Psychometric evaluation of the Dutch Resilience Scale RS-nl on 3265 healthy participants: a confirmation of the association between age and resilience found with the Swedish version

Psychological resilience, athletic experience, and competitive level of judokas. A transversal study

Introduction

While there is agreement on the positive link between psychological resilience and athletic performance, conclusive findings regarding the association between psychological resilience and other variables of interest (for example, age, gender, type of sport, or competitive level) remain elusive.

Objective

The study aimed to assess psychological resilience levels among judokas and explore potential associations with demographic factors, judo experience and competitive level.

Methods

A total of 702 judokas (469 men and 233 women) participated in the study, of whom 194 (27.6%) were classified as TOP by their competitive level. Psychological resilience was evaluated using the Spanish version of the 10 item Connor-Davidson Resilience Scale (CD-RISC 10), with a score range from 0 to 40. Independent T-test and Pearson's coefficient were used for bivariate analysis. A two-way non-parametric ANCOVA was carried out to analyse the impact of gender and competitive level on psychological resilience.

Results

The judokas showed total mean scores in the CD-RISC 10 of 33.08 points (SD = 4.79), considered high. Levels of psychological resilience were significantly higher among men (33.36 ± 4.76) than women (32.53 ± 4.80) and were positively correlated with age and number of years practicing and competing in Judo (p = 0.019). Judokas with a higher competitive level (TOP judokas) showed significantly higher levels of resilience than the others (non-TOP judokas) (p < 0.001). These differences in resilience according to competitive level persisted, among both men and women, when adjusting the model of analysis (two-way ANCOVA) for all variables considered in the study, although with a small effect size.

Conclusion

The results suggest that the practice of Judo, especially over long periods of time, is associated with high scores in psychological resilience. Furthermore, psychological resilience appears to be a differentiating variable among judokas at a high-competitive level, and its evaluation and development using different strategies based on age and gender should be considered by trainers and psychologists.

Translation and validation of Persian version of resilience evaluation scale (RES): A cross-cultural methodological research

BACKGROUND

The Resilience Evaluation Scale (RES) is a new, free and short self-report questionnaire for measuring psychological resilience. This study aims to translate and assess the psychometric properties of the RES.

MATERIALS AND METHOD

In the present methodological study, after the translation process, face and content validity were conducted through qualitative and quantitative methods. To determine the construct validity, exploratory and confirmatory factor analysis (CFA) was used, and for the reliability, Cronbach's α test and inter-counter coefficient test were calculated. Persian version of the Connor-Davidson Resilience Scale was used to determine the convergent validity of the questionnaire.

RESULTS

Results show that the face and content validity of 9 items of RES were acceptable and they were all approved [Impact scores (IS) >1.5, S-CVI/Ave = 0.97, I-CVI = 0.93]; the Internal consistency of the scale was confirmed by the Cronbach's α coefficient (0.82) and McDonald's omega (0.83). The reliability of the scale also was confirmed by the Spearman's correlation coefficient and intra-group correlation coefficient (ICC), with results obtained above 0.8 for all items. The factor analysis identified two factors that accounted for about 56% of the variance. Also, the CFA model fitted well according to the results of the fitting indices (RMSEA = 0.084, CFI = 0.98, SRMR = 0.064, and TLI = 0.97). In addition, the convergent validity of the scale was equal to 0.65 (P < 0.001).

CONCLUSION

Development of a valid and reliable psychological resilience scale may bring great benefits to the Persian society. Our findings suggest that the Persian RES has good psychometric properties, and it may serve as a valuable instrument in research and clinical practice.

The effect of the stress autism mate app on perceived stress, coping, and resilience in adults with autism: a single-case experimental design

Introduction

The mobile health application "Stress Autism Mate" (SAM) was designed to support adults with autism in identifying and managing daily stress. SAM measures stress four times daily, provides a daily and weekly stress overview, and provides personalised stress reduction advice. This study aimed to assess the effectiveness of SAM over four weeks in reducing perceived stress and internalised stigma, and enhancing coping self-efficacy, quality of life, and resilience among adults with autism.

Methods

Using an A1-B-A2 single-case experimental design, the effect of using SAM on adults with autism was assessed. The phases consisted of A1; treatment as usual (TAU), B; introducing SAM, and finally A2; follow-up with TAU and without the use of SAM. Each phase lasted four weeks, and data were collected via questionnaires before and after each phase. Linear mixed models were used for data analysis.

Results

Results show significant reductions in perceived stress levels, increased coping self-efficacy, and improved perceived health and psychological well-being after using SAM. Furthermore, increased resilience, and decreased internalised stigma were reported after follow-up.

Discussion

In conclusion, this study highlights SAM as a valuable tool for empowering adults with autism to reduce stress and internalised stigmaand to improve coping self-efficacy, psychological well-being, and resilience.

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

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

Effectiveness of trauma-focused art therapy (TFAT) for psychological trauma: study protocol of a multiple-baseline single-case experimental design

INTRODUCTION

Treatments such as eye movement desensitisation and reprocessing and (narrative) exposure therapies are commonly used in psychological trauma. In everyday practice, art therapy is also often used, although rigorous research on its efficacy is lacking. Patients seem to benefit from the indirect, non-verbal experiential approach of art therapy. This protocol paper describes a study to examine the effectiveness of a 10-week individual trauma-focused art therapy (TFAT) intervention.

METHODS AND ANALYSIS

A mixed-methods multiple-baseline single-case experimental design will be conducted with 25-30 participants with psychological trauma. Participants will be randomly assigned to a baseline period lasting 3-5 weeks, followed by the TFAT intervention (10 weeks) and follow-up (3 weeks). Quantitative measures will be completed weekly: the Beck Depression Inventory-II, the Mental Health Continuum Short Form, the Resilience Scale, the Rosenberg Self-Esteem Scale and the Self-expression and Emotion Regulation in Art Therapy Scale. The Post-Traumatic Stress Disorder Checklist-5 will be completed at week 1 and week 10. Qualitative instruments comprise a semistructured interview with each individual patient and therapist, and a short evaluation for the referrer. Artwork will be used to illustrate the narrative findings. Quantitative outcomes will be analysed with linear mixed models using the MultiSCED web application. Qualitative analyses will be performed using thematic analysis with ATLAS.ti.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee of the HAN University of Applied Sciences (ECO 394.0922). All participants will sign an informed consent form and data will be treated confidentially. Findings will be published open access in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05593302.

Resilience and family quality of life in parents of children with autism spectrum disorders

INTRODUCTION

Resilience and quality of life (QOL) can involve a positive approach in group interventions for parents of children with autism spectrum disorders (ASD). This study aims to evaluate resilience and family QOL at the start of a psychoeducational group.

METHODS

Cross-sectional assessment of resilience and family QOL used the Family Quality of Life Scale (ECVF) and 14-item Resilience Scale (RS-14).

RESULTS

The study group showed high levels of resilience. Parents considered the resources/support domain crucial, although satisfaction in this area was comparatively lower. Concerns about low satisfaction with available resources and support were notable. Gender differences were observed but not statistically significant.

DISCUSSION

The study's findings support prior research on parental resilience in families of children with ASD. The literature on the QOL for these families presents mixed findings. The importance of parental involvement in service planning is highlighted.

CONCLUSIONS

This study emphasizes the importance of resilience in parents of children with ASD, suggesting it as a potential therapeutic target. The findings underscore the need to address the perceived low quality of available resources and support. Further investigation is needed.

The mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants: Cross-sectional study

PURPOSE

This study aimed to examine the relationship of stress, mental resilience, and coping style, and the mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants.

DESIGN AND METHODS

A cross-sectional design was used. A total of 231 parents of children with cochlear implants were recruited from May 1, 2022, to February 28, 2023 at a comprehensive tertiary hospital and a cochlear implant rehabilitation center in China. Parenting Stress Index-Short Form (PSI-SF), the Connor-Davidson Resilience Scale (CD-RISC) and the Simplified Coping Style Questionnaire(SCSQ) were used to measure stress, mental resilience, and coping style respectively.

RESULTS

The mean score observed for PSI-SF, CD-RISC, active coping, and passive coping was 87.85 ± 24.59, 55.63 ± 16.11, 21.36 ± 6.73, and 9.05 ± 4.52, respectively. Mental resilience was a significant mediator explaining the effect of stress on active coping (β = -0.294; 95% bias-corrected bootstrap CI: -0.358 to -0.164).

CONCLUSIONS

Attention should be paid to the status of stress, mental resilience and coping style in parents of children with cochlear implants. Mental resilience mediated stress and coping style.

PRACTICE IMPLICATIONS

This study provides a theoretical basis for establishing an active coping care program for parents of children with cochlear implants. There is a need to identify strategies that can help increase the level of mental resilience of parents of children with cochlear implants and more subjective and objective social support should be provided to reduce their stress and to encourage active coping style.

How Reflective Automated e-Coaching Can Help Employees Improve Their Capacity for Resilience: Mixed Methods Study

BACKGROUND

An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection.

OBJECTIVE

In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees' self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process.

METHODS

Of the 28 participants, 14 (50%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed.

RESULTS

Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events.

CONCLUSIONS

Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach.

Individual differences in resilience to stress are associated with affective flexibility

Cognitive flexibility is frequently linked to resilience because of its important contribution to stress regulation. In this context, particularly affective flexibility, defined as the ability to flexibly attend and disengage from affective information, may play a significant role. In the present study, the relationship of cognitive and affective flexibility and resilience was examined in 100 healthy participants. Resilience was measured with three self-report questionnaires, two defining resilience as a personality trait and one focusing on resilience as an outcome in the sense of stress coping abilities. Cognitive and affective flexibility were assessed in two experimental task switching paradigms with non-affective and affective materials and tasks, respectively. The cognitive flexibility paradigm additionally included measures of cognitive stability and spontaneous switching in ambiguous situations. In the affective flexibility paradigm, we explicitly considered the affective valence of the stimuli. Response time switch costs in the affective flexibility paradigm were significantly correlated to all three measures of resilience. The correlation was not specific for particular valences of the stimuli before or during switching. For cognitive (non-affective) flexibility, a significant correlation of response time switch costs was found with only one resilience measure. A regression analysis including both affective and cognitive switch costs as predictors of resilience indicated that only affective, but not cognitive switch costs, explained unique variance components. Furthermore, the experimental measures of cognitive stability and the rate of spontaneous switching in ambiguous situations did not correlate with resilience scores. These findings suggest that specifically the efficiency of flexibly switching between affective and non-affective information is related to resilience.

Cross-sectional study examining psychometric properties of the Slovenian version of the 14-item Resilience Scale (RS-14-SL)

PURPOSE

Resilience has become an important concept in health research, addressing mental health outcomes. The purpose of this study was to translate, adapt, and evaluate psychometric properties of the Slovenian version of the 14-item Resilience Scale (RS-14), using a sample of general population and cancer survivors.

METHODS

The original version of the RS-14 was first back-translated and pilot tested. The factor structure was assessed with an exploratory analysis and confirmed with a confirmatory analysis. To assess reliability, internal consistency (Cronbach's alpha) and test-retest (ICC, t student test) were determined. Measurement validity was assessed with demographic (age and gender) and psychological characteristics (symptoms of anxiety and depression and health-related quality of life).

RESULTS

An exploratory factor analysis revealed one-factor solution in both samples and the fit indexes showed an acceptable model fit. Internal consistency showed excellent values (0.91-0.96), and test-retest reliability was found to be acceptable (ICC = 0.89). Significant correlations were found between RS-14 and anxiety and depression HADS subscales in Sample 1 (r = - 0.62, - 0.72 for anxiety and depression) and Sample 2 (r = - 0.43, r = - 0.51 for anxiety and depression) and the majority of EQ-5D subscales (usual activities, pain, anxiety/depression).

CONCLUSION

The study showed that the Slovenian version of the RS-14 test scores is valid and stable.

TRIAL REGISTRATION NUMBER

0120-25/2019/6.

Resilience and quality of life in young adults with a 22q11.2 deletion syndrome: a patient's perspective

In the transition period between adolescence and young adulthood, individuals with 22q11.2DS are at an increased risk of developing severe psychiatric disorders. Various studies have focused on detecting risk factors, but until now protective factors are still understudied in 22q11.2DS. The current case-control study focuses on the role of resilience and quality of life (QoL) in young adults with 22q11.2DS and behavioural problems, in comparison with persons with an intellectual disability (ID) without a known genetic disorder. Self-report (and caregiver report) standardized questionnaires were used. Predictive general linear models were constructed to compare the resilience and quality of life across both groups (22q11.2DS vs ID-group) and to analyse the association between personal characteristics in both groups. Young adults with a 22q11.2DS show less resilience compared with both the general population norms and young adults with ID. Only a subscale of resilience (Acceptance of self and life) contributes to the reported level of QoL. Reported health problems are not related to resilience, but have an important effect on QoL. Our results suggest different factors are underlying resilience and the relation with QoL in 22q11.2DS and ID in general. These factors deserve more research and are important to take into account in clinical practice.

The prevalence and associated factors of prenatal depression and anxiety in twin pregnancy: a cross-sectional study in Chongqing, China

Background

Pregnant women expecting twins are more likely to experience stress, which can lead to anxiety and depression. Our aim was to investigate the prevalence of prenatal anxiety and depressive symptoms in women with twin pregnancies and the associated factors.

Methods

In a cross-sectional survey, 210 women with twin pregnancies who satisfied the inclusion and exclusion criteria in two tertiary centers in Southwestern China were asked to complete a basic information form, the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). To compare statistics with normal distribution in distinct characteristic groups, a paired t-test, and one-way ANOVA were utilized. Binary logistic step regression was used to analyze the associated factors of antenatal anxiety and depressive symptoms.

Results

The 210 women with twin pregnancies (age = 30.8 ± 4.2 years) were between 7 and 37 gestational weeks (29.2 ± 1.2 weeks), were typically well-educated (72.4% had a post-high-school degree), and reasonably affluent (88.1% were above the low-income cutoff). Among them, 34.8% had symptoms associated with clinical levels of anxiety, and 37.1% had symptoms indicating possible depression. The prevalence of co-morbid anxiety and depressive symptoms was 24.3%. Binary stepwise logistic regression analysis showed that previous health status and sleep disturbance during pregnancy were the associated factors of anxiety symptoms in women with twin pregnancies (P < 0.05), whereas age, previous health status, negative life events, and physical activity during pregnancy were the associated factors of depressive symptoms in women with twin pregnancies (P < 0.05).

Conclusion

About one-third of women with twin pregnancies had symptoms of anxiety or depression; these were most strongly predicted by some modifiable factors, suggesting that early preventive mind-body interventions may be a promising strategy to protect against mental health issues for women with twin pregnancies.

Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience

Introduction: The COVID-19 pandemic generated a significant burden on the German health care system, affecting the mental health of health care workers (HCW) in particular. Resilience may serve as an essential protective factor for individuals’ well-being. Objective: Our objective was to identify demographic and work-related correlates of individual resilience and to investigate the association between pandemic-related stress, resilience and mental health using different resilience models. Methods: Our sample comprised 1034 German HCW in different medical professions who completed an online survey from 20 April to 1 July 2020. Resilience was assessed using the Resilience Scale-5 (RS-5). The pandemic-related self-reported stress burden was captured by a single item, while depression and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Additionally, various sociodemographic and work-related factors were assessed. Results: Overall, we found high levels of resilience in the sample compared to a German sample before the pandemic, which were significantly associated only with the older age of participants and having children in both univariate and multivariate analyses. Regarding mechanisms of resilience, moderation analysis revealed that low individual resilience and high pandemic-related stress burden independently contributed to both anxiety and depression symptoms while resilience additionally moderated the relationship between stress burden and anxiety symptoms. The link between self-reported stress burden and mental health symptoms was also partially mediated by individual resilience. Conclusion: Taken together, the findings based on the present sample during the COVID-19 pandemic suggest that resilience plays a central role in the mental health of healthcare workers and that resilience-building interventions should be expanded, especially with a focus on younger employees.

Patient-reported outcomes measures used in facial vascularized composite allotransplantation: A systematic literature review

BACKGROUND

Facial vascularized composite allotransplantation (fVCA) is a life-enhancing procedure performed to improve quality of life (QOL). Patient-reported outcome measures (PROMs) are tools used to assess QOL from the patients' perspective, and are increasingly recognized as an important clinical metric to assess outcomes of treatment. A systematic literature review was performed to identify and appraise the content of PROMs used in fVCA.

METHODS

We searched PUBMED/Medline, CINAHL, Embase, PsychInfo, and Web of Science from their inception through to June 2020. Included studies used a PROM in candidates and recipients of fVCA of any gender or age. We excluded abstracts, reviews, editorials, and dissertations. Items from each PROM were extracted and coded, using top-level codes and subcodes, to develop a preliminary conceptual framework of QOL concerns in fVCA, and to guide future PROM selection.

RESULTS

Title and abstract screening of 6089 publications resulted in 16 studies that met inclusion criteria. Review of the 16 studies identified 38 PROMs, none of which were developed for fVCA. Review of the coded content for each PROM identified six top-level codes (appearance, facial function, physical, psychological and social health, and experience of care) and 16 subcodes, making up the preliminary conceptual framework.

CONCLUSION

There are currently no PROMs designed to measure QOL concerns of fVCA candidates and recipients. Findings from this systematic review will be used to inform an interview guide for use in qualitative interviews to elicit and refine important concepts related to QOL in fVCA.

Combined effects of tDCS over the left DLPFC and gaze-contingent training on attention mechanisms of emotion regulation in low-resilient individuals

Low resilience is characterized by impairments in attention and emotion regulation mechanisms that depend on prefrontal cortical activity. The aim of this study was to test whether transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) can augment the effectiveness of a new computerized mouse-based (gaze)contingent training (MCAT) to improve attention and emotion regulation processes (improved reappraisal, reduced rumination) in individuals reporting low resilience levels. The study used a full-factorial between-subject design combining active and sham MCAT and tDCS interventions. One hundred participants reporting low resilience levels were randomly assigned to receive either a single session of: tDCS with sham MCAT treatment (tDCS group), MCAT with sham tDCS (MCAT group), a combination of tDCS and MCAT (combined group), or sham tDCS and sham MCAT (control group). Transfer to attention regulation, reappraisal success, and state rumination was evaluated using an eye-tracking disengagement task and an emotion regulation paradigm, respectively. MCAT, either alone or combined with tDCS, resulted in improved attention regulation. Furthermore, the group receiving combined MCAT and tDCS also showed some evidence of increased reappraisal ability and reduced rumination. MCAT in combination with left DLPFC neuromodulation has potential to maximize transfer to emotion regulation capacities and to promote resilience.

Reward prospect improves inhibitory control in female university students with a history of childhood sexual and physical abuse

BACKGROUND AND OBJECTIVES

Childhood abuse and neglect increase the risk for psychiatric disorders (e.g., depression and anxiety) during adulthood and have been associated with deficits in cognitive control. The specific mechanisms underlying these cognitive control deficits are still unknown.

METHODS

This study examined the expectation for reward to improve inhibitory control in young women (ages 18-35 years) with a history of childhood sexual and/or physical abuse (AG, N = 28), childhood emotional and/or physical neglect (NG, N = 30), or unaffected comparison women (HC, N = 40). They completed a previously validated rewarded (color-word) Stroop task and filled out questionnaires on depression, anxiety, and resilience.

RESULTS

Surprisingly, a significant group by reward interaction revealed larger performance benefits under reward prospect (relative to no-reward) for the AG group relative to both the NG and HC groups.

LIMITATIONS

A small sample size limiting generalizability.

CONCLUSIONS

These results demonstrate sensitivity of abused subjects to reward in modulating cognitive control and might aid in discussing whether using reward schedules during therapeutic interventions could be effective.

The Polish Version of the Resilience Scale 25: Adaptation and Preliminary Psychometric Evaluation

Background: The aim of the presented series of studies was to test the factor structure and assess the psychometric properties of the Resilience Scale 25 in the Polish population. It was developed and tested during the course of four independent studies analysing various aspects of the validation of the RS 25 questionnaire’s Polish version.

Method: Study 1 concerned the procedure for developing the Polish language version. Study 2 (N = 2716) consisted of reliability tests and a confirmatory factor analysis. In Studies 3 (N = 733) and 4 (N = 431), the validity was assessed by examining the relationship between resilience and the assessment of ego-resiliency, the risk of depression, styles of coping with stress, perceived stress, and satisfaction with life.

Results: The presented research results obtained using the measure indicate that it can be considered to be a reliable and valid research tool. A five-factor solution showed a good fit to the data: χ²/df = 12.85; RMSEA = 0.066 (low = 0.064; high = 0.068; 90% CI); GFI = 0.90; AGFI = 0.90. An assessment of the internal consistency was carried out on the basis of Cronbach’s alpha. The values achieved were satisfactory and indicate acceptable internal reliability of the questionnaire (0.89) and of the five dimensions: (1) purpose (0.65); (2) equanimity (0.65); (3) self-reliance (0.75); (4) perseverance (0.72); and (5) existential aloneness (0.66). In accordance with the predictions and earlier studies, resilience was correlated positively with ego-resiliency, a task-oriented style of coping with stress, and life satisfaction and negatively with perceived stress, the risk of depression, and an emotion-oriented coping style.

Conclusion: The Polish version of the RS 25 allows the assessment of the intensity of resilience as a general indicator and its five constituting dimensions. Such a measurement seems to be important from the perspective of assessing the role of an individual’s resources in clinical psychology, health psychology, and psychotherapy.

The resilience scale: factorial structure, reliability, validity, and parenting-related factors among disaster-exposed adolescents

BACKGROUND

In this study, we examined psychometric properties of the Chinese version of the Resilience Scale (RS) and parenting-related factors associated with resilience among disaster-exposed adolescents.

METHODS

Eighteen months after the earthquake, a total of 1266 adolescents (43.4% male, mean age = 15.98; SD = 1.28) were assessed using the RS, the Post-traumatic Stress Disorder Self-Rating Scale, the Depression Self-rating Scale for Children, the Screen for Child Anxiety Related Emotional Disorders, and Parental Bonding Instrument.

RESULTS

Through exploratory factor analyses (EFAs) and parallel analysis, responses were characterized into a 3-factor structure: personal competence, meaningfulness, and acceptance of self and life. Cronbach's alpha coefficient for the RS was 0.89 and the test-retest reliability coefficient was 0.72. In terms of predictive validity, resilience was found to be a significant predictor for PTSD, depression, and anxiety. Multiple regression analysis showed that maternal parenting styles were significant predictors of resilience after adjusting for gender, age, sibling number, and earthquake experiences.

CONCLUSIONS

The Chinese version of RS is a reliable and valid tool for assessing resilience among adolescent survivors after disasters. The implications for research and resilience-oriented interventions were also discussed.

Associations Between Resilience, Psychological Well-Being, Work-Related Stress and Covid-19 Fear in Forensic Healthcare Workers Using a Network Analysis

Forensic healthcare workers deal with patients with severe psychiatric and behavioral problems that put them at an increased risk of developing work-related stress and burnout. Working with this target group of patients during the Coronavirus disease 2019 (Covid-19) pandemic with far-reaching restrictive measures can negatively affect the psychological well-being of forensic workers. Research suggests that resilience can buffer workplace stress and contribute positively to psychological well-being. However, research on resilience, psychological well-being and work-related stress among forensic healthcare workers is still lacking. Therefore, in this study, we investigated the interrelations between psychological well-being and resilience on the one hand and work-related stress and Covid-19 fear-related symptoms on the other hand. Self-report data were obtained from 318 healthcare workers (73.9% women) working in three Forensic Psychiatric Centers (M age = 44.20, SD = 14.31) and are in direct contact with forensic patients. The data were analyzed using network analysis. Consistent with previous research, the results showed that workplace stress and fear associated with the Covid-19 pandemic can be detrimental to workers' psychological well-being, while resilience can serve as a protective factor against being personally attacked or threatened by patients at the workplace. Last but not least, we identified highly central symptoms, namely tremors due to the fear of the coronavirus and anxiety when other people coughing, which would be the best candidates for future treatment targets. This knowledge can help clinicians optimize interventions to reduce workplace stress and fear due to the pandemic. Future studies should aim to replicate our findings in a larger and more representative sample of forensic healthcare workers.

Reliability and validity of the RS14 in orphaned and separated adolescents and youths in western Kenya

PURPOSE

The 14-item Resilience Scale (RS14) is a tool designed to measure psychological resilience. It has been used effectively in diverse populations. However, its applicability is largely unknown for Sub-Saharan adolescent populations and completely unknown for orphaned and separated adolescents and youths (OSAY), a highly vulnerable population for whom resilience may be critical. This study assesses the RS14's psychometric properties for OSAY in Uasin Gishu County, Kenya.

METHODS

Survey responses from a representative sample of 1016 OSAY (51.3% female) aged 10-25 (mean = 16; SD = 3.5) living in institutional and home-based environments in Uasin Gishu County were analyzed. The RS14's psychometric properties were assessed by examining internal consistency reliability, confirmatory factor analyses, and convergent validity using correlations between resilience and each of social support and depression. Sub-analyses were conducted by age and sex.

RESULTS

Resilience scores ranged from 14-98 (mean = 66; SD = 19) with no sex-based significant difference. Resilience was higher for those aged ≥18 (mean = 69; range = 14-98) versus age <18 (mean = 65; range = 14-98). Internal consistency was good (Cronbach's α = .90). Confirmatory factor analysis indicated a 1-factor solution, though the model fit was only moderate. Resilience was positively correlated with social support in all ages (.22; p < .001) and negatively correlated with depression in individuals age <18 (-.22; p < .001). The relationship between resilience and depression in individuals age ≥18 was statistically significant only in females (-.17; p = .026).

CONCLUSION

This study demonstrates reasonable evidence that the RS14 is both valid and reliable for measuring psychological resilience in the population of OSAY in western Kenya.

Transdiagnostic vulnerability factors in eating disorders: A network analysis

OBJECTIVE

Eating disorder (ED) symptoms and transdiagnostic vulnerability characteristics play a crucial role in the aetiology and maintenance of EDs. Over the last decade, researchers have started to model complex interrelations between symptoms using network models, but the literature is limited in that it has focused solely on symptoms and investigated-specific disorders while ignoring transdiagnostic aspects of mental health.

METHOD

This study tackles these challenges by investigating network relations among core ED symptoms, comorbid clinical symptoms (depression and anxiety) and empirically supported vulnerability and protective mechanisms (personality traits, maladaptive cognitive schemata, perfectionism and resilience) in a sample of 2302 treatment-seeking ED patients. We estimated a regularized partial correlation network to obtain conditional dependence relations among all variables. We estimated node centrality (interconnectivity) and node predictability (the overall magnitude of symptom inter-relationships).

RESULTS

The findings indicate a central role of overvigilance, excessive focus on inhibiting emotions and feelings, interoceptive awareness and perfectionism.

CONCLUSIONS

These results suggest that excessive control of bodily aspects by dietary restraint (possibly through inhibition) and interoceptive awareness may be important constructs that warrant future research in understanding vulnerability in EDs. We provide all code and data via the Open Science Framework.

Formal Elements of Art Products Indicate Aspects of Mental Health

Formal elements are often used in art therapy assessment. The assumption is that formal elements are observable aspects of the art product that allow reliable and valid assessment of clients' mental health. Most of the existing art therapy assessment instruments are based on clinical expertise. Therefore, it is not clear to what degree these instruments are restricted to formal elements. Other aspects might also be included, such as clinical expertise of the therapist. This raises the question of whether and how formal elements as observable aspects of the art product are related to clients' mental health. To answer this question, four studies are presented that look at: (1) a meta-theoretical description of formal elements; (2) operationalization of these formal elements so they can be analyzed reliably in clients' art products; (3) establishment of reliable and clinically relevant formal elements; (4) the relationship between formal elements and adult clients' mental health. Results show that the combination of the formal elements "movement," "dynamic," and "contour" are significantly interrelated and related to clients' mental health, i.e., psychopathology, psychological flexibility, experiential avoidance, and adaptability. These findings give insight in the diagnostic value of art products and how they may add to clients' verbal expression and indicate their potential to benefit from therapy.

The multidimensional construct of resilience across the psychosis spectrum: Evidence of alterations in people with early and prolonged psychosis

OBJECTIVE

Research has demonstrated that resilience impacts functional outcomes and is often reduced among those with prolonged psychosis. However, little work has examined when during the course of psychosis resilience declines and whether resilience impacts symptoms and functioning similarly in different illness phases. This study examined whether overall resilience (a) differed between those with early compared to relatively prolonged psychosis, (b) differed between the psychosis groups and nonclinical controls, and (c) differentially related to symptoms and functioning in the psychosis groups.

METHOD

Participants with early (n = 30) and prolonged psychosis (n = 64) and nonclinical controls (n = 58) completed the Resilience Scale. Psychosis participants also completed clinician-rated functioning and symptom measures. Analyses of Variance were used to compare group resilience levels. Pearson's correlations identified relationships between resilience, symptoms, and functioning.

RESULTS

Overall resilience levels did not significantly differ between the psychosis groups, but both psychosis groups had lower resilience than nonclinical controls. Higher overall resilience was significantly associated with lower negative symptoms in the early psychosis group and lower mood symptoms in the prolonged psychosis group; greater resilience was significantly associated with higher functioning in both psychosis groups.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Resilience may be reduced throughout the course of psychosis but may differentially impact symptom domains in different illness phases. Targeting resilience with psychosocial interventions may be important throughout the course of psychosis and may lead to improvements in functioning as well as negative symptoms and mood symptoms (in early and prolonged psychosis, respectively). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Resilience as a mediator factor in the relationship between childhood trauma and mood disorder: A community sample of young adults

BACKGROUND

Studies on the field of mood disorders has mainly focusing on the risk factors associated to develop the illness or the clinical factors associated with the clinical progression. Less attention was given to factors such as resilience that may be associated with better outcomes in the course of mood disorders. In this study, we assessed the mediation effect of resilience on the relationship between childhood trauma and mood disorders, as well as the severity of depressive symptoms in a population-based sample.

METHODS

This is a cross-sectional study with a community sample of young adults with bipolar disorder (BD), major depressive disorder (MDD), and community controls without any mood disorder. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and to assess the resilience was used the Resilience Scale (RS-25).

RESULTS

All subtypes of trauma were associated with both MDD and BD, however, only physical and emotional abuse differentiated BD from MDD subjects. Bootstrapping-enhanced mediation analyses indicated that resilience partly mediated the association of childhood trauma to both mood disorder and severity of depression.

LIMITATION

The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality.

CONCLUSIONS

The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of childhood trauma. This study provides important information regarding the relationships among childhood trauma, resilience, and mood disorder.

Depression, trauma and mentalizing: No influence of depressive symptoms on spontaneous theory of mind in a subclinical sample

BACKGROUND

Depressive symptoms are associated with impaired social functioning, arguably because of reduced mentalizing abilities. However, findings in persons with depressive symptoms and/or major depressive disorder (MDD) are presently mixed, finding evidence both for and against the hypothesis of reduced mentalizing abilities.

AIMS

This study investigated spontaneous cognitive mentalizing in 36 age-, sex- and education-matched students with depressive symptoms and 45 comparisons with minimal depressive symptoms.

METHOD

To assess spontaneous mentalizing, we used the implicit theory of mind (ToM) task, which looks specifically at spontaneous computation of false belief.

RESULTS

Bayesian analysis did not support the hypothesis of impaired mentalizing; in fact, it suggested that the results were 3.90 times more likely to have occurred under the null hypothesis. Results remained stable when comparing depressed and non-depressed individuals without maltreatment exposure but were inconclusive in the maltreatment-exposed groups.

CONCLUSION

The findings suggest no effect of spontaneous mentalizing in a high-functioning depressed sample. Moreover, the findings also emphasize the need to control for childhood maltreatment experiences in future ToM and social functioning research, as these may constitute subgroups within depressed samples. Tailored therapy for maltreated depression individuals may be beneficial.

Sex-linked neurofunctional basis of psychological resilience in late adolescence: a resting-state functional magnetic resonance imaging study

Psychological resilience refers to the ability to adapt effectively in the face of adversity, which is closely related to an individual's psychological and physical health and well-being. Although previous behavioural studies have shown sex differences in psychological resilience, little is known about the neural basis of sex differences in psychological resilience. Here, we measured amplitude of low-frequency fluctuations (ALFF) via resting-state functional magnetic resonance imaging to investigate the sex-linked neurofunctional basis of psychological resilience in 231 healthy adolescents. At the behavioural level, we replicated previous findings indicating that males are more resilient than females. At the neural level, we found sex differences in the relationship between psychological resilience and ALFF in the right orbitofrontal cortex (OFC). Specifically, males showed a positive correlation between psychological resilience and ALFF in the right OFC, while females showed a negative correlation in this region. The sex-specific association between psychological resilience and spontaneous brain activity might be dependent on differences in hormonal systems and brain development between male and female adolescents. Taken together, the results of our study might provide the first evidence of sex-specific neurofunctional substrates of psychological resilience in adolescents, emphasizing the vital role of sex effects in future psychological resilience-related studies.

Resilience and cortical thickness: a MRI study

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.

The effect of written information and counselling by an advanced practice nurse on resilience in women with vulvar neoplasia six months after surgical treatment and the influence of social support, recurrence, and age: a secondary analysis of a multicenter randomized controlled trial, WOMAN-PRO II

BACKGROUND

Women with vulvar neoplasia often complain about physical and psychological distress after surgical treatment. Lack of information and support can influence resilience. Whether an information-related intervention through an advanced practice nurse supports resilience and which other factors affect resilience in women with vulvar neoplasia has never been investigated.

METHODS

The aims of this study were (a) to analyse whether counselling based on the WOMAN-PRO II program causes a significant improvement in the resilience scores of women with vulvar neoplasia compared to written information and (b) to identify the potential predictors of resilience. A randomized controlled trial was conducted in women with vulvar neoplasia (n = 49) 6 months after surgical treatment in four Swiss hospitals and one Austrian hospital. Analyses of resilience and its predictors were performed using a linear mixed model.

RESULTS

Thirty-six women (intervention I, n = 8; intervention II, n = 28) completed the randomized controlled trial. In total, 13 women (26.5%) dropped out of the trial. The resilience score did not differ significantly between the two interventions three and six months after randomisation (p = 0.759). Age (b = .04, p = 0.001), social support (b = .28, p = 0.009), counselling time (b = .03, p = 0.018) and local recurrence (b = -.56, p = 0.009) were identified as significant predictors of resilience in the linear mixed model analyses.

CONCLUSION

The results indicate that the WOMAN-PRO II program as single intervention does not cause a significant change in the resilience scores of women with vulvar neoplasia 6 months after surgery. Predictors that promote or minimise resilience have been identified and should be considered when developing resilience programs for women with vulvar neoplasia. A repetition of the study with a larger sample size is recommended.

TRIAL REGISTRATION

The WOMAN-PRO II program was registered in ClinicalTrials.gov NCT01986725 on 18 November 2013.

A Controlled Trial in Community Pediatrics to Empower Parents Who Are at Risk for Parenting Stress: The Supportive Parenting Intervention

The goal of the Supportive Parenting Intervention is to prevent and/or decrease parenting stress and provide a sense of empowerment to parents with a newborn child. We evaluated the effectiveness of the Supportive Parenting Intervention in terms of parenting skills, social support, self-sufficiency, resilience, and child psychosocial health. A controlled trial with pre- and post-intervention testing was conducted in the setting of community pediatrics among parents at risk for developing parenting stress. The 177 parents in the control group received care-as-usual, whereas the 124 parents in the intervention group received six home visits by a trained Youth Health Care nurse during the first 18 months of the child’s life. The result with respect to parenting skills, social support (both from family and friends, and the partner), self-sufficiency, and resilience at the 18-month follow-up was either unchanged or (p < 0.05) worse compared to the respective baseline score for both groups. We found no significant difference between intervention and control group with respect to the child’s Child Behavior Check List (CBCL). This study shows no positive effect with respect to the indicators of parental empowerment. We recommend research to strengthen the intervention and its application in daily practice, for example by increasing the intervention duration, and to evaluate it in a large randomized controlled trial.

In flight again with wings that were once broken; effects of post-traumatic growth and personal resources on burnout recovery

Purpose

Adequate recovery from burnout is important to understand. The purpose of this paper is to investigate whether post-traumatic growth (PTG) contributes to higher engagement and reduced symptoms of burnout and whether this process is mediated by personal resources.

Design/methodology/approach

In a cross-sectional survey, 166 Dutch workers who had fully recovered from burnout were questioned on their level of PTG, their personal resources (optimism, resilience and self-efficacy), and their levels of engagement and burnout.

Findings

Fully recovered workers scored somewhat higher on current burnout level, but did not differ from norm group workers in their engagement level. Moreover, PTG appeared to positively affect both higher engagement and lower burnout levels, which is fully mediated by personal resources.

Research limitations/implications

Post-traumatic growth (PTG) impacts on engagement and burnout levels amongst workers who have recovered from burnout by enhancing personal resources. The role of personal resources and the impact of PTG on engagement and burnout complaints following (recovery from) burnout deserve further investigation.

Practical implications

Management can support workers who have (recovered from a) burnout, by being aware of their (higher) engagement, and facilitate the enhancement of PTG and personal resources.

Originality/value

This study is one of the first to study the role of PTG after (recovery from) burnout and reveals valuable findings for both research and practice.

Measurement properties and implications of the Brief Resilience Scale in healthy workers

Objectives

The aim of this study was to study measurement properties of the Dutch Language Version of the Brief Resilience Scale (BRS‐DLV) in blue and white collar workers employed at multiple companies and to compare the validity and factor structure to other language versions.

Methods

Workers (n = 1023) were assessed during a cross‐sectional health surveillance. Construct validity was tested with exploratory and confirmatory factor analyses (EFA and CFA) and hypothesis testing. Reliability was tested with Cronbach's alpha.

Results

A two‐factor structure of the BRS‐DLV had good model fit in both EFA and CFA, which could be explained by difficulties of workers with reversed order items. After excluding these inconsistent answering patterns, a one‐factor structure showed good model fit resembling the original BRS (χ² = 16.5; CFI & TLI = 0.99; SRMR = 0.02;RMSEA = 0.04). Internal consistency is sufficient (Cronbach's α = 0.78). All five hypotheses were confirmed, suggesting construct validity.

Conclusions

Reliability of the BRS‐DLV is sufficient and there is evidence of construct validity. Inconsistent answering, however, caused problems in interpretation and factor structure of the BRS‐DLV. This can be easily detected and handled because item 2, 4 and 6 are in reversed order. Other language versions differ in factor structure, most likely because systematic errors are not corrected for. To collect valid data, it is advised to be aware of inconsistent answering of respondents.

Polish Version of the Resilience Scale (RS-14): A Validity and Reliability Study in Three Samples

There has been a need for an instrument which not only can adequately evaluate trait-like resilience, but also can be applied to Polish adolescents and young adults. The purpose of this study was to validate the Resilience Scale RS-14 (Wagnild, 2009a,b). We aimed to examine and assess the psychometric properties of the Polish version in three different samples. The first sample was made up of adolescents aged 13–17 (N = 400).The second sample was made up of a problem group aged 13–18 (N = 656) who had special needs and attended either Probation Centers, Youth Sociotherapy Centers, or Youth Educational Centers. The third sample was made up of students in early adulthood aged 19–27 (N = 1,659). Exploratory and confirmatory factor-analytic methods were employed. CFA demonstrated a good fit of the factor structure in all three samples. The original one-dimensional structure of the RS short form was confirmed. All items loaded (>0.40) onto 1 factor, indicating cohesive structure for a 1-factor model explaining 35.02% of the variance in the whole sample, 34.62% in the young adolescent sample, 31.11% in the problem sample, and 38.51% in the early adulthood sample. Descriptive statistics, reliability (young adolescence α = 0.85, problem sampleα = 0.82 early adulthood α = 0.87) and validity data were calculated; test-retest showed good stability [r₍₄₀₎ = 0.88; p < 0.001]. The validity of the scale RS-14 was applied in two groups (the N = 382 early adulthood aged 19–27, and the N = 120 problem group aged 13–18) and was subsequently evaluated. The RS-14 correlated significantly, as expected, with measures of positive concepts (satisfaction with life). Results showed that resilience was negatively related with indexes of perceived stress and the dimension-of-depression. Findings support the RS-14 to be a valid and useful instrument for assessing resilience in diverse Polish adolescent groups, including those with special needs and those in early adulthood.

The influence of socio-demographic factors, resilience and stress reducing activities on academic outcomes of undergraduate nursing students: A cross-sectional research study

BACKGROUND

Nursing students who stop their education before obtaining their degree (dropout) is a common problem. Scientific studies on factors influencing academic outcomes amongst nursing students are sparse and difficult to transfer to undergraduate nursing students.

OBJECTIVES

The objective of the present study was to explore in undergraduate nursing students the influence of socio-demographic factors, resilience and stress reducing activities on the academic outcomes: intention to leave, academic success and dropout.

DESIGN

A cross-sectional design was used.

PARTICIPANTS/SETTING

554 participants form 6 nursing colleges in the Antwerp region in Belgium were included.

METHODS

Data were collected using SurveyMonkey®. In a second phase, these data were linked to the academic outcomes from the school administration.

RESULTS

Lower resilience, more destructive and less positive stress reducing activities, having committed a suicide attempt in the past, studying in a densely populated area and starting as a regular student was significantly influenced with higher intentions to leave. Higher resilience significantly predicted academic success. Finally, students that dropped out showed a significantly lower resilience.

CONCLUSION

Resilience was the only factor that significantly predicted the three academic outcomes: intention to leave, academic success and dropout. Known predictors of academic outcomes such as young age, gender, previous education, nationality and caring for family members were not confirmed in this study. To study in depth dropout within the undergraduate nursing course, conducting a cohort study might be recommended.

Subgroups of Dutch homeless young adults based on risk- and protective factors for quality of life: Results of a latent class analysis

It is important to gain more insight into specific subgroups of homeless young adults (HYA) to enable the development of tailored interventions that adequately meet their diverse needs and to improve their quality of life. Within a heterogeneous sample of HYA, we investigated whether subgroups are distinguishable based on risk- and protective factors for quality of life. In addition, differences between subgroups were examined regarding the socio-demographic characteristics, the use of cognitive coping strategies and quality of life. A total of 393 HYA using shelter facilities in the Netherlands were approached to participate, between December 2011 and March 2013. Structured face-to-face interviews were administered approximately 2 weeks after shelter admission by trained research assistants. A latent class analysis was conducted to empirically distinguish 251 HYA in subgroups based on common risk factors (former abuse, victimisation, psychological symptoms and substance use) and protective factors (resilience, family and social support and perceived health status). Additional analysis of variance and chi-square tests were used to compare subgroups on socio-demographic characteristics, the use of cognitive coping strategies and quality of life. The latent class analysis yielded four highly interpretable subgroups: the at-risk subgroup, the high-risk and least protected subgroup, the low-risk subgroup and the higher functioning and protected subgroup. Subgroups of HYA with lower scores in risk factors showed higher scores in protective factors, the adaptive cognitive coping strategies and quality of life. Our findings confirm the need for targeted and tailored interventions for specific subgroups of HYA. Social workers need to be attentive to the pattern of risk- and protective factors in each individual to determine which risk factors are prominent and need to be targeted and which protective factors need to be enhanced to improve the quality of life of HYA.

Predictive value of psychological resilience for mental health disturbances: A three-wave prospective study among police officers

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.

Assessing Psychological Resilience: Development and Psychometric Properties of the English and Dutch Version of the Resilience Evaluation Scale (RES)

Background: Psychological resilience is a distinct factor that affects mental health outcomes after adversities. This study describes the development, validity and measurement invariance (MI) of a Dutch and English scale on psychological resilience, called the Resilience Evaluation Scale (RES). Methods: Separate online surveys with the Dutch and English version of the RES and hypothesized related measures were distributed in a Dutch- and English-speaking group, both drawn from the general population. Results: Exploratory factor analysis, using data from 522 respondents (n = 296 Dutch, n = 226 English), yielded a two-factor structure for the final 9-item RES. The factors reflected the hypothesized underlying constructs of psychological resilience: self-confidence and self-efficacy. The items and constructs of psychological resilience as measured by the RES were interpreted and conceptualized in the same way by both language groups, with the exception of one item. The RES showed good convergent validity and good internal consistency. Conclusions: The current study establishes sound psychometric properties of a new, brief, and freely available scale on psychological resilience. This study contributes to the identification and measurement of psychological resilience after adversities. The final 9-item RES may serve as a valuable instrument in research and in clinical practice.

Resilience or hope? Incremental and convergent validity of the resilience scale for adults (RSA) and the Herth hope scale (HHS) in the prediction of anxiety and depression

BACKGROUND

Hope and resilience protect against inner vulnerabilities or harsh life circumstances; they explain individual differences in physical or mental health outcomes under high stress. They have been studied in complementary or competing theoretical frameworks; therefore, the study of measures of hope and resilience should be undertaken prior to explore if they are truly value-added for research. This study investigates the convergent and incremental validity of the Resilience Scale for Adults (RSA) and the Herth Hope Scale (HHS), in the prediction of anxiety and depression (HSCL-25).

METHODS

Participants in this community-based sample are 762 adults from 18 to 74 years old. They answered the RSA, HHS, Spanish Language Stressful Life-Events Checklist (SL-SLE), and the Hopkins Symptom Checklist-25 (HSCL-25). Incremental validity analyses combined hierarchical regression and structural equation models (SEM). First, hierarchical regression models were compared based on three criteria (R 2Diff., ΔF, and semi-partial r), then the direct effect of resilience on affective symptoms was compared with the mediated effect of resilience on affective symptoms through hope.

RESULTS

The hierarchical models showed that (1) hope and resilience account significantly for the variance of affective symptoms above age, sex, and life-stress; (2) Resilience Total score has greater incremental validity than positive scales of HHS Hope; and (3) RSA Total score, HHS Optimism/Spiritual support, Stressful life-events and sex are unique predictors of affective symptoms. The SEM analyses verified a stronger direct effect of resilience in the prediction of affective symptoms above the significant partial mediated effect of resilience through hope. Additionally, results show that age and better educational opportunities were associated with protection (i.e. resilience and hope) and emotional well-being (i.e. affective symptoms and hopelessness). Women showed higher scores in social competences and resources (RSA), interconnectedness and initiative to take action (HHS). However, they have poorer evaluations of own abilities and efficacy (RSA), and higher scores in all the affective symptoms assessed.

CONCLUSION

The RSA has incremental validity above the HHS, however, both the RSA and the HHS are effective, differentiated and complementary measures of protection that are of high relevance for research on psychosocial and emotional well-being.

Investigating the (cost-) effectiveness of attention bias modification (ABM) for outpatients with major depressive disorder (MDD): a randomized controlled trial protocol

BACKGROUND

Despite the range of available, evidence-based treatment options for Major Depressive Disorder (MDD), the rather low response and remission rates suggest that treatment is not optimal, yet. Computerized attention bias modification (ABM) trainings may have the potential to be provided as cost-effective intervention as adjunct to usual care (UC), by speeding up recovery and bringing more patients into remission. Research suggests, that a selective attention for negative information contributes to development and maintenance of depression and that reducing this negative bias might be of therapeutic value. Previous ABM studies in depression, however, have been limited by small sample sizes, lack of long-term follow-up measures or focus on sub-clinical samples. This study aims at evaluating the long-term (cost-) effectiveness of internet-based ABM, as add-on treatment to UC in adult outpatients with MDD, in a specialized mental health care setting.

METHODS/DESIGN

This study presents a double-blind randomized controlled trial in two parallel groups with follow-ups at 1, 6, and 12 months, combined with an economic evaluation. One hundred twenty six patients, diagnosed with MDD, who are registered for specialized outpatient services at a mental health care organization in the Netherlands, are randomized into either a positive training (towards positive and away from negative stimuli) or a sham training, as control condition (continuous attentional bias assessment). Patients complete eight training sessions (seven at home) during a period of two weeks (four weekly sessions). Primary outcome measures are change in attentional bias (pre- to post-test), mood response to stress (at post-test) and long-term effects on depressive symptoms (up to 1-year follow-up). Secondary outcome measures include rumination, resilience, positive and negative affect, and transfer to other cognitive measures (i.e., attentional bias for verbal stimuli, cognitive control, positive mental imagery), as well as quality of life and costs.

DISCUSSION

This is the first study investigating the long-term effects of ABM in adult outpatients with MDD, alongside an economic evaluation. Next to exploring the mechanism underlying ABM effects, this study provides first insight into the effects of combining ABM and UC and the potential implementation of ABM in clinical practice.

TRIAL REGISTRATION

Trialregister.nl, NTR5285 . Registered 20 July 2015.

The interplay between cognitive risk and resilience factors in remitted depression: A network analysis

BACKGROUND

Individuals in remission from depression are at increased risk for developing future depressive episodes. Several cognitive risk- and resilience factors have been suggested to account for this vulnerability. In the current study we explored how risk- and protective factors such as cognitive control, adaptive and maladaptive emotion regulation, residual symptomatology, and resilience relate to one another in a remitted depressed (RMD) sample.

METHODS

We examined the relationships between these constructs in a cross-sectional dataset of 69 RMD patients using network analyses in order to obtain a comprehensive, data-driven view on the interplay between these constructs. We subsequently present an association network, a concentration network, and a relative importance network.

RESULTS

In all three networks resilience formed the central hub, connecting perceived cognitive control (i.e., working memory complaints), emotion regulation, and residual symptomatology. The contribution of the behavioral measure for cognitive control in the network was negligible. Moreover, the directed relative importance network indicates bidirectional influences between these constructs, with all indicators of centrality suggesting a key role of resilience in remission from depression.

LIMITATIONS

The presented findings are cross-sectional and networks are limited to a fixed set of key constructs in the literature pertaining cognitive vulnerability for depression.

CONCLUSIONS

These findings indicate the importance of resilience to successfully cope with stressors following remission from depression. Further in-depth studies will be essential to identify the specific underlying resilience mechanisms that may be key to successful remission from depression.

Resilience moderates the association between chronic pain and depressive symptoms in the elderly

BACKGROUND

Chronic pain is frequent in elderly people and, especially if widespread, associated with poor mental health. We investigated whether a resilient personality protects older adults against the adverse effects of chronic pain.

METHODS

Pain status [no pain, chronic local pain (CLP) and chronic widespread pain (CWP)] was determined using the American College of Rheumatologists' criteria for widespread pain in a cross-sectional sample of 724 participants aged 68-92 years drawn from the population-based KORA-Age study in Southern Germany. Depressive symptoms and resilience were assessed via the scales GDS-15 and RS-5. The relation between pain, resilience and depressive symptoms was modelled using logistic and quantile regression.

RESULTS

CLP prevalence and CWP prevalence were 57.5% and 12.3%, respectively. Confounder-adjusted logistic regression indicated a fourfold risk of depressed mood (GDS-15 ≥ 5) in CWP, vs. no pain (OR = 4.08, 95% CI 1.90-8.74). However, in quantile regression, the adverse effect of CWP was significantly attenuated by resilience when looking at the GDS-15 score lower quartile (p = 0.011) and median (p = 0.011). This effect appeared to be mainly driven by participants aged 75-84 years. Confounder adjustment reduced the effect of CLP on depressive symptoms to non-significance, and effect modification by resilience was undetectable in regression models of CLP.

CONCLUSIONS

Resilience was protective in the association of CWP with depressive symptoms in this analysis. Older adults with CWP may potentially benefit from interventions supporting resilience. Prospective research should investigate the protective role of resilience in the potentially self-perpetuating relation between chronic pain and depressed affect. WHAT DOES THIS STUDY ADD?: The association of chronic widespread pain with depressive symptoms in the elderly population is attenuated by resilience.

Resilience measurement in later life: a systematic review and psychometric analysis

OBJECTIVES

To systematically review and examine the psychometric properties of established resilience scales in older adults, i.e. ≥60 years.

METHODS

A systematic review of Scopus and Web of Science databases was undertaken using the search strategy "resilience" AND (ageing OR aging)". Independent title/abstract and fulltext screening were undertaken, identifying original peer-reviewed English articles that conducted psychometric validation studies of resilience metrics in samples aged ≥60 years. Data on the reliability/validity of the included metrics were extracted from primary studies.

RESULTS

Five thousand five hundred nine studies were identified by the database search, 426 used resilience psychometrics, and six psychometric analysis studies were included in the final analysis. These studies conducted analyses of the Connor Davidson Resilience Scale (CD-RISC) and its shortened 10-item version (CD-RISC10), the Resilience Scale (RS) and its shortened 5- (RS-5) and 11- (RS-11) item versions, and the Brief Resilient Coping Scale (BRCS). All scales demonstrated acceptable levels of internal consistency, convergent/discriminant validity and theoretical construct validity. Factor structures for the RS, RS-11 and CD-RISC diverged from the structures in the original studies.

CONCLUSION

The RS, RS-5, RS-11, CD-RISC, CD-RISC10 and BRCS demonstrate psychometric robustness adequate for continued use in older populations. However, results from the current study and pre-existing theoretical construct validity studies most strongly support the use of the RS, with modest and preliminary support for the CD-RISC and BRCS, respectively. Future studies assessing the validity of these metrics in older populations, particularly with respect to factor structure, would further strengthen the case for the use of these scales.

Design of a controlled trial to evaluate the effectiveness of Supportive Parenting ('Stevig Ouderschap'): an intervention to empower parents at increased risk of parenting problems by providing early home visits

Background

In the Netherlands, 15 % of all families with children under the age of 13 years deal with significant parenting problems. Severe parenting problems may lead to adverse physical, cognitive, and psychosocial outcomes for children, both in the short and long run. The intervention Supportive Parenting (in Dutch: “Stevig Ouderschap”) is a preventive program, which aims to reduce the risk of (developing) parenting problems among parents at risk of these problems. The intervention consists of six additional home visits by a Youth Health Care nurse during the first 18 months after childbirth and is focusing on the following elements of parental empowerment: activating social networks, increasing parenting skills and supporting parent(s)/caregiver(s) in getting grip on their own life.

Methods and design

A controlled trial is performed in two regions in the Netherlands. An intervention group receives the intervention Supportive Parenting, and a control group receives ‘care-as-usual’. Parents in both the intervention and control group fill out three questionnaires focusing on various elements of empowerment (social support, parenting skills, self-sufficiency and resilience), behavioral and emotional problems of the child. The effects of the intervention will be evaluated at child age 1–3 months (baseline) and child age 18 months by comparing the outcomes between the intervention group and the control group on the primary outcomes. Additionally, interviews and focus group interviews will be held to identify factors, which hinder or stimulate a wider implementation of the intervention Supportive Parenting.

Discussion

It is hypothesized that parents at increased risk of parenting problems who receive the intervention Supportive Parenting during the first 18 months after childbirth, will have enhanced their social support networks and parenting skills, increased their self-sufficiency and strengthened resilience compared to at risk parents receiving care-as-usual. Additionally children of parents from the intervention group will display less parent-reported behavioral and emotional problems.

Trial registration

Netherlands Trial Register NTR5307. Registered 16 July 2015.

Psychometric properties of the Haitian Creole version of the Resilience Scale with a sample of adult survivors of the 2010 earthquake

BACKGROUND

Resilience is defined as the ability of people to cope with disasters and significant life adversities. The present paper aims to investigate the underlying structure of the Creole version of the Resilience Scale and its psychometric properties using a sample of adult survivors of the 2010 earthquake.

METHODS

A parallel analysis was conducted to determine the number of factors to extract and confirmatory factor analysis was performed using a sample of 1355 adult survivors of the 2010 earthquake from people of specific places where earthquake occurred with an average age of 31.57 (SD=14.42). All participants completed the Creole version of Resilience Scale (RS), the Impact of Event Scale Revised (IES-R), the Beck Depression Inventory (BDI) and the Social Support Questionnaire (SQQ-6). To facilitate exploratory (EFA) and confirmatory factor analysis (CFA), the sample was divided into two subsamples (subsample 1 for EFA and subsample 2 for CFA).

RESULTS

Parallel analysis and confirmatory factor analysis results showed a good-fit 3-factor structure. The Cronbach α coefficient was .79, .74 and .72 respectively for the factor 1, 2 and 3 and correlated to each other. Construct validity of the Resilience scale was provided by significant correlation with measures of depression and social support satisfaction, but no correlation was found with posttraumatic stress disorder measure, except for factor 2.

CONCLUSIONS

The results reveal a different factorial structure including 25 items of the RS. However, the Haitian Creole version of RS is a valid and reliable measure for assessing resilience for adults in Haiti.

What is in the feedback? Effect of induced happiness vs. sadness on probabilistic learning with vs. without exploration

According to dominant neuropsychological theories of affect, emotions signal salience of events and in turn facilitate a wide spectrum of response options or action tendencies. Valence of an emotional experience is pivotal here, as it alters reward and punishment processing, as well as the balance between safety and risk taking, which can be translated into changes in the exploration-exploitation trade-off during reinforcement learning (RL). To test this idea, we compared the behavioral performance of three groups of participants that all completed a variant of a standard probabilistic learning task, but who differed regarding which mood state was actually induced and maintained (happy, sad or neutral). To foster a change from an exploration to an exploitation-based mode, we removed feedback information once learning was reliably established. Although changes in mood were successful, learning performance was balanced between the three groups. Critically, when focusing on exploitation-driven learning only, they did not differ either. Moreover, mood valence did not alter the learning rate or exploration per se, when titrated using complementing computational modeling. By comparing systematically these results to our previous study (Bakic et al., 2014), we found that arousal levels did differ between studies, which might account for limited modulatory effects of (positive) mood on RL in the present case. These results challenge the assumption that mood valence alone is enough to create strong shifts in the way exploitation or exploration is eventually carried out during (probabilistic) learning. In this context, we discuss the possibility that both valence and arousal are actually necessary components of the emotional mood state to yield changes in the use and exploration of incentives cues during RL.