Psychometric Assessment of the Connor-Davidson Resilience Scale for People With Lower-Limb Amputation

Relationships of Multidimensional Factors to Diabetes Complications: A Cross-Sectional, Correlational Study

BACKGROUND

Diabetes complications are prevalent in people with diabetes, causing considerable individual suffering and increased health costs. However, the relationships of multidimensional, modifiable, and nonmodifiable factors to diabetes complications and the role of diabetes distress have been rarely examined.

OBJECTIVE

The aims of this study were to examine the associations of age, sex, knowledge, self-efficacy, self-compassion, resilience, self-esteem, depressive symptoms, diabetes distress, social support, and body mass index with diabetes complications and to investigate the mediating role of diabetes distress.

METHODS

In this cross-sectional, correlational study, data on all study variables were collected from 148 people with diabetes through REDCap in 2023. Multiple regression analysis and the PROCESS macro for SPSS were used to address the aims.

RESULTS

Older age and higher levels of diabetes distress were associated with more diabetes complications. Depressive symptoms were associated with diabetes distress; and diabetes distress, but not depressive symptoms, was associated with diabetes complications, controlling for all other variables.

CONCLUSIONS

Depressive symptoms and diabetes distress were directly or indirectly associated with diabetes complications, and diabetes distress was a mediator in the relationship between depressive symptoms and diabetes complications. Health care providers can target reduction of depressive symptoms and diabetes distress to reduce diabetes complications.

Relationships of Psychosocial Factors to Diabetes Self-efficacy: A Cross-sectional, Correlational Study

BACKGROUND

Self-care in people with diabetes is poor, which could be influenced by positive and negative psychosocial factors. Self-efficacy is an important factor affecting self-care, and depressive symptoms and diabetes distress may directly and indirectly affect self-efficacy.

OBJECTIVE

The aim of this study was to examine the relationships of depressive symptoms, diabetes distress, age, sex, self-compassion, resilience, self-esteem, and social support to diabetes self-efficacy and the mediating roles of diabetes distress and depressive symptoms in the relationships among people with diabetes.

METHODS

In this cross-sectional, correlational study, data on all the psychosocial and demographic factors were collected (N = 148; 57.6 years old) through Research Electronic Data Capture in 2023. The PROCESS macro for SPSS was used to address the purpose.

RESULTS

The mean score of diabetes self-efficacy was 28.6 (range, 8-40). In 1 model, depressive symptoms were directly and indirectly associated with diabetes self-efficacy through diabetes distress (direct effect, -3.524; t = -3.020, P = .003; indirect effect, -2.089; 95% bootstrap confidence interval, -3.494 to -0.911). In another model, diabetes distress was directly and indirectly associated with diabetes self-efficacy through depressive symptoms (direct effect, -3.778; t = -3.638, P < .001; indirect effect, -0.785; 95% bootstrap confidence interval, -1.868 to -0.089). In addition, self-esteem was associated with both depressive symptoms and diabetes distress. Resilience was associated with diabetes self-efficacy in 1 model.

CONCLUSIONS

Negative psychological factors were directly and indirectly associated with diabetes self-efficacy. Depressive symptoms, diabetes distress, self-esteem, and resilience can be important targets of interventions to improve diabetes self-efficacy.

Connor-Davidson Resilience Scale: a systematic review psychometrics properties using the COSMIN

Background

Psychometrical evaluation of persons of diverse contexts and different populations, including general or clinical.

Objective

This review study aimed to evaluate the psychometrics quality of resilience scales.

Methods

International and Iranian databases were searched with MESH terms, including "psychometric", "validity", "reliability", "Connor-Davidson resilience scale", "Resilience scale", for published articles up to 1 February 2023. For each of the selected studies, the risk of bias was evaluated using the COSMIN Risk of Bias Checklist. Then the COSMIN checklist was used to evaluate the entire text of the article for methodological quality.

Results

Considering the inclusion criteria, 80 documents were evaluated. According to the COSMIN's criteria for evaluating the risk of bias, the current study findings revealed the included studies' limitations in assessing the three versions of CD-RISC cross-cultural and content validity as well as their stability (e.g. conducting test re-test), whereas the majority of psychometric studies of CD-RISC-25, and CD-RISC-2 rated as very good or adequate in terms of structural validity. In terms of quality assessment of the included studies, the current study indicated that investigating the structural validity of the CD-RISC was mainly done based on exploratory factor analysis (EFA), and confirmatory factor analysis was absent.

Conclusion

The general result indicates the acceptability of the quality of the studies. However, concerns for measurement properties such as responsiveness and criterion validity as well as the standard error of measurement have been neglected.

Mixed-Mode Mindfulness-based cognitive therapy for psychological resilience, Self Esteem and Stigma of patients with schizophrenia: a randomized controlled trial

BACKGROUND

People with schizophrenia often face challenges such as lower psychological resilience, reduced self-worth, and increased social stigma, hindering their recovery. Mindfulness-Based Cognitive Therapy (MBCT) has shown promise in boosting psychological resilience and self-esteem while diminishing stigma. However, MBCT demands professional involvement and substantial expenses, adding to the workload of professionals and the financial strain on patients. Mixed-mode Mindfulness-Based Cognitive Therapy (M-MBCT) integrates both "face-to-face" and "self-help" approaches to minimize staff effort and costs. This study aims to assess the impact of M-MBCT on the psychological resilience, self-esteem, and stigma in schizophrenia patients.

METHODS

This randomized, controlled, parallel-group, assessor-blinded clinical trial enrolled 174 inpatients with schizophrenia. Participants were randomly assigned to either the experimental or control group. The experimental group underwent an 8-week M-MBCT intervention, while the control group received standard treatment. Data collection employed the Connor-Davidson Resilience Scale (CD-RISC), Internalized Stigma of Mental Illness Scale (ISMI), and Rosenberg Self-Esteem Scale (RSES) before and after the intervention. Post-intervention, significant differences in ISMI, CD-RISC, and RSES scores were observed between the experimental and control groups.

RESULTS

In the experimental group, ISMI scores notably decreased, while CD-RISC and RSES scores significantly increased (P < 0.05). Multiple linear regression analysis identified age, education, and family history of mental illness as significant factors related to stigma (P < 0.05). Additionally, correlation analysis indicated a significant negative relationship between the reduction in CD-RISC scores and the reduction in ISMI scores (P < 0.05).

CONCLUSION

M-MBCT effectively enhanced psychological resilience and self-esteem while diminishing stigma in individuals with schizophrenia. M-MBCT emerges as a promising treatment option for schizophrenia sufferers.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry on 03/06/2023 ( www.chictr.org.cn ; ChiCTR ID: ChiCTR2300069071).

Relationships of multidimensional factors to self-management in patients with diabetes: A Cross-sectional, correlational study

Poor self-management in patients with diabetes is a consistent issue, leading to diabetes complications. The purpose of this study was to examine the relationships of demographic, cognitive, psychological, social, and physiological factors to self-management in patients with diabetes. In this cross-sectional, correlational study, data were collected from 98 patients through REDCap in 2023. Multiple regression analysis was used to address the study purpose. In the sample, adherence to adequate self-management was poor. Knowledge, self-efficacy, and body mass index (BMI) were associated with overall diabetes self-management. Self-efficacy and BMI were associated with diet and exercise. Knowledge and self-efficacy were associated with blood glucose testing. No factors were associated with smoking and foot care. In conclusion, different factors were associated with different types of self-management, but BMI and self-efficacy were associated with most types of self-management. Clinicians and researchers can target BMI, self-efficacy, and knowledge to improve self-management in patients with diabetes.

The Resilience of Pediatric Nurses in Context: A Mixed Methods Study

BACKGROUND

Resilience, an individual's ability to cope with and recover from stressors, is supported by contextually specific factors. Factors in the work environment may support or hinder nurses' resilience to the specific stressors present in pediatric nursing, an understudied population.

OBJECTIVE

We aimed to explore the contextual factors in the work environment of pediatric nurses with varying levels of resilience, including social support, the work environment, and opportunities for coping from an individual approach.

METHODS

This study is a secondary mixed-methods analysis using ordinal logistic regression and a meta-matrix of survey responses and semi-structured interview transcripts from 30 pediatric nurses.

RESULTS

5 themes, 3 supporting and 2 hindering resilience, emerged from the interviews. Nurses described their resilience as supported by sharing the burden, support from administration, and taking a break. Participants described resilience as hindered when they found it challenging to provide quality nursing care and when they felt unappreciated or undervalued. No theme significantly changed the odds of having higher resilience.

CONCLUSIONS

Our findings suggest that nurses recognize resources and conditions within their work environment as influencing their resilience. However, workplace resources and conditions are only one contributor to pediatric nurse resilience. Encouraging breaks and informal opportunities for nurses to support each other may support resilience in pediatric nurses. In addition, nursing leaders can support pediatric nurse resilience by regularly spending time connecting with nurses. Finally, health care organizations should consider how changes in the work environment may hinder nurse resilience by adding stress or changing access to supportive factors.

A prospective assessment of resilience in trauma patients using the Connor-Davidson Resilience Scale

BACKGROUND

Resilience, or the ability to adapt to difficult or challenging life experiences, may be an important mediator in trauma recovery. The primary aim of this study was to describe resilience levels for trauma patients using the validated Connor-Davidson Resilience Scale.

METHODS

Adult trauma patients admitted to a Level 1 trauma center (June 2022-August 2022) were surveyed at the time of admission and by phone between 2 weeks and 1 month after the original survey to obtain follow-up scores. We utilized the validated Connor-Davidson Resilience Scale score, a 25-question survey with 5 subfactors (Tenacity, Positive Outlook, Social Support, Problem Solving, and Meaning and Purpose). Each question was scored from 0 to 4 (maximum score 100, representing the highest resilience). Patient factors were collected from the electronic medical record and trauma health registry. Wilcoxon signed-rank test and multivariable linear regression were used to understand associations with Connor-Davidson Resilience Scale scores.

RESULTS

We enrolled 98 patients. The median age was 50 years (interquartile range 32-67), and 74% were male sex. The baseline median Connor-Davidson Resilience Scale score on admission was 88 (interquartile range 81-94). Follow-up surveys (N = 64) showed a median score of 89.5 (80-90.5) (P = non-significant). No demographic variable was significantly associated with increasing baseline Connor-Davidson Resilience Scale score. Increased length of stay (β = 1.03), insurance (β = -7.50), and unknown race (β = 23.69) were correlated with follow-up Connor-Davidson Resilience Scale scores. The subfactor "Meaning and Purpose" decreased at follow-up but was not statistically significant (P = .05).

CONCLUSION

Validated tools that can accurately distinguish variability in resilience scores are needed for the trauma patient population to understand its relationship with long-term patient health outcomes.

Psychometric properties of the Persian version of abridged Connor-Davidson Resilience Scale 10 (CD-RISC-10) among older adults

Background

Resilience is an ability of an individual to respond positively to environmental challenges. This ability could help elderly people to better cope with their age-related changes and diseases. The aim of this study was to examine the psychometric properties of Persian version of abridged Connor- Davidson scale of resilience among Iranian elderly people with chronic diseases.

Methods

Standard translation/back-translation procedure was applied to prepare the Persian version of abridged Connor-Davidson scale of resilience (CD-RISC 10-P) and its face and content validity were examined by an expert panel. The internal consistency and reliability of the drafted CD-RISC 10-P were investigated using the Cronbach’s alpha and intra-class correlation coefficients. A sample of 400 Muslim and Zoroastrian Persian older adults residing in the city of Yazd, Iran was recruited to assess factor structure of CD-RISC 10-P using the confirmatory factor analysis.

Results

The calculated values of the Cronbach’s alpha (0.89) and ICC (0.90) coefficients were in the within of acceptable range. The confirmatory factor analysis outputs also confirmed the unidimensionality of the CD-RISC 10-P (RMSEA = 0.073, SRMR = 0.030).

Conclusions

The study findings showed that the CD-RISC 10-P is a valid and reliable scale to measure resilience with age-related challenges of chronic diseases among Persian-speaking elderly people. Cross-cultural adaptability of the CD-RISC 10-P is recommended to be assessed in different subgroups of the Iranian elderly people and possibly in other Persian-speaking populations of different countries.

Coping and resilience levels of bariatric surgery candidates and affecting factors

PURPOSE

This study aimed to evaluate coping and resilience levels and affecting factors in candidates for bariatric surgery.

DESIGN AND METHODS

This was a descriptive study. Data were collected with Personal Information Form, Connor-Davidson Resilience Scale, and Ways of Coping Inventory.

FINDINGS

This study was completed with 138 bariatric surgery candidates with a mean age of 35.70 ± 10.76. Candidates used problem-focused coping, and their resilience level was moderate.

PRACTICE IMPLICATIONS

Psychiatric nurses can develop training and counseling programs for the bariatric surgery candidates to enhance problem-focused coping and psychological resilience. These programs can apply routinely throughout the preoperative period and the postoperative period.

Postamputation Cognitive Impairment Is Related to Worse Perceived Physical Function Among Middle-Aged and Older Prosthesis Users

OBJECTIVE

To compare characteristics between middle-aged and older prosthesis users with and without cognitive impairment and determine whether cognitive impairment contributes to variability in perceived physical function.

DESIGN

Cross-sectional, observational study SETTING: General community.

PARTICIPANTS

Adults 45 years or older, at least 1-year post lower limb amputation (LLA) who were walking independently with a prosthesis (N=119).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

We identified cognitive impairment using an education-adjusted Telephone Interview for Cognitive Status-modified score. Perceived physical function was measured using the Prosthesis Mobility Questionnaire.

RESULTS

Of 119 participants (mean age, 62.6±8.2 years; male: 89.1%; vascular etiology: 82.4%; years since amputation: 4.9±4.7 years), 28 (23.5%) had cognitive impairment. Compared with participants without cognitive impairment, those with cognitive impairment were more likely to use an assistive device (60.7% vs 25.3%, P=.002); were older (66.3±7.3 vs 61.5±8.1 years, P=.006) and had more chronic conditions (7.1±3.4 vs 5.4±2.5, P=.004), more depressive symptoms (6.6±5.1 vs 4.2±3.8, P=.008), and worse perceived physical function (2.0±0.6 vs 2.6±0.7, P<.001). Using backward stepwise linear regression, we found that participants with cognitive impairment had worse perceived physical function (standardized parameter estimate [β]=-0.15, P=.02), even after adjusting for depressive symptoms (β=-0.31, P<.001), prosthesis satisfaction (β=0.34, P<.001), number of chronic conditions (β=-0.19, P=.006), and assistive device use (βcane=0.01, P=.93; βother=-0.20, P=.003). Together, these variables explained 59% of perceived physical function variability.

CONCLUSIONS

Cognitive impairment is common and associated with worse perceived physical function post LLA, even after controlling for physical and mental health differences. Tailored rehabilitation interventions may be needed to improve perceived physical function in prosthesis users with cognitive impairment.

Are orthopaedic surgeons tough as nails? A regional resilience study

BACKGROUND

Healthcare professionals require resilience in the workplace to cope with the high demands of the job. Resilience reduces anxiety and distress following an adverse event, which orthopaedic surgeons must be prepared for. This cross-sectional study aims to assess the resilience levels of orthopaedic surgeons in one region to determine whether there are any factors which enhance it.

METHODS

Data from one hundred orthopaedic surgeons of varying levels was collected and compared using a validated scoring questionnaire (Connor-Davidson resilience scale 25). Scores were assessed and compared to experience level and participant demographics such as age, sex and subspeciality. Data on extracurricular activities i.e. sport, meditation/prayer and crafts were also collected.

RESULTS

There was no significant difference between the scores between genders (p = 0.74). The highest scores were found in trust grade doctors, SHOs and senior consultants. Higher resilience trends were noted for those who performed regular meditation and participated in regular arts and crafts. Those who participated in daily sports had lower resilience levels than those who participated less frequently. A concerning 13% reported that they felt pandemic had negatively impacted their resilience.