidence interval = 1.31-3.37]). A significant negative relationship was observed between resilience and post-traumatic stress symptoms particularly in the affected group.

CONCLUSIONS

Low personal resilience predicted post-traumatic stress symptoms among local government employees who experienced some house damage or injury during the Great East Japan Earthquake. This result may indicate that resilience reduces the onset of post-traumatic stress symptoms, even when faced by the difficulties imposed by a natural disaster such as an earthquake.

Revisão sistemática dos aspectos psicossociais, neurobiológicos, preditores e promotores de resiliência em militares

Objetivo: Conduzir uma revisão sistemática sobre resiliência psicológica e/ou hardiness em militares, explorando seus aspectos psicossociais, neurobiológicos, preditores e promotores. Métodos: Utilizaram-se as bases de dados PubMed/MedLine, ISI/Web of Science e PsycINFO, incluindo artigos empíricos publicados nas línguas inglesa, portuguesa e espanhola até maio de 2012. Os seguintes termos foram utilizados: “militar*”, “Army”, “war”, “veteran*”, “resilien*” e “hardiness”. Resultados: Foram incluídos 32 estudos selecionados a partir de 1.205 artigos. O foco da maioria das pesquisas recai sobre a correlação resiliência/hardiness e aspectos psicossociais. Confirmou-se o papel protetivo da resiliência/hardiness quanto ao transtorno de estresse pós-traumático (TEPT), assim como a associação direta entre resiliência e saúde. Neuropeptídeo Y (NPY) e deidroepiandrosterona (DHEA) foram os biomarcadores mais estudados. Os níveis de NPY no plasma podem representar um correlato biológico de resiliência ou recuperação dos efeitos adversos do estresse. Somente dois estudos abordaram fatores preditores de resiliência em amostras militares, sugerindo ser a exposição a situações adversas, o apoio social e o gênero fatores considerados preditores desse construto. Apenas um estudo avaliou a eficiência de intervenção para fortalecer a resiliência. Conclusão: Apesar da crucial relevância da resiliência, há poucos estudos em amostras militares. Estudos neurobiológicos como os do NPY são promissores. A ausência de ensaio randomizado controlado avaliando eficácia de intervenções promotoras da resiliência demonstra como esse construto vem sendo negligenciado nessa profissão de risco, constituindo área prioritária para foco de estudos futuros.

Traumatic loss and helplessness: qualitative analysis of responses in the Rorschach

The aim in this paper is to compare the answers on the Rorschach's inanimate motion (m) and blood content (Bl) between sexual abuse victims and non-victims. Among the protocols of 76 individuals between 10 and 14 years old, 29 were selected. Qualitative analysis showed that the victims presented: a) narratives with m responses, suggesting the presence of feelings of helplessness and powerlessness; b) replies with m or Bl associated with contents far more violent and destructive; c) images filled with morbid characteristics. The findings support evaluation practices, illustrate the traumatic effects of sexual abuse and ascertain the validity of Rorschach's test for the ideographic approach, derived from the responses' qualitative analysis, and also from the normothetic perspective derived from the structural summary.

Organizational psychosocial factors and deployment-related exposure concerns in Afghanistan/Iraq War veterans

OBJECTIVE

Environmental exposure concerns are associated with adverse health outcomes in soldiers deployed to South West Asia. There is little data on factors associated with the reporting of exposure concerns. We explored the relationship between deployment-related preparedness/support and exposure concerns.

METHODS

Retrospective chart review of 489 Afghanistan/Iraq veterans evaluated at a Veterans Affairs tertiary center for postdeployment health.

RESULTS

Virtually all subjects were concerned about environmental exposure(s). There were no significant demographic differences in exposure concerns, preparedness/support variables, or both. Preparedness/support correlated inversely with exposure concerns. Mental health function mediated the relationship between preparedness/support and exposure concerns.

CONCLUSIONS

Deployment-related preparedness/support is associated with exposure concerns and mental health functioning. Definitive studies will provide data and insight on how the military may better prepare/support soldiers to optimize their resilience and reduce deployment-related exposure concerns.

Bloodied but unbowed: resilience examined in a South asian community

The construct of resilience was examined in a South Asian community impacted by natural and human-made disasters. Forty-three Sinhala, Tamil, and Muslim Sri Lankans (27 women; age range 21-62 years) participated in 6 focus groups, conducted in either Sinhala or Tamil, to elicit participants' own ideas about components of resilience. Schema analysis of transcripts revealed that although some elements of resilience were common across ethnocultural groups, others differed by ethnic group. The differences appeared to be as much a function of type of trauma exposure as of culture. Components of resilience included many that are recognized in the western construct of resilience as well as 2 culturally unique components: strong will relating either to religious faith or to karma and psychosocial gratitude. These components could be examined in future measures of resilience with similar populations. Findings also revealed that some components of resilience can be taught; thus they can be the focus of interventions and public health policies.

Ethical Considerations in Emergency Planning, Preparedness, and Response to Acts of Terrorism

Throughout the globe, healthcare providers are increasingly challenged with the specter of terrorism and the fallout from weapons of mass destruction. Preparing for and responding to such manmade emergencies, however, threatens the ethical underpinnings of routine, individualized, patient-centered, emergency healthcare. The exigency of a critical incident can instantly transform resource rich environs, to those of austerity. Healthcare workers, who only moments earlier may have been seeing two to three patients per hour, are instantly thrust into a sea of casualties and more basic lifeboat issues of quarantine, system overload and the thornier determinations of who will be given every chance to live and who will be allowed to die. Beyond the tribulations of triage, surge capacity, and the allocation of scarce resources, terrorism creates a parallel need for a host of virtues not commonly required in daily medical practice, including prudence, courage, justice, stewardship, vigilance, resilience, and charity. As a polyvalent counterpoint to the vices of apathy, cowardice, profligacy, recklessness, inflexibility, and narcissism, the virtues empower providers at all levels to vertically integrate principles of safety, public health, utility, and medical ethics at the micro, meso, and macro levels. Over time, virtuous behavior can be modeled, mentored, practiced, and institutionalized to become one of our more useful vaccines against the threat of terrorism in the new millennium.

Compassion fatigue and burnout: what managers should know

Most health care employees experience and are bolstered by compassion satisfaction as they deal with patients in need. However, the more empathetic a health care provider is, the more likely he or she will experience compassion fatigue. Compassion fatigue is a negative syndrome that occurs when dealing with the traumatic experiences of patients, and examples of symptoms include intrusive thoughts, sleeping problems, and depression. Compassion fatigue is different from burnout. Compassion fatigue is a rapidly occurring disorder for primary health care workers who work with suffering patients, whereas burnout, a larger construct, is a slowly progressing disorder for employees who typically are working in burdensome organizational environments. Managers can mitigate problems associated with compassion fatigue with a number of interventions including patient reassignments, formal mentoring programs, employee training, and a compassionate organizational culture. With burnout, health care managers will want to focus primarily on chronic organizational problems.

Psychological resilience in OEF-OIF Veterans: application of a novel classification approach and examination of demographic and psychosocial correlates

A growing number of studies have examined the prevalence and correlates of psychopathology in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF), but few have examined determinants of resilience in this population. This study employed a novel approach to classify psychological resilience in a cross-sectional sample of OEF-OIF Veterans. A total of 272 predominantly older reserve/National Guard OEF/OIF Veterans completed a mail survey that assessed combat exposure, psychopathology, psychosocial functioning, and aspects of social support. Cluster analysis of scores on measures of combat exposure and PTSD symptoms revealed that a three-group solution best fit the data: Controls (low combat exposure, low PTSD symptoms); PTSD (high combat exposure, high PTSD symptoms); and Resilient (high combat exposure, low PTSD symptoms). Compared to the PTSD group, the Resilient group was more likely to be in a relationship and active duty; they also scored lower on a measure of psychosocial dysfunction, and higher on measures of psychological resilience and postdeployment social support. Logistic regression analysis revealed that being in a relationship, having fewer psychosocial difficulties, and reporting greater perceptions of purpose/control and family support and understanding were significantly associated with resilient group membership. Results of this study demonstrate a novel approach to classifying psychological resilience and suggest that interventions to mitigate psychosocial difficulties, enhance perceptions of purpose and control, and bolster family support and understanding may help promote resilience to combat-related PTSD in OEF-OIF Veterans.

Suicidal or self-harming ideation in military personnel transitioning to civilian life

Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.

Detainment and health: the case of the Lebanese hostages of war

The purpose of the current research was to compare former detainees of Khiam prison to a comparison group regarding depression, anxiety, presence of chronic diseases, smoking, and alcohol drinking. The sample consisted of 118 ex-detainees and 90 community controls. The Beck Depression Inventory, the Hamilton Anxiety Scale, the Clinician-Administered Post-Traumatic Stress Disorder Scale, and the Harvard Trauma Questionnaire were used. The ex-detainees suffered from an increased level of depression, high anxiety scores, increased chronic diseases, smoked more, and consumed more alcohol than their comparison group. Regression analyses showed that detainment independently predicted depression and anxiety.

Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom

BACKGROUND

A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population.

METHODS

A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support.

RESULTS

Resilience scores in the full sample were comparable to those observed in civilian outpatient primary-care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure.

CONCLUSIONS

These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans.

Does prior exposure to interpersonal violence increase risk of PTSD following subsequent exposure?

Research has generally found a "dose relationship" between potentially traumatic events (PTEs) and the likelihood of developing PTSD, with greater number of events associated with greater likelihood. Most of these studies have been cross-sectional, however. A recent prospective study (Breslau, Peterson, & Schultz, 2008) found that PTSD response to prior potentially traumatic event (PTE) exposure, rather than prior exposure itself, acts as a risk factor for PTSD in response to subsequent PTE; however, this analysis combined many different types of events, and the unique contribution of specific events (e.g., assault) that may be associated with differential risk of PTSD was indeterminable. The present study examined the effects of cumulative PTE exposure prospectively using a two-wave design in the National Survey of Adolescents (N = 1703). History of assault and witnessing serious violence were the focal PTEs examined. Wave I assault without PTSD was found to predict PTSD at Wave II following exposure to new assault or witnessed violence; however, among those without prior PTSD, Wave I witnessed violence did not increase risk of subsequent PTSD following exposure.

Positive and negative psychological impact after secondary exposure to politically motivated violence among body handlers and rehabilitation workers

The positive and negative psychological impact of secondary exposure to politically motivated violence was examined among body handlers and hospital rehabilitation workers, 2 groups that differed in their proximity and immediacy to violent events. Survivors of politically motivated violence served as a comparison group. Body handlers experienced high levels of positive psychological impact and traumatic stress symptoms. Levels of positive psychological impact among on-scene body handlers were higher than those experienced by rehabilitation workers. Traumatic stress symptoms predicted positive psychological impact among body handlers. These findings indicate that proximity to stressors is associated with higher levels of positive and negative psychological impact. Physical proximity is a major contributory factor to both positive and negative psychological effects of secondary exposure to trauma.