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Pakenham KI, Landi G, Grandi S, Tossani E. The mediating role of psychological flexibility in the relationship between resilience and distress and quality of life in people with multiple sclerosis. J Health Psychol 2024; 29:65-80. [PMID: 37387365 DOI: 10.1177/13591053231182364] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
The purpose of this study is to investigate the role of psychological flexibility in mediating the beneficial effects of resilience on distress and quality of life (QoL) in people with MS (PwMS). The psychological flexibility framework underpinning acceptance and commitment therapy (ACT) was used to conceptualise psychological flexibility. A total of 56 PwMS completed an online survey that assessed global psychological flexibility and each of its six core sub-processes, resilience, distress, mental and physical health QoL, socio-demographics, and illness variables. Mediation analyses showed that, as hypothesised, higher levels of global psychological flexibility and its sub-processes were associated with increases in the positive impacts of resilience on distress and mental and physical health QoL via a mediational mechanism. These findings suggest that psychological flexibility skills build resilience capacities in PwMS. The psychological flexibility framework offers an ACT-based intervention pathway to build resilience and enhance mental health and QoL in PwMS.
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2
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Wright E, Elliott TR, Kwok OM, Zhang Q, Spooner M. Resilience and distress among young adults with chronic health conditions: A longitudinal study. Br J Health Psychol 2023; 28:1036-1051. [PMID: 37186348 DOI: 10.1111/bjhp.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/26/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To test the beneficial associations of a resilient personality prototype among emerging adults with chronic health conditions (CHC) over an 8-year period. DESIGN Longitudinal, prospective observation study. METHODS Data obtained from emerging adults in the Add Health project with a CHC and completed study measures at two time points (286 men, 459 women) were examined. Cluster analysis was used to identify a resilient personality prototype at the first time point, as defined in the Block model of personality. Differences between those with a resilient and non-resilient prototype were examined. A structural equation model (SEM) tested the association of a resilience prototype with positive affect, perceived control and family relationships in predicting distress over time. RESULTS A resilient personality profile was identified (n = 256). These individuals reported higher positive affect, greater perceived control and less distress at both measurement occasions than those without this profile (n = 489). Women reported more distress than men. SEM revealed the relationship of a resilient prototype to distress was explained by its beneficial association with positive affect and perceived control at the first assessment, and through its beneficial association with perceived control 8 years later. Gender independently predicted distress. CONCLUSIONS A resilient personality prototype appears to operate through its beneficial association with perceived control to prospectively predict distress reported by emerging adults with CHC. The self-regulatory properties theoretically associated with a resilient personality prototype may function through perceptions of control which, in turn, prevent prolonged experiences of distress. Clinical implications are considered.
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Affiliation(s)
- Erika Wright
- Department of Educational Psychology, Texas A&M University, College Station, Texas, USA
| | - Timothy R Elliott
- Department of Educational Psychology, Texas A&M University, College Station, Texas, USA
| | - Oi-Man Kwok
- Department of Educational Psychology, Texas A&M University, College Station, Texas, USA
| | - Qiyue Zhang
- Department of Educational Psychology, Texas A&M University, College Station, Texas, USA
| | - Mikaela Spooner
- Department of Educational Psychology, Texas A&M University, College Station, Texas, USA
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3
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Patel TA, Blakey SM, Halverson TF, Mann AJD, Calhoun PS, Beckham JC, Pugh MJ, Kimbrel NA. Experiential Avoidance, Posttraumatic Stress Disorder, and Self-Injurious Thoughts and Behaviors: A Moderation Analysis in a National Veteran Sample. Int J Cogn Ther 2023; 1:10.1007/s41811-023-00164-2. [PMID: 37360585 PMCID: PMC10288701 DOI: 10.1007/s41811-023-00164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/28/2023]
Abstract
Experiential avoidance (EA) is associated with posttraumatic stress disorder (PTSD) and self-injurious thoughts and behaviors (SITBs) across different populations, and extant literature has demonstrated a strong relationship between PTSD and SITBs. However, no study has explored the potential moderating role EA plays in the association of PTSD with nonsuicidal self-injury (NSSI), suicidal ideation, and suicide attempts. The objective of the present study was to determine if EA would moderate the association with PTSD and SITBs such that the association between PTSD and individuals SITBs would be stronger among individuals with higher EA. In a large national sample of Gulf War Era veterans (N = 1,138), EA was associated with PTSD, lifetime and past-year NSSI, current suicidal ideation, and lifetime suicide attempts in bivariate analyses. Multivariate analyses detected a significant EA by PTSD interaction on lifetime NSSI (AOR = 0.96), past-year NSSI (AOR = 1.03), and suicide attempts (AOR =1.03). Probing of the interactions revealed that the respective associations between PTSD, lifetime and past-year NSSI, and suicide attempts were stronger at lower levels of EA (i.e., better), counter to our hypotheses. These preliminary findings contextualize the relationship between these variables in a Gulf War veterans sample and signal the need to further investigate these relationships. Further, these findings highlight the need for advancement in assessment and intervention of EA and SITBs.
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Affiliation(s)
- Tapan A. Patel
- Department of Psychology, Florida State University; Tallahassee, FL
| | | | - Tate F. Halverson
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
| | | | - Patrick S. Calhoun
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | - Jean C. Beckham
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | - Mary J. Pugh
- VA Salt Lake City Healthcare System, Salt Lake City; UT
- University of Utah School of Medicine Department of Medicine; Salt Lake City, UT
| | - Nathan A. Kimbrel
- Durham VA Health Care System; Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
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4
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Grau PP, Sripada RK, Ganoczy D, Weinstein JH, Pfeiffer PN. Outcomes of Acceptance and Commitment Therapy for depression and predictors of treatment response in Veterans Health Administration patients. J Affect Disord 2023; 323:826-833. [PMID: 36529407 DOI: 10.1016/j.jad.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy for depression (ACT-D) is a promising depression treatment which has not been evaluated on a large scale within VA. This study aimed to evaluate ACT-D's effectiveness in a national, treatment-seeking sample of Veterans. METHODS The sample comprised 831 Veterans who received a primary depression diagnosis and received at least two sessions of ACT-D during fiscal years 2015-2020. We used GLM to measure predictors of symptom change, treatment response (50 % reduction in PHQ-9 and AAQ-II scores), subthreshold depression symptoms (PHQ-9 < 10; AAQ-II < 27), and treatment completion. RESULTS Veterans experienced an average reduction of 3.39 points on the PHQ-9 (Cohen's d = 0.56) and 3.76 points on the AAQ-II (Cohen's d = 0.43). On the PHQ-9, 40 % achieved subthreshold depression symptoms. On the AAQ-II, 36 % of Veterans achieved subthreshold psychological inflexibility scores. Service-connected disability rating for depression and higher levels of medical comorbidity were both related to lower levels of overall depression symptom change and treatment response. Substance use disorder and bipolar/psychosis diagnoses were associated with greater reductions in psychological inflexibility. LIMITATIONS This is an observational study without a control group, so we were unable to compare the effectiveness of ACT-D to other usual care for depression. We were also unable to assess variables that can influence treatment success, such as therapist fidelity and patient engagement. CONCLUSIONS ACT-D achieved similar improvements in depression as reported in controlled trials. Adaptations to ACT-D may be needed to improve outcomes for Veterans with depression and comorbid PTSD.
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Affiliation(s)
- Peter P Grau
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road, Bldg 16, Ann Arbor, MI 48109, United States; VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States.
| | - Rebecca K Sripada
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
| | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
| | - Jonathan H Weinstein
- VA Northport Medical Center, 79 Middleville Road, Northport, NY 11768, United States
| | - Paul N Pfeiffer
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
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5
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Paasila JM, Smith E, Daher M, Simpson GK. Reasons for living, positive psychological constructs and their relationship with suicide ideation in people with moderate to severe traumatic brain injury: A cross-sectional study. Neuropsychol Rehabil 2022; 32:2125-2146. [PMID: 35862622 DOI: 10.1080/09602011.2022.2100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Positive psychological constructs such as reasons for living, self-esteem and resilience have previously been shown to act as protective psychological barriers against negative psychological outcomes, including suicide ideation in both clinical populations and the general population. This study aims to explore the positive psychological constructs of reasons for living, self-esteem, resilience and their relationship with suicide ideation and predictors of suicide ideation (depression, hopelessness) for N = 50 people who have a severe TBI and are currently receiving community rehabilitation at Liverpool Brain Injury Rehabilitation Unit (LBIRU), NSW. Results indicated good reliability for the use of the RFLI with people who have TBI, with the most frequently endorsed subscale (range 0-5) being "survival and coping beliefs" (4.7 ± 1.0) and the least frequently being "fear of suicide" (2.2 ± 1.1). The shortened version of the RFLI (BRFLI) also displayed good reliability. Positive psychological constructs (reasons for living, resilience, self-esteem) were all significantly inversely associated with suicide and suicide predictors (depression, hopelessness). This study suggests that positive psychological constructs can act as a buffer against suicide ideation after moderate to severe TBI.
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Affiliation(s)
- Josephine M Paasila
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Psychology, Western Sydney University, Sydney, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Evelyn Smith
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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6
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Park HRP, Williams LM, Turner RM, Gatt JM. TWIN-10: protocol for a 10-year longitudinal twin study of the neuroscience of mental well-being and resilience. BMJ Open 2022; 12:e058918. [PMID: 35777871 PMCID: PMC9252211 DOI: 10.1136/bmjopen-2021-058918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/08/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mental well-being is a core component of mental health, and resilience is a key process of positive adaptive recovery following adversity. However, we lack an understanding of the neural mechanisms that contribute to individual variation in the trajectories of well-being and resilience relative to risk. Genetic and/or environmental factors may also modulate these mechanisms. The aim of the TWIN-10 Study is to characterise the trajectories of well-being and resilience over 12 years across four timepoints (baseline, 1 year, 10 years, 12 years) in 1669 Australian adult twins of European ancestry (to account for genetic stratification effects). To this end, we integrate data across genetics, environment, psychological self-report, neurocognitive performance and brain function measures of well-being and resilience. METHODS AND ANALYSIS Twins who took part in the baseline TWIN-E Study will be invited back to participate in the TWIN-10 Study, at 10-year and 12-year follow-up timepoints. Participants will complete an online battery of psychological self-reports, computerised behavioural assessments of neurocognitive functions and MRI testing of the brain structure and function during resting and task-evoked scans. These measures will be used as predictors of the risk versus resilience trajectory groups defined by their changing levels of well-being and illness symptoms over time as a function of trauma exposure. Structural equation models will be used to examine the association between the predictors and trajectory groups of resilience and risk over time. Univariate and multivariate twin modelling will be used to determine heritability of the measures, as well as the shared versus unique genetic and environmental contributions. ETHICS AND DISSEMINATION This study involves human participants. This study was approved by the University of New South Wales Human Research Ethics Committee (HC180403) and the Scientific Management Panel of Neuroscience Research Australia Imaging (CX2019-05). Results will be disseminated through publications and presentations to the public and the academic community. Participants gave informed consent to participate in the study before taking part.
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Affiliation(s)
- Haeme R P Park
- Neuroscience Research Australia, Randwick, New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Robin M Turner
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, Central Dunedin, New Zealand
| | - Justine M Gatt
- Neuroscience Research Australia, Randwick, New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Dong S, Elliott TR, Luo W, Warren AM, Warren R. Personality metatraits predict resilience among family caregivers responsible for a dependent youth's chronic respiratory management. BMC Psychol 2022; 10:85. [PMID: 35365207 PMCID: PMC8973997 DOI: 10.1186/s40359-022-00791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Family caregivers of children and youth with severe neurodisabilities that require chronic respiratory management often report a compromised quality of life. In this cross-sectional study, we used DeYoung’s (Psychol Inq 21(1): 26–33, 2010. 10.1080/10478401003648674) conceptualization of two personality metatraits, Alpha and Beta, to test their theorized role in facilitating resilience among these family caregivers. We expected higher Alpha and Beta would exhibit direct, beneficial effects on caregiver mental and physical health quality of life (QoL), and they would operate through self-reported resilience and coping to exert positive, indirect effects on caregiver QoL. Methods Family caregivers of children and youth at an outpatient chronic respiratory management clinic were informed of the study. Of the 68 who consented, 61 provided complete data on measures of personality traits, coping styles, and physical and mental health-related QoL. Factor analytic techniques verified the two personality metatraits, consistent with the DeYoung model. The metatraits were then used as predictor variables in a path model to predict physical and mental health-related QoL. Self-reported resilience and a coping variable were examined as possible mediators of the personality-QoL relationship. Results Correlational analyses isolated a coping variable that met criteria as a possible mediator. The path model exhibited good fit to the data. The Alpha metatrait—characterized by emotional stability, self-regulation, perseverance, and intrinsic motivation—was directly predictive of caregiver mental health. The Beta metatrait, reflecting a disposition for adaptive flexibility, responsiveness, and interpersonal initiative, demonstrated significant indirect effects to physical and mental health through its positive association with coping efforts to maintain social support and a sense of self. Conclusions Consistent with DeYoung’s conceptualization, higher Alpha and Beta predicted caregiver resilience, albeit through different pathways. The emotional stability, perseverance and emotional regulation associated with Alpha likely accounted for its positive association with caregiver mental health. Beta, in contrast, may operate through their adaptive flexibility, personal resourcefulness and social engagement to augment coping efforts that involve others and support family activities, which, in turn, promote their own physical and mental health. Limitations of the cross-sectional design, and potential theoretical and clinical implications of the personality metatraits and their relation to resilience are discussed. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00791-y.
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Affiliation(s)
- Sidai Dong
- Department of Educational Psychology, Texas A&M University (4225 TAMU), College Station, TX, 77843-4225, USA
| | - Timothy R Elliott
- Department of Educational Psychology, Texas A&M University (4225 TAMU), College Station, TX, 77843-4225, USA.
| | - Wen Luo
- Department of Educational Psychology, Texas A&M University (4225 TAMU), College Station, TX, 77843-4225, USA
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Robert Warren
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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8
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McDaniel JT, Hascup ER, Hascup KN, Trivedi M, Henson H, Rados R, York M, Albright DL, Weatherly T, Frick K. Psychological Resilience and Cognitive Function Among Older Military Veterans. Gerontol Geriatr Med 2022; 8:23337214221081363. [PMID: 35252475 PMCID: PMC8891840 DOI: 10.1177/23337214221081363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/06/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to explore the association between psychological resilience and cognitive function in military veterans. We obtained public-use data from the Health and Retirement Study (HRS) for this cross-sectional study of military veterans aged 52 to 101 years (n = 150). We estimated a multivariable linear regression model in which cognitive function served as the dependent variable and psychological resilience served as the independent variable. After controlling for demographics, health conditions, and health behaviors, veterans who had higher psychological resilience scores had better cognitive function (b = 0.22, p = 0.03). Our findings suggest that psychological resilience may be associated with cognitive function among veterans. These findings highlight the importance of assessing psychological resilience in gerontological social work practice.
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Affiliation(s)
- Justin T. McDaniel
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Erin R. Hascup
- Dale and Deborah Smith Center for Alzheimer’s Research and trEatment (CARE), Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kevin N. Hascup
- Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, IL USA
| | - Mehul Trivedi
- Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, IL USA
| | - Harvey Henson
- School of Education, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Robert Rados
- School of Health Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Mary York
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | | | - Taryn Weatherly
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Kaitlyn Frick
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
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Merritt VC, Brickell TA, Bailie JM, Hungerford L, Lippa SM, French LM, Lange RT. Low resilience following traumatic brain injury is strongly associated with poor neurobehavioral functioning in U.S. military service members and veterans. Brain Inj 2022; 36:339-352. [PMID: 35171749 DOI: 10.1080/02699052.2022.2034183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between resilience and self-reported neurobehavioral functioning following traumatic brain injury (TBI) in U.S. military service members and veterans (SMVs). A secondary objective was to examine the interaction between resilience and posttraumatic stress disorder (PTSD) on neurobehavioral functioning. METHOD Participants included 795 SMVs classified into four groups: Uncomplicated Mild TBI (MTBI; n=300); Complicated Mild, Moderate, Severe, or Penetrating TBI (STBI, n 162); Injured Controls (IC, n=185); and Non-injured Controls (NIC, n=148). Two independent cohorts were evaluated - those assessed within 1-year of injury and those assessed 10-years post-injury. SMVs completed self-report measures including the PTSD Checklist-Civilian version, Neurobehavioral Symptom Inventory, and TBI-Quality of Life. RESULTS Results showed that (1) lower resilience was strongly associated with poorer neurobehavioral functioning across all groups at 1-year and 10-years post-injury, and (2) PTSD and resilience had a robust influence on neurobehavioral functioning at both time periods post-injury, such that SMVs with PTSD and low resilience displayed the poorest neurobehavioral functioning. CONCLUSION Results suggest that regardless of injury group and time since injury, resilience and PTSD strongly influence neurobehavioral functioning following TBI among SMVs. Future research evaluating interventions designed to enhance resilience in this population is indicated.
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Affiliation(s)
- Victoria C Merritt
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA.,Naval Hospital Camp Pendleton, Oceanside, CA, Oceanside, CA, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA.,Naval Medical Center San Diego, San Diego, CA, USA
| | - Sara M Lippa
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA.,University of British Columbia, Vancouver, BCCanada
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10
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Schmidt AT, Lindsey HM, Dennis E, Wilde EA, Biekman BD, Chu ZD, Hanten GR, Formon DL, Spruiell MS, Hunter JV, Levin HS. Diffusion Tensor Imaging Correlates of Resilience Following Adolescent Traumatic Brain Injury. Cogn Behav Neurol 2021; 34:259-274. [PMID: 34851864 PMCID: PMC8647770 DOI: 10.1097/wnn.0000000000000283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is associated with considerable mortality and morbidity in adolescents, but positive outcomes are possible. Resilience is the concept that some individuals flourish despite significant adversity. OBJECTIVE To determine if there is a relationship between resilience-promoting factors that are known to promote resilience and white matter (WM) microstructure 1 year after complicated mild TBI or moderate or severe TBI that is sustained by adolescents. METHOD We examined the relationship between performance on a self-report measure of resilience-promoting factors and WM integrity assessed by diffusion tensor imaging in a group of adolescents who had sustained either a TBI (n = 38) or an orthopedic injury (OI) (n = 23). RESULTS Immediately following injury, the individuals with TBI and the OI controls had comparable levels of resilience-promoting factors; however, at 1 year post injury, the TBI group endorsed fewer resilience-promoting factors and exhibited WM disruption compared with the OI controls. The individuals with TBI who had more resilience-promoting factors at 1 year post injury exhibited increased WM integrity, but the OI controls did not. Findings were particularly strong for the following structures: anterior corona radiata, anterior limb of the internal capsule, and genu of the corpus callosum-structures that are implicated in social cognition and are frequently disrupted after TBI. Relationships were notable for caregiver and community-level resilience-promoting factors. CONCLUSION The current findings are some of the first to indicate neurobiological evidence of previously noted buffering effects of resilience-promoting factors in individuals with TBI.
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Affiliation(s)
- Adam T. Schmidt
- Department of Psychological Sciences, Texas Tech University Campus, Lubbock, Texas
| | | | - Emily Dennis
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | | | - Brian D. Biekman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Zili D. Chu
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gerri R. Hanten
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Dana L. Formon
- Colorado Department of Human Services, Office of Behavioral Health, Court Services Division, Denver, Colorado
| | - Matthew S. Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas
- Department of Pediatric Radiology, Texas Children’s Hospital, Houston, Texas
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
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11
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Elliott TR, Perrin PB, Bell AS, Powers MB, Warren AM. Resilience, coping, and distress among healthcare service personnel during the COVID-19 pandemic. BMC Psychiatry 2021; 21:489. [PMID: 34615501 PMCID: PMC8493044 DOI: 10.1186/s12888-021-03506-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has a detrimental effect on the health and well-being of health care workers (HCWs). The extent to which HCWs may differ in their experience of depression and anxiety is unclear, and longitudinal studies are lacking. The present study examined theorized differences in distress between resilient and non-resilient HCWs over time, as reported in a national online survey. We also examined possible differences in distress as a function of sex and doctoral-level status. METHODS A national sample responded to an online survey data that included the study measures. Of the HCWs who responded, 666 had useable data at the two time points. A longitudinal structural equation model tested an a priori model that specified the relationship of a resilient personality prototype to self-reported resilience, coping, depression and anxiety at both measurement occasions. Additional invariance models examined possible differences by sex and doctoral-level status. RESULTS The final model explained 46.4% of the variance in psychological distress at Time 1 and 69.1% at Time 2. A non-resilient personality prototype predicted greater depression and anxiety. A resilient personality prototype was predictive of and operated through self-reported resilience and less disengaged coping to effect lower distress. No effects were found for active coping, however. The final model was generally invariant by sex and HCWs status. Additional analyses revealed that non-doctoral level HCWs had significantly higher depression and anxiety than doctoral-level HCWs on both occasions. CONCLUSIONS HCWs differ in their susceptibility to distress imposed by COVID-19. Those who are particularly vulnerable may have characteristics that contribute to a lower sense of confidence and efficacy in stressful situations, and more likely to rely on ineffective, disengaged coping behaviors that can exacerbate stress levels. Individual interventions and institutional policies may be implemented to support HCWs at risk.
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Affiliation(s)
- Timothy R. Elliott
- grid.264756.40000 0004 4687 2082Department of Educational Psychology, Texas A&M University, College Station, TX 77843-4225 USA
| | - Paul B. Perrin
- grid.224260.00000 0004 0458 8737Department of Psychology, Virginia Commonwealth University, Richmond, Virginia USA
| | - Anne-Stuart Bell
- grid.264756.40000 0004 4687 2082Department of Educational Psychology, Texas A&M University, College Station, TX 77843-4225 USA
| | - Mark B. Powers
- grid.411588.10000 0001 2167 9807Baylor University Medical Center, Dallas, TX USA
| | - Ann Marie Warren
- grid.411588.10000 0001 2167 9807Baylor Scott & White Research Institute, Baylor University Medical Center, Dallas, TX USA
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12
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Blakey SM, Halverson TF, Evans MK, Patel TA, Hair LP, Meyer EC, DeBeer BB, Beckham JC, Pugh MJ, Calhoun PS, Kimbrel NA. Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans. J Psychiatr Res 2021; 142:17-24. [PMID: 34314990 PMCID: PMC8429252 DOI: 10.1016/j.jpsychires.2021.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022]
Abstract
A substantial minority of deployed Gulf War veterans developed posttraumatic stress disorder (PTSD), depression, and several chronic illnesses. Although military combat and exposure to certain nuclear, biological, and chemical agents (NBCs) increase risk for post-deployment health problems, they do not fully explain many Gulf War veteran health diagnoses and are not viable treatment targets. Experiential avoidance (EA; one's unwillingness to remain in contact with unpleasant internal experiences) is a modifiable psychosocial risk factor associated with PTSD and depression in veterans as well as pain and gastrointestinal diseases in the general population. In this study, we recruited a national sample of deployed Gulf War veterans (N = 454) to test the hypothesis that greater EA would be significantly associated with higher lifetime odds of PTSD, depression, "Gulf War Illness" (GWI/CMI), and other chronic illnesses common in this veteran cohort. Participants completed a self-report battery assessing demographic, military-related, and health-related information. Multivariate analyses showed that after adjusting for age, sex, race, combat exposure, and NBC exposure, worse EA was associated with higher lifetime odds of PTSD, depression GWI/CMI, gastrointestinal problems, irritable bowel syndrome, arthritis, fibromyalgia, and chronic fatigue syndrome (ORs ranged 1.25 to 2.89; effect sizes ranged small to large), but not asthma or chronic obstructive pulmonary disease. Our findings suggest medical and mental health providers alike should assess for EA and potentially target EA as part of a comprehensive, biopsychosocial approach to improving Gulf War veterans' health and wellbeing. Study limitations and future research directions are also discussed.
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Affiliation(s)
- Shannon M Blakey
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA.
| | - Tate F Halverson
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Mariah K Evans
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Tapan A Patel
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Lauren P Hair
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Eric C Meyer
- University of Pittsburgh Department of Rehabilitation Science and Technology, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA.
| | - Bryann B DeBeer
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | - Jean C Beckham
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Mary J Pugh
- VA Salt Lake City Healthcare System, 500 Foothill Dr, Salt Lake City, UT, 84148, USA; University of Utah School of Medicine Department of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA.
| | - Patrick S Calhoun
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Nathan A Kimbrel
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
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13
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Assonov D. Two-Step Resilience-Oriented Intervention for Veterans with Traumatic Brain Injury: A Pilot Randomized Controlled Trial. CLINICAL NEUROPSYCHIATRY 2021; 18:247-259. [PMID: 34984068 PMCID: PMC8696289 DOI: 10.36131/cnfioritieditore20210503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present randomized parallel two-arm pilot study aimed to compare the efficacy of two-step resilience-oriented intervention with treatment as usual in veterans with mild to moderate traumatic brain injury. METHOD Two-step Resilience-Oriented Intervention (TROI) is a brief psychological intervention that targets cognitive (step 1) and emotional (step 2) factors of resilience and consists of six 1-hour sessions. Overall, 70 Ukrainian veterans serviced in Anti-Terrorist Operation / Joint Forces Operation were randomly assigned to an intervention group (TROI group) or a control group that underwent treatment as usual (TAU group). For pre- (T1) and post-treatment (T2) assessment the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment Scale (MoCA), Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist 5 (PCL-5), Chaban Quality of Life Scale (CQLS), Positive and Negative Affect Scale (PANAS) were used. RESULTS Multivariable linear regression with the treatment group, gender, baseline cognitive performance level and TBI severity as the independent variables revealed statistically significant improvements in the TROI group in resilience (CD-RISC), cognitive performance (MoCA), postconcussive symptoms (NSI), posttraumatic symptoms (PCL-5), positive affect (PANAS) and quality of life (CQLS) comparing to such in TAU group. We found no statistically significant differences between groups in depression, anxiety (HADS) and negative affect (PANAS) outcomes. Additionally, Wilcoxon signed-rank test revealed that participants who completed two-step resilience-oriented intervention had significantly improved scores for all outcomes compared to the baseline (p < 0.05). CONCLUSIONS In summary, we can tentatively conclude that adding TROI to the standard treatment measures may improve the resilience and sustainable symptoms in veterans with TBI when compared with standard treatment. Targeting cognitive and emotional factors like problem-solving, decision-making, positive thinking can promote resilience in veterans with TBI and be useful in facilitating recovery from injury. Results of this pilot study are promising, but the intervention needs to be studied in a larger trial.
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Affiliation(s)
- Dmytro Assonov
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, Bogomolets National Medical University, Kyiv, Ukraine,Corresponding author Dmytro Assonov, E-mail:
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14
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Crabtree MA, Hale WJ, Meyer EC, Kimbrel NA, DeBeer BB, Gulliver SB, Morissette SB. Dynamics of risk: Recent changes in psychological inflexibility precede subsequent changes in returning US veterans' posttraumatic stress. J Clin Psychol 2021; 77:2507-2528. [PMID: 34487365 DOI: 10.1002/jclp.23244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/19/2020] [Accepted: 02/15/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES As a malleable risk-factor, psychological inflexibility is implicated in the development and maintenance of posttraumatic stress symptoms (PTS). Unfortunately, limited research has addressed whether changes in psychological inflexibility are antecedent to changes in PTS severity over time, or whether such changes are mutually dependent. METHODS Utilizing bivariate latent difference score modeling, this longitudinal study sequenced intraindividual changes in psychological inflexibility and PTS severity within a sample of 305 returning US veterans. Veterans' self-reported psychological inflexibility and PTS severity were assessed quarterly over 1 year. RESULTS Results indicated that early reductions in psychological inflexibility potentiated later declines in veterans' PTS severity, accounting for veterans' prior levels of psychological inflexibility and PTS severity. CONCLUSIONS These findings underscore the unique role of changes in psychological inflexibility as an important mechanism of change in PTS severity and provide empirical support for an antecedent model of the role of psychological inflexibility in PTS recovery.
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Affiliation(s)
- Meghan A Crabtree
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Eric C Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.,Department of Psychiatry, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA.,Warriors Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.,Warriors Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Suzy B Gulliver
- Department of Psychiatry, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA.,Warriors Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
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15
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Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia. Qual Life Res 2021; 31:507-516. [PMID: 34173172 DOI: 10.1007/s11136-021-02920-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life. METHODS Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). RESULTS Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; rs = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience. CONCLUSION Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.
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16
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Sakamoto MS, Merritt VC, Jurick SM, Crocker LD, Hoffman SN, Jak AJ. Self-efficacy and coping style in Iraq and Afghanistan-era veterans with and without mild traumatic brain injury and posttraumatic stress disorder. J Clin Psychol 2021; 77:2306-2322. [PMID: 33991109 DOI: 10.1002/jclp.23154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine self-efficacy and coping style in combat-exposed Veterans with and without mild traumatic brain injury (mTBI) history and posttraumatic stress disorder (PTSD). METHODS Veterans (N = 81) were categorized into four groups: comorbid mTBI and PTSD (n = 23), PTSD-only (n = 16), mTBI-only (n = 25), and combat-exposed controls (n = 17). Outcomes included the Self-Efficacy for Symptom Management Scale and the Brief Coping Orientation to Problems Experienced. RESULTS Significant group effects were found on self-efficacy and coping style, even when adjusting for total mTBIs and psychiatric comorbidities. Post-hoc analyses revealed that the comorbid and PTSD-only groups generally had lower self-efficacy than the mTBI-only and control groups and that the PTSD-only group used less action-focused coping than the mTBI-only and control groups. CONCLUSION Our results suggest that self-efficacy and coping style vary as a function of mTBI history and PTSD status and that it may be important to integrate these malleable factors into interventions for this population.
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Affiliation(s)
- McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, California, USA
| | - Sarah M Jurick
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, California, USA
| | - Laura D Crocker
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, California, USA
| | - Samantha N Hoffman
- Joint Doctoral Program (JDP) in Clinical Psychology, San Diego State University/University of California San Diego (SDSU/UC San Diego), San Diego, California, USA
| | - Amy J Jak
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, California, USA
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17
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Barczak-Scarboro NE, Cole WR, DeLellis SM, Means GE, Kane SF, Lynch JH, Mihalik JP. Mental Health Symptoms Are Associated With Mild Traumatic Brain Injury History in Active Special Operations Forces (SOF) Combat and Combat Support Soldiers. Mil Med 2020; 185:e1946-e1953. [PMID: 32676649 DOI: 10.1093/milmed/usaa167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Special Operations Forces (SOF) combat arms and combat support Soldiers are at risk for impaired mental health, such as mood- and stress-related disorders, due to operational and training demands. Additionally, these individuals experience high risk for sustaining mild traumatic brain injury (mTBI). These mTBIs have also been linked to negative psychological outcomes, such as anxiety and depressive symptoms. Studying mental illnesses and their related symptoms alone does not fully address mental health, which may be better understood by 2 separate but overlapping continua measuring both mental illness and subjective well-being (ie, emotional, psychological, and social well-being). Due to the lack of research in this area, current mental health symptoms in active SOF combat Soldiers in relation to mTBI warrants investigation. MATERIALS AND METHODS In this study, 113 SOF combat and combat support Soldiers completed self-report psychological and mTBI history measures during an in-person laboratory setting. These psychometric measures included (1) psychological distress (Brief Symptom Inventory 18), (2) anxiety (Generalized Anxiety Disorder 7-item), (3) posttraumatic stress (PTSD Checklist for DSM-5), (4) somatization (Patient Health Questionnaire-15), and (5) subjective well-being (Mental Health Continuum Short Form). RESULTS On average, SOF combat Soldiers endorsed moderate well-being and low psychological distress, somatization, posttraumatic stress, and anxiety. Most SOF combat Soldiers had sustained 1 or more mTBI. We observed mTBI history had significant effects on each dependent variable in the expected directions. History of more mTBIs, controlling for age, was associated with lower subjective well-being as well as higher psychological distress, somatization, posttraumatic stress, and anxiety symptoms. CONCLUSION Although SOF combat Soldiers reported relatively adaptive mental health symptoms across participants, there was considerable variance in the measures reported. Some of the variance in mental health symptoms was accounted for by mTBI history while controlling for age, with reporting higher numbers of lifetime mTBIs and older age being associated with worse mental health symptoms. Longitudinal investigations into these associations and their impact on Soldier performance is warranted.
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Affiliation(s)
- Nikki E Barczak-Scarboro
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599.,Human Movement Science Curriculum, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, Campus Box 7120, Chapel Hill, NC 27599
| | - Wesley R Cole
- Intrepid Spirit Center, Womack Army Medical Center, 3908 Longstreet Road, Building #3-403, Fort Bragg, NC 28310
| | - Stephen M DeLellis
- Defense Medical Strategies, LLC, 136 Timberlake Drive, Fayetteville, NC 28314
| | - Gary E Means
- United States Army Special Operations Command, E-2929 Desert Storm Drive, Fort Bragg, NC 28310
| | - Shawn F Kane
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599.,Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27514
| | - James H Lynch
- United States Army Special Operations Command, E-2929 Desert Storm Drive, Fort Bragg, NC 28310
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599.,Human Movement Science Curriculum, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, Campus Box 7120, Chapel Hill, NC 27599
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18
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Gómez-Galán J, Lázaro-Pérez C, Martínez-López JÁ, Fernández-Martínez MDM. Burnout in Spanish Security Forces during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8790. [PMID: 33256195 PMCID: PMC7729515 DOI: 10.3390/ijerph17238790] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
Since the beginning of the COVID-19 pandemic in Spain, members of the State Security Forces and the Armed Forces have been mobilized to guarantee the security and mobility of the population and to support health institutions by providing personnel for care, creating field hospitals, transferring the sick and the dead, etc. The objective of this study was to determine the levels of burnout in these professionals using the Maslach Burnout Inventory (MBI) scale, both in its different subscales and its total value. The study was developed using a quantitative methodology through a simple random sample (n = 2182). An ad hoc questionnaire was administered including variables related to: (a) socio-demographic issues, (b) subjective perceptions about their working conditions and the need for psychological and psychiatric treatment, and (c) the Death Anxiety Scale developed by Collett-Lester, and the MBI. The results show high levels of burnout (28.5%) in all its subscales: emotional exhaustion (53.8%), depersonalization (58.0%), and lack of personal development (46.3%). The logistic regression verifies a series of predictive variables that coincide in each of the subscales. These data indicate the need to implement prevention and treatment measures for workers so that their, stress, and anxiety to which they are subjected during their professional activity does not become a norm that can have negative repercussions for them, especially given the risk of new pandemic waves.
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Affiliation(s)
- José Gómez-Galán
- Department of Education, University of Extremadura, Avda. de Elvas, s/n, 06006 Badajoz, Spain
- College of Education, Ana G. Méndez University, Cupey Campus, San Juan, PR 00926, USA
| | - Cristina Lázaro-Pérez
- Department of Sociology, University of Murcia, Avda. Teniente Flomesta, 5, 30003 Murcia, Spain;
| | - Jose Ángel Martínez-López
- Department of Social Work and Social Services, University of Murcia, Avda. Teniente Flomesta, 5, 30003 Murcia, Spain;
| | - María del Mar Fernández-Martínez
- College of Education Sciences & College of Sociology, Social Work and Public Health, University of Huelva, Campus El Carmen, Avda. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain;
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19
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Kahl M, Wagner G, de la Cruz F, Köhler S, Schultz CC. Resilience and cortical thickness: a MRI study. Eur Arch Psychiatry Clin Neurosci 2020; 270:533-539. [PMID: 30542819 DOI: 10.1007/s00406-018-0963-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
Resilience is defined as the psychological resistance which enables the processing of stress and adverse life events and thus constitutes a key factor for the genesis of psychiatric illness. However, little is known about the morphological correlates of resilience in the human brain. Hence, the aim of this study is to examine the neuroanatomical expression of resilience in healthy individuals. 151 healthy subjects were recruited and had to complete a resilience-specific questionnaire (RS-11). All of them underwent a high-resolution T1-weighted MRI in a 3T scanner. Fine-grained cortical thickness was analyzed using FreeSurfer. We found a significant positive correlation between the individual extent of resilience and cortical thickness in a right hemispherical cluster incorporating the lateral occipital cortex, the fusiform gyrus, the inferior parietal cortex as well as the middle and inferior temporal cortex, i.e., a reduced resilience is associated with a decreased cortical thickness in these areas. We lend novel evidence for a direct linkage between psychometric resilience and local cortical thickness. Our findings in a sample of healthy individuals show that a lower resilience is associated with a lower cortical thickness in anatomical areas are known to be involved in the processing of emotional visual input. These regions have been demonstrated to play a role in the pathogenesis of stress and trauma-associated disorders. It can thus be assumed that neuroanatomical variations in these cortical regions might modulate the susceptibility for the development of stress-related disorders.
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Affiliation(s)
- Michael Kahl
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Feliberto de la Cruz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Stefanie Köhler
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - C Christoph Schultz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany. .,Department of Psychiatry and Psychotherapy, Klinikum Fulda gAG, Universitätsmedizin Marburg, Campus Fulda, Fulda, Germany.
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20
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Shebuski K, Bowie J, Ashby JS. Self‐Compassion, Trait Resilience, and Trauma Exposure in Undergraduate Students. JOURNAL OF COLLEGE COUNSELING 2020. [DOI: 10.1002/jocc.12145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Karen Shebuski
- Department of Counseling and Psychological ServicesGeorgia State University
| | - Jhodi‐Ann Bowie
- Department of Counseling and Psychological ServicesGeorgia State University
- Now at Department of Sociology, Psychology and Social WorkUniversity of the West Indies Mona Kingston Jamaica
| | - Jeffrey S. Ashby
- Department of Counseling and Psychological ServicesGeorgia State University
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21
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Eman Abdulle A, van der Naalt J. The role of mood, post-traumatic stress, post-concussive symptoms and coping on outcome after MTBI in elderly patients. Int Rev Psychiatry 2020; 32:3-11. [PMID: 31592690 DOI: 10.1080/09540261.2019.1664421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Elderly patients are at increased risk for persistent complaints after mild traumatic brain injury (MTBI). This study aimed to investigate the role of post-concussive symptoms, mood, post-traumatic stress, and coping on functional outcome in elderly with MTBI. Information on mood, post-concussive symptoms, post-traumatic stress, and coping was collected 2 weeks post-injury. Six months post-injury functional outcome was assessed with the Glasgow Outcome Scale Extended. One hundred and sixty-two patients aged ≥ 60 years were included, 55% male, mean age = 71 (±6.2) years. The most frequent cause of injury was falls from standing height (75%). Two weeks post-injury anxiety, depression, and post-traumatic stress were present in 15%, 12%, and 38% of patients, respectively, with 73% reporting post-concussive symptoms. Avoidant coping was the most frequently used coping style. Six months post-injury, 44% showed incomplete recovery. Higher depression scores (OR = 0.87, p = 0.005) and number of post-concussive symptoms (OR = 0.91, p = 0.03) were associated with incomplete recovery. Half of the elderly showed incomplete recovery 6 months after MTBI, with early depression or post-concussive symptoms as important factors. Coping style was not related to outcome. These results underline the need for a different approach in elderly patients, focusing on other predicting factors and fall prevention strategies.
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Affiliation(s)
- Amaal Eman Abdulle
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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22
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Mantua J, Brager AJ, Alger SE, Adewale F, Skeiky L, Balkin TJ, Capaldi VF, Simonelli G. Self-Reported Sleep Need, Subjective Resilience, and Cognitive Performance Following Sleep Loss and Recovery Sleep. Psychol Rep 2020; 124:210-226. [DOI: 10.1177/0033294119899896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Individuals vary in response to sleep loss: some individuals are “vulnerable” and demonstrate cognitive decrements following insufficient sleep, while others are “resistant” and maintain baseline cognitive capability. Physiological markers (e.g., genetic polymorphisms) have been identified that can predict relative vulnerability. However, a quick, cost-effective, and feasible subjective predictor tool has not been developed. The objective of the present study was to determine whether two factors—“subjective sleep need” and “subjective resilience”—predict cognitive performance following sleep deprivation. Methods Twenty-seven healthy, sleep-satiated young adults participated. These individuals were screened for sleep disorders, comorbidities, and erratic sleep schedules. Prior to 40 hours of in-laboratory total sleep deprivation, participants were questioned on their subjective sleep need and completed a validated resilience scale. During and after sleep deprivation, participants completed a 5-minute psychomotor vigilance test every 2 hours. Results Both subjective resilience and subjective sleep need individually failed to predict performance during sleep loss. However, these two measures interacted to predict performance. Individuals with low resilience and low sleep need had poorer cognitive performance during sleep loss. However, in individuals with medium or high resilience, psychomotor vigilance test performance was not predicted by subjective sleep need. Higher resilience may be protective against sleep loss-related neurobehavioral impairments in the context of subjective sleep need. Conclusions Following sleep loss (and recovery sleep), trait resilient individuals may outperform those with lower resiliency on real-world tasks that require continuous attention. Future studies should determine whether the present findings generalize to other, operationally relevant tasks and additional cognitive domains.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Allison J. Brager
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sara E. Alger
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Folarin Adewale
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lillian Skeiky
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Vincent F. Capaldi
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Guido Simonelli
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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van der Meulen E, van der Velden PG, van Aert RCM, van Veldhoven MJPM. Longitudinal associations of psychological resilience with mental health and functioning among military personnel: A meta-analysis of prospective studies. Soc Sci Med 2020; 255:112814. [PMID: 32388075 DOI: 10.1016/j.socscimed.2020.112814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Military personnel are exposed to severe stressors across different stages of their career that may have a negative impact on mental health and functioning. It is often suggested that psychological resilience plays an important role in the maintenance and/or enhancement of their mental health and functioning under these circumstances. METHOD A systematic literature search was conducted using PsycINFO, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Web of Science, and PubMed up to August of 2019 retrieving 3,698 reports. Schmidt and Hunter meta-analytical techniques were used to assess the predictive value of psychological resilience on ten different military relevant mental health and functioning outcomes. Multivariate meta-analysis assessed the origin of heterogeneity among bivariate effect sizes. RESULTS The effect sizes of 40 eligible peer-reviewed papers covering 40 unique samples were included in the meta-analysis. Seventy-eight percent of these studies were published after 2010 and were predominantly conducted in western countries. Bivariate effect sizes were low to medium (absolute values: 0.08 to 0.36) and multivariate effect sizes, adjusting for across studies varying sets of covariates, were low to trivial (absolute values: 0.02 to 0.08). Moderator analyses using multivariate meta-analysis on 60 bivariate effect sizes, revealed no significant effect of type of psychological resilience scale, time-lag, and career stage. CONCLUSIONS The current review found no indications that different conceptualizations of psychological resilience across a variety of research designs, are strongly predictive of mental health and functioning among military personnel. Future directions (moderator/mediator models, stressor type specifications, and directionality) for prospective studies are discussed. Our results question the usefulness of interventions to enhance the resilience of soldiers to improve their mental health and functioning.
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Affiliation(s)
- Erik van der Meulen
- Academy of Healthcare, NHL Stenden University of Applied Sciences, Leeuwarden, the Netherlands; Intervict, Tilburg University, Tilburg, the Netherlands.
| | - Peter G van der Velden
- CentERdata, Tilburg, the Netherlands; Tilburg University's Network on Health and Labour (NETHLAB), Tilburg, the Netherlands
| | - Robbie C M van Aert
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
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The role of personality in posttraumatic stress disorder, trait resilience, and quality of life in people exposed to the Kiss nightclub fire. PLoS One 2019; 14:e0220472. [PMID: 31356601 PMCID: PMC6663027 DOI: 10.1371/journal.pone.0220472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the relationship among personality (according to Cloninger’s psychobiological model), posttraumatic stress disorder (PTSD) symptoms, trait resilience and quality of life (QoL) in people who were exposed to the Kiss nightclub fire. Methods 188 participants were assessed with the Posttraumatic Checklist–civilian version (PCL-C), the Resilience Scale (RS), the Temperament and Character Inventory (TCI), the World Health Organization Quality of Life–Bref (WHOQOL-Bref), and the WHOQOL-100 Spirituality, religiousness, and personal beliefs (WHOQOL-100-SRPB). Data were analyzed in a dimensional approach, with correlation analysis, multiple linear regression and Structural Equation Modeling (SEM), with PCL-C, RS, and WHOQOL-Bref dimensions as dependent variables. Results Multiple linear regression showed that PTSD symptoms were predicted by harm avoidance (β = .34, p < .001), self-directedness (β = -.28, p < .01), and self-transcendence (β = .24, p < .01). Trait resilience was predicted by harm avoidance (β = -.38, p < .01), self-directedness (β = .20, p < .05), and self-transcendence (β = .18, p < .05). Also, PTSD symptoms had considerable negative effect on all dimensions of QoL. Self-transcendence was a positive predictor of subjective and spiritual QoL. SEM showed that QoL was predicted by PTSD symptoms (β = -.52, p < .001), trait resilience (β = .30, p < .001), cooperativeness (β = .135, p = 0.40), and self-directedness (β = .27, p < .01). The effect of self-directedness on QoL was mediated by PTSD symptoms and trait resilience. PTSD symptoms also mediated the relationship between trait resilience and QoL, and RS mediated the relationship of personality and PTSD symptoms. Conclusion The study gives insights on prediction of PTSD severity, trait resilience and QoL from temperament and character traits, in a sample of people exposed to the Kiss nightclub fire. Harm avoidance was the most influent trait on PTSD symptoms and trait resilience. Self-directedness was the most import trait related to QoL, still that it was more related to PTSD severity than personality traits. Self-transcendence had positive effects on both PTSD symptoms and trait resilience, indicating a coping style that may coexist with psychopathology.
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Goode J, Swift JK. An empirical examination of stigma toward mental health problems and psychotherapy use in Veterans and active duty service members. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1630231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan Goode
- Department of Psychology, Idaho State University, Pocatello, Idaho
| | - Joshua K. Swift
- Department of Psychology, Idaho State University, Pocatello, Idaho
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Abstract
Purpose: This study examined the extent to which resilience is associated with well-being outcomes after traumatic brain injury, and whether those relationships are independent of global personality traits, such as affectivity.Materials and methods: Sixty-seven adults with complicated-mild to severe traumatic brain injury participated. Measures included the Connor-Davidson Resilience Scale, Modified Cumulative Illness Rating Scale, Disability Rating Scale, SF-12 Health Survey, Satisfaction with Life Scale, and Community Integration Measure.Results: Objective physical health and disability showed modest relation to resilience, indicating that adverse health conditions and disability decreased with increasing resilience. The three measures of subjective well-being showed modest-to-strong positive relation to resilience. These correlations between resilience and well-being generally remained significant after accounting for negative and positive affectivity. Results also suggest that the influence of resilience on well-being has a threshold effect: a greater influence on outcome among people with low or inadequate resilience than among people with average or high resilience.Conclusion: The experience of brain injury does not diminish the positive influence resilience may have on long-term well-being. Resilience may function as a buffer to trauma even in the challenging context of cognitive insult. Routine assessment of resilience might be beneficial to the rehabilitation team.Implications for rehabilitationResilience is positively associated with subjective and objective well-being among adults with moderate-to-severe traumatic brain injury, and it appears to function among adults with traumatic brain injury similarly to adults without cognitive disabilities.Resilience overlaps with overarching trait personality constructs such as affectivity; yet, it has unique characteristics and unique value in understanding well-being.The adverse effects of low resilience show stronger influence on well-being than do the positive effects of high resilience.Routine assessment of resilience might be beneficial to the rehabilitation team in understanding patients and their families, especially in discharge planning, where beliefs about personal capabilities to rebound from adversity shape likely future behavior.
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Affiliation(s)
- Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Christina G Wong
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan, USA
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Richardson CM, Jost SA. Psychological flexibility as a mediator of the association between early life trauma and psychological symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.12.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shackelford JL, Smith LS, Farrell CT, Neils-Strunjas J. Interrelationships Among Resilience, Posttraumatic Stress Disorder, Traumatic Brain Injury, Depression, and Academic Outcomes in Student Military Veterans. J Psychosoc Nurs Ment Health Serv 2019; 57:35-43. [DOI: 10.3928/02793695-20180924-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/26/2018] [Indexed: 11/20/2022]
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Meyer EC, Kotte A, Kimbrel NA, DeBeer BB, Elliott TR, Gulliver SB, Morissette SB. Predictors of lower-than-expected posttraumatic symptom severity in war veterans: The influence of personality, self-reported trait resilience, and psychological flexibility. Behav Res Ther 2019; 113:1-8. [DOI: 10.1016/j.brat.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/21/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
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Abstract
Traumatic brain injury (TBI) is the cause for long-term disability in more than 3 million patients in the US alone, with chronic pain being the most frequently reported complain. To date, predisposing mechanisms for chronic pain in TBI patients are largely unknown. Psychological disorders, including post-traumatic stress disorder, depression and anxiety following TBI are commonly reported comorbidities to post-traumatic pain. Long term consequences can be debilitating and affect quality of life even when the injury is mild. In this review, we present the most commonly reported chronic pain conditions across the spectrum of severity of TBI, mainly focusing on mild TBI. We discuss chronic post- traumatic headaches, widespread pain as well as post-traumatic central pain. We discuss pain in the context of injury severity and military versus civilian populations. We are only starting to understand the biological mechanisms behind post-traumatic pain and associated psychological distress following TBI, with genetic, biochemical and imaging studies pointing to the dopaminergic, neurotrophic factors and the role of Apolipoprotein. Physiological and neurological mechanisms are proposed to partially explain this interaction between post-traumatic pain and psychological distress. Nevertheless, the evidence for the role of structural brain damage remains incomplete and to a large extent debatable, as it is still difficult to establish clear causality between brain trauma and chronic pain. Finally, general aspects of management of chronic pain post-TBI are addressed.
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31
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Herbert MS, Leung DW, Pittman JOE, Floto E, Afari N. Race/ethnicity, psychological resilience, and social support among OEF/OIF combat veterans. Psychiatry Res 2018; 265:265-270. [PMID: 29763847 DOI: 10.1016/j.psychres.2018.04.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/12/2018] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
Abstract
This study examined the relationship between race/ethnicity and psychological resilience, and the moderating role of social support in this relationship among non-Hispanic White (n = 605), Hispanic (n = 107), African American (n = 141), and Asian American (n = 97) Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Veterans were primarily male (88%) with a mean age of 31.4 years (SD = 8.35). An analysis of covariance showed that Asian American veterans reported significantly lower psychological resilience than non-Hispanic White veterans. The interaction of race/ethnicity and social support with psychological resilience was examined via linear regression. We found that the relationship between psychological resilience and social support significantly differed by race/ethnicity such that social support was positively associated with psychological resilience among non-Hispanic White veterans, but not among other racial/ethnic groups. Our findings are consistent with previous studies that show Asian American veterans report lower psychological resilience than non-Hispanic White veterans. Cultural differences in how and why individuals use social support may underlie racial/ethnic differences in the relationship between social support and psychological resilience. Future qualitative and quantitative research is encouraged to better understand how social support relates to psychological resilience among minority OEF/OIF combat veterans.
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Affiliation(s)
- Matthew S Herbert
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Desmond W Leung
- Baruch College & The Graduate Center, City University of New York, NY USA
| | - James O E Pittman
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Elizabeth Floto
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Niloofar Afari
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA.
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32
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van der Meulen E, van der Velden PG, Setti I, van Veldhoven MJPM. Predictive value of psychological resilience for mental health disturbances: A three-wave prospective study among police officers. Psychiatry Res 2018; 260:486-494. [PMID: 29289832 DOI: 10.1016/j.psychres.2017.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
Psychological resilience is considered an important predictor for mental health disturbances among rescue workers. To what extent resilience predicts mental health disturbances among police officers at different stages while adjusting for existing (mental) health disturbances is unclear. Among 566 police officers resilience was operationalized by the Resilience Scale-nl and the Mental Toughness Questionnaire-48 questionnaires (8 scales in total). Mental health disturbances (such as depression symptoms and PTSD) and other health-related variables were assessed at baseline and follow-ups at three and nine months. Hierarchical logistic regression analyses assessed the predictive values of the 8 resilience scales for mental health disturbances at baseline (n = 566), three months (n = 566) and nine months (n = 364), adjusted for demographics, work circumstances, and health-related factors at baseline. Seven of the eight resilience scales at baseline were cross sectional associated with mental health disturbances at baseline. Only four scales were independent predictors for mental health disturbances at three months. When examining mental health disturbances at nine months, only one resilience scale remained a significant predictor. In sum, psychological resilience has a declining protective capacity for mental health disturbances over a medium time-span, specifically when corrected for baseline mental health disturbances.
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Affiliation(s)
- Erik van der Meulen
- International Victimology Institute Tilburg, Tilburg University, Tilburg, The Netherlands.
| | - Peter G van der Velden
- International Victimology Institute Tilburg, Tilburg University, Tilburg, The Netherlands
| | - Ilaria Setti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Krystal JH, Abdallah CG, Averill LA, Kelmendi B, Harpaz-Rotem I, Sanacora G, Southwick SM, Duman RS. Synaptic Loss and the Pathophysiology of PTSD: Implications for Ketamine as a Prototype Novel Therapeutic. Curr Psychiatry Rep 2017; 19:74. [PMID: 28844076 PMCID: PMC5904792 DOI: 10.1007/s11920-017-0829-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Studies of the neurobiology and treatment of PTSD have highlighted many aspects of the pathophysiology of this disorder that might be relevant to treatment. The purpose of this review is to highlight the potential clinical importance of an often-neglected consequence of stress models in animals that may be relevant to PTSD: the stress-related loss of synaptic connectivity. RECENT FINDINGS Here, we will briefly review evidence that PTSD might be a "synaptic disconnection syndrome" and highlight the importance of this perspective for the emerging therapeutic application of ketamine as a potential rapid-acting treatment for this disorder that may work, in part, by restoring synaptic connectivity. Synaptic disconnection may contribute to the profile of PTSD symptoms that may be targeted by novel pharmacotherapeutics.
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Affiliation(s)
- John H. Krystal
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Psychiatry Services, Yale-New Haven Hospital, New Haven, CT, USA
| | - Chadi G. Abdallah
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Lynette A. Averill
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Steven M. Southwick
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ronald S. Duman
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
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Wingo AP, Briscione M, Norrholm SD, Jovanovic T, McCullough SA, Skelton K, Bradley B. Psychological resilience is associated with more intact social functioning in veterans with post-traumatic stress disorder and depression. Psychiatry Res 2017; 249:206-211. [PMID: 28119173 DOI: 10.1016/j.psychres.2017.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/03/2017] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
Patients with depression or post-traumatic stress disorder (PTSD), common sequelae among individuals exposed to stressful or traumatic events, often report impairment in social functioning. Resilience is a multidimensional construct that enables adaptive coping with life adversity. Relationship between resilience and social functioning among veterans with depression and PTSD is not entirely clear and is the focus of this report. Resilience was assessed in 264 veterans using the Connor-Davidson Resilience Scale, PTSD with the PTSD Symptom Scale, depression with the Beck Depression Inventory, and social functioning with the Short Form Health Survey. Higher resilience was associated with more intact social functioning after PTSD and depression severity, childhood maltreatment, physical health, gender, education, marital status, and employment were simultaneously adjusted for. Childhood maltreatment, gender, marital status, education, and employment did not predict social functioning; however, greater severity of PTSD, depression, or physical health problems was each significantly associated with more impaired social functioning. Our findings suggest that higher resilience was associated with more intact social functioning regardless of the severity of PTSD and depression. Given the importance of social functioning in depression and/or PTSD recovery, studies are needed to examine if enhancing resilience presents a complementary approach to alleviating impaired social functioning.
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Affiliation(s)
- Aliza P Wingo
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Maria Briscione
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Seth D Norrholm
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - S Ashley McCullough
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA
| | - Kelly Skelton
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA
| | - Bekh Bradley
- Atlanta VA Medical Center, Trauma Recovery Program, 1670 Clairmont Road Decatur, GA 30033, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 4339, Atlanta, GA 30322, USA.
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35
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Neils-Strunjas J, Paul D, Clark AN, Mudar R, Duff MC, Waldron-Perrine B, Bechtold KT. Role of resilience in the rehabilitation of adults with acquired brain injury. Brain Inj 2017; 31:131-139. [DOI: 10.1080/02699052.2016.1229032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, Western Kentucky University, Bowling Green, KT, USA
| | - Diane Paul
- American Speech-Language-Hearing Association, Rockville, MD, USA
| | - Allison N. Clark
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Brain Injury Research Center at TIRR Memorial Hermann, Houston, TX, USA
| | - Raksha Mudar
- Department of Speech & Hearing Science, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Melissa C. Duff
- Department of Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA
| | | | - Kathleen T. Bechtold
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Isaacs K, Mota NP, Tsai J, Harpaz-Rotem I, Cook JM, Kirwin PD, Krystal JH, Southwick SM, Pietrzak RH. Psychological resilience in U.S. military veterans: A 2-year, nationally representative prospective cohort study. J Psychiatr Res 2017; 84:301-309. [PMID: 27814502 DOI: 10.1016/j.jpsychires.2016.10.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/31/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who completed web-based surveys in two waves (2011 and 2013) as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of cumulative lifetime exposure to potentially traumatic events and Wave 2 measures of current symptoms of posttraumatic stress, major depressive, and generalized anxiety disorders was performed to characterize different profiles of current trauma-related psychological symptoms. Different profiles were compared with respect to sociodemographic, clinical, and psychosocial characteristics. A three-group cluster analysis revealed a Control group with low lifetime trauma exposure and low current psychological distress (59.5%), a Resilient group with high lifetime trauma and low current distress (27.4%), and a Distressed group with both high trauma exposure and current distress symptoms (13.1%). These results suggest that the majority of trauma-exposed veterans (67.7%) are psychologically resilient. Compared with the Distressed group, the Resilient group was younger, more likely to be Caucasian, and scored lower on measures of physical health difficulties, past psychiatric history, and substance abuse. Higher levels of emotional stability, extraversion, dispositional gratitude, purpose in life, and altruism, and lower levels of openness to experiences predicted resilient status. Prevention and treatment efforts designed to enhance modifiable factors such as gratitude, sense of purpose, and altruism may help promote resilience in highly trauma-exposed veterans.
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Affiliation(s)
- Kayla Isaacs
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA.
| | - Natalie P Mota
- Department of Clinical Health Psychology, University of Manitoba, College of Medicine, 771 Bannatyne Ave., Winnipeg, Manitoba R3E 3N4, Canada.
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; US. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, 950 Campbell Ave. 161E, West Haven, CT 06516, USA.
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; US. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
| | - Joan M Cook
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; US. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Evaluation Division, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
| | - Paul D Kirwin
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; US. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
| | - Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; US. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA; US. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
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Elliott TR, Hsiao YY, Kimbrel NA, Meyer E, DeBeer BB, Gulliver SB, Kwok OM, Morissette SB. Resilience and Traumatic Brain Injury Among Iraq/Afghanistan War Veterans: Differential Patterns of Adjustment and Quality of Life. J Clin Psychol 2016; 73:1160-1178. [PMID: 27922725 DOI: 10.1002/jclp.22414] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/28/2016] [Accepted: 10/05/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure. METHOD A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4- and 8-month follow-ups. RESULTS Veterans with resilient personalities reported less sleep disturbance, more health-promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD. CONCLUSION Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed.
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Affiliation(s)
| | | | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center.,VA Mid-Atlantic Mental Illness Research, Education Clinical Center.,Duke University Medical Center
| | - Eric Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System.,Texas A&M University Health Science Center
| | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System.,Texas A&M University Health Science Center
| | - Suzy Bird Gulliver
- Texas A&M University Health Science Center.,Warrior Research Institute at Baylor Scott & White Health
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Talaei-Khoei M, Fischerauer SF, Lee SG, Ring D, Vranceanu AM. Pain Catastrophizing Mediates the Effect of Psychological Inflexibility on Pain Intensity and Upper Extremity Physical Function in Patients with Upper Extremity Illness. Pain Pract 2016; 17:129-140. [DOI: 10.1111/papr.12494] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/18/2016] [Accepted: 06/21/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Mojtaba Talaei-Khoei
- Orthopaedic Hand and Upper Extremity Service; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Stefan F. Fischerauer
- Orthopaedic Hand and Upper Extremity Service; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Orthopaedics and Traumatology; University Hospital Graz; Medical University of Graz; Graz Austria
| | - Sang-Gil Lee
- Orthopaedic Hand and Upper Extremity Service; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
| | - Ana-Maria Vranceanu
- Department of Psychiatry; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts U.S.A
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Butera-Prinzi F, Charles N, Story K. Holding Resilience in Trust: Working Systemically With Families Following an Acquired Brain Injury. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2016; 15:285-304. [PMID: 27618587 DOI: 10.1080/1536710x.2016.1220882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The conceptualization of resilience following acquired brain injury needs to remain sensitive to the complex nature and enduring dimensions of trauma, loss, and stress. It is essential that a systemic and dynamic view be maintained with a focus on the key adaptation tasks that families face: grieving, restructuring, identity redefinition, and growing through adversity. These tasks are explored in a case example illustrating how these challenges reemerge across the life cycle. The key theme in this contribution is that resilience is a fluid property, a potential that practitioners and service systems can listen for, support, strengthen, and hold in trust.
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Affiliation(s)
| | - Nella Charles
- a Bouverie Family Centre, LaTrobe University , Bundoora , Australia
| | - Karen Story
- a Bouverie Family Centre, LaTrobe University , Bundoora , Australia
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Resilience, Pain Interference, and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress. Arch Phys Med Rehabil 2016; 97:781-7. [PMID: 26854856 DOI: 10.1016/j.apmr.2016.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference with distress reported by individuals with traumatic upper limb loss evaluated for prosthetics. DESIGN Cross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and posttraumatic stress. SETTING Six regional centers throughout the United States. PARTICIPANTS A total of 263 prospective participants consented to be evaluated for eligibility and need for upper extremity prosthetics; participants (N=202; 57 women [28.2%] and 145 men [71.8%]; mean age, 41.81±14.83y; range, 18.01-72.95y) who sustained traumatic injuries were retained in this study. Most of them were identified as white (70.8%; n=143), followed by black (10.4%; n=21), Hispanic (9.9%; n=20), Asian (3.0%; n=6), other (1.5%; n=3), and missing (4.5%; n=9). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Primary Care Posttraumatic Stress Disorder Screen and depression screen. RESULTS Resilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction, and the 2 distress variables. A path model revealed that the associations of resilience and pain interference with both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference on either distress variable. CONCLUSIONS Resilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with the environment. These relations are independent of the significant and inverse associations of pain interference with these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment after traumatic limb loss. Individuals reporting depression and/or posttraumatic stress disorder symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.
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