Resilience, Trauma, and Coping

The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.

Validation and Adaptation of the Academic-Resilience Scale in the Spanish Context

The aim of this study was to validate and adapt the academic-resilience scale in the Spanish context. The study involved 2967 university students aged 18-33 (Mean, M = 23.65; Standard Deviation, SD = 2.57) from several universities in Andalusia (Spain). Exploratory and confirmatory factorial analyses revealed adequate adjustment rates for the new version of the scale showing the factorial structure invariant with respect to that generated. Three factors that integrate the scale obtained high correlation, internal consistency, and temporal stability. The Spanish version of the academic-resilience scale was shown to have adequate psychometric properties to measure academic resilience in the Spanish university context.

Physical Education Classes as a Precursor to the Mediterranean Diet and the Practice of Physical Activity

Physical activity and a healthy, balanced diet are remaining unresolved issues among young people. According to the World Health Organization, young people do not get enough exercise during the week, and physical education classes are the best way to promote healthy habits. This study aims to analyze how the role of the teacher influences the frustration of psychological needs, coping strategies, motivation, and the adoption of healthy eating habits through the Mediterranean diet and the regular practice of physical activity. The study involved 1031 boys and 910 girls between the ages of 13 and 18. To explain the relationships between the different variables included in this study, a model of structural equations has been developed. The results showed that autonomy support negatively predicted the frustration of four psychological needs. The failure to meet four psychological needs negatively predicted resilience. Likewise, resilience positively predicted autonomous motivation, and this positively predicted the Mediterranean diet and the practice of physical activity. Thus, the results obtained in the present study are in line with those of various studies wherein physical education classes were seen to help consolidate healthy living habits.

The influence of the trainer on the motivation and resilience of sportspeople: A study from the perspective of self-determination theory

The aim of this study was to evaluate the influence of a trainer's interpersonal relations from the perspective of autonomy support and controlling style on sportspeople's basic need satisfaction and frustration, motivation, and resilience. The study used a cross-sectional design based on self-determination theory (SDT). Sportspeople (N = 324) completed questionnaires to measure their perceptions of trainers' autonomy-supportive and controlling coaching styles, basic need satisfaction and frustration in the sports context, motivation for sport, and resilience. Structural equation modeling of the proposed relations among variables supported SDT by showing a positive relation between perceived autonomy support and the satisfaction of basic psychological needs (β = .39, p < .001) and a negative relation with the frustration of psychological needs (β = -.17, p < .05). The coach's perceived interpersonal controlling style showed a positive relation with the frustration of psychological needs (β = .55, p < .001) and a negative relation with the satisfaction of basic psychological needs (β = -.27, p < .05). Furthermore, autonomous motivation showed a negative relation (β = -.46, p < .001) with the frustration of psychological needs and a positive relation (β = .35, p < .05) with the satisfaction of basic psychological needs and resilience (β = .60, p < .001). In addition, the resilience of sportspeople was indirectly affected to the same extent by the trainer's influence through control (β = -.38, p < .05) and perception of autonomy support (β = .16, p < .05) through the mediators of satisfaction of basic psychological needs and motivation. These results show the influence of the coach on the motivation and resilience of sportspeople.

Influence of Emotional Intelligence, Motivation and Resilience on Academic Performance and the Adoption of Healthy Lifestyle Habits among Adolescents

Included among the basic objectives of Physical Education (PE) classes is the consolidation of habits of a healthy lifestyle among adolescents. However, the main studies in this field have focused on cognitive aspects related to students during these classes, yet they ignore the role that emotions can play in the adoption of future habits. Objectives: To analyze how emotions (emotional intelligence and emotional state) can influence the resilience and motivation of adolescents, as well as academic performance and adoption of healthy lifestyle habits. Methodology: 615 secondary school students between the ages of 14 and 19 participated (M = 16.02; SD = 1.57) in the study. A structural equations model was developed using the main variables and by applying some of the principles of Self-Determination Theory. The results show that emotional intelligence is positively related to positive emotions and negatively related to negative emotions. Positive emotions positively predict both self-motivation towards physical education classes and resilience. Resilience positively predicts self-motivation. Finally, self-motivation acts as a predictor of both academic performance and regular participation in physical activity. Conclusions: This study successfully shows the importance of focusing on emotions in PE classes inasmuch as emotion increases the tendency to get good grades and maintain active lifestyle habits. In this sense, focusing on the emotions of students in PE could prove quite beneficial.

Examining the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in Uganda

In this study, we examined the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in HIV-impacted communities in Uganda. We analyzed data from a cluster randomized experimental study for orphaned adolescents aged 11-17 years. Participants were randomly assigned to either the control condition, which received bolstered standard of care (BSOC) services, or the treatment condition, which received BSOC services plus an economic-strengthening intervention. We conducted binary logistic regression analyses to examine the effect of the intervention on participants' nonkin support networks. Results indicated that the existing social support networks for orphaned adolescents are small, limited, and usually comprised individuals with similar socioeconomic situations and challenges. Because orphaned adolescents are socially isolated and the threshold for nonkin supportive services is very low, the BSOC services provided to the control condition appeared to be instrumental in their survival and well-being. Availability of personal savings was associated with higher odds of identifying at least one supportive nonkin tie. The extended family system is still the primary and major source of social support to orphaned children in HIV-affected communities. In the absence of public safety nets, building social assets, over and above offering economic opportunities to extended families supporting orphaned children, is critical.

Psycho-educational and social interventions provided for orphans and vulnerable children at a community-based organisation in Soweto, South Africa

This qualitative study explored the psycho-educational and social interventions provided for orphans and vulnerable children (OVC) in a community-based organisation (CBO) in Soweto, South Africa. The study involved 12 OVC (males = 40%, and females = 60%; aged 10 to 18 years). Data was collected using individual interviews, focus group discussions, and autobiographies. The thematically analysed data revealed that the OVC received psychological interventions through mentorship and peer-group support in the CBO. Educational interventions included the provision of school uniforms and educational materials, as well as sponsorship of tuition, sports and excursion fees. Academic track records presented a challenge, however, which was attributed to the enormous numbers of OVC under the care of the CBO. It was further established that social interventions were addressed by empowering the OVC with life skills and providing economic support for their families, specifically to pay rent and provide meals. The major contributions of this study are to note the importance of the CBO in addressing issues related to the lack of counselling, the stigmatisation of OVC by community members and the need for empowerment of their families by providing income-generating activities. The information obtained is useful in opening up avenues for interested parties to further explore the effectiveness of these psycho-educational and social interventions in improving the lives of OVC in society.

Resilience, Trauma, and Coping

The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.

Complicated grief and caregiving correlates among bereaved adolescent girls in South Africa

To our knowledge, this is the first study to document correlates of complicated grief among bereaved adolescents in sub-Saharan Africa. Participants included 339 female adolescents in South Africa who experienced the loss of a loved one at least six months prior to the survey; their primary caregivers were also surveyed. One-fifth of adolescents were classified as having complicated grief using the Inventory of Complicated Grief Revised for Children in conjunction with grief-induced functional impairment. The loss of a biological parent, the primary caregiver's level of grief, and economic stressors since the loss were associated with increased odds of complicated grief among adolescents. Adolescents' age, residential changes, time since the loss, multiple losses, bereavement due to death by illness, and caregiver depression did not affect the odds. Findings signal the potential of family-centered interventions and economic support services for bereaved adolescents.

The resilience-enabling value of African folktales: The read-me-to-resilience intervention

Resilience, or the process of adjusting well to adversity, draws on personal and social ecological resources (i.e., caregiving and community supports). Previous research—conducted mostly in the Global North—has shown that bibliotherapy offers a way to support children in identifying and utilizing resilience-enabling resources. In so doing, bibliotherapy has the potential to facilitate resilience. In this article, we confirm the resilience-supporting value of bibliotherapy for African orphans and vulnerable children (OVC). To do so, we report the quantitative and qualitative pre- and post-test results of the Read-me-to-Resilience Study ( N = 345). This quasi-experimental study showed that African children who listened to indigenous resilience-themed stories had a significantly increased awareness of personal and community-based protective resources post-intervention, than those who did not. Interestingly, there was no significant increase in their perceptions of caregiving resources. The findings suggest that school psychologists and teachers should include resilience-enabling stories in their support of children who are orphaned. However, further research is needed on how best to use stories in ways that will enable children to identify caregiving resources.

Effect of a bereavement support group on female adolescents' psychological health: a randomised controlled trial in South Africa

BACKGROUND

Bereavement increases children's risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in South Africa.

METHODS

This randomised controlled trial enrolled female adolescents at 11 schools in three peri-urban towns of Free State province, South Africa. 453 bereaved ninth-grade students aged 13-17 years who had expressed interest in taking part in the group were randomly assigned (1:1) to receive the intervention or to be waitlisted for programme enrolment after the study period and serve as the control group. The intervention, Abangane ("friends" in isiZulu), is a locally derived, curriculum-based support group focused on coping with loss incorporating indigenous stories and cognitive behavioural therapy components. Weekly group sessions were facilitated by trained social workers or social auxiliary workers from a local non-profit organisation. The primary outcomes included indicators of grief and depression as reported by adolescents and behavioural problems reported by their caregivers. Grief was measured with three scales: the grief subscale of the Core Bereavement Items to assess normative grief; and the Intrusive Grief Thoughts Scale and the Inventory of Complicated Grief-Revised for Children to assess maladaptive grief symptoms in the past 4 weeks. Depression symptoms in the past 7 days were measured with the Center for Epidemiological Studies-Depression Scale for Children. Caregivers completed the Brief Problem Monitor-Parent Form to report on adolescent's behaviour in the previous 4 weeks. Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT02368808.

FINDINGS

Between Sept 30, 2014, and Feb 5, 2015, eligible female participants were identified, of whom 226 were assigned to the intervention, Abangane, and 227 were assigned to the waitlisted control group. Analysis included 382 adolescents who completed both surveys (193 participants assigned to Abangane and 189 assigned to waitlist). At follow up, the intervention group had significantly lower scores for primary outcomes, including intrusive grief (p=0·000, Cohen's d=-0·21), complicated grief (p=0·015, d=-0·14), and depression (p=0·009, d=-0·21) relative to the waitlisted group, while core bereavement scores were similar between groups (p=0·269). Caregivers in the intervention group reported lower levels of behavioural problems among adolescents (p=0·017, d=-0·31).

INTERPRETATION

Short-term, structured, theory-based support groups with contextually relevant content show promise in mitigating psychological and behavioural problems among bereaved adolescents. Abangane is replicable in resource limited settings, using freely available curriculum materials, existing programme structures, and appropriately trained personnel to implement it.

FUNDING

US Agency for International Development Southern Africa.

The intersection of abandonment, HIV-positive status and residential care for a group of perinatally infected adolescents

Although anti-retroviral treatments have significantly reduced the incidence of mother-to-child transmission of HIV and AIDS, there remains, for the foreseeable future, a group of adolescents who have been perinatally infected. Noting the paucity of information regarding the impact of paediatric AIDS and its intersection with residential care, this paper investigates the lived realities of 20 South African adolescents who were vertically infected with HIV and AIDS, were abandoned, and have been raised in residential care. The exploratory study highlights that for these youth the dimensions of their adolescence, HIV-positive status and associated abandonment as well as life in residential care are mutually reinforcing and interconnected. Issues of race and class also interact with these social dimensions. Ultimately, these dimensions intersect to create a particular form of social exclusion. Intentional, critical intervention is required on the micro level to support these teens develop a coherent identity. On the meso level, the residential facility should actively facilitate community integration, particularly with the adolescents' communities (and where possible, families) of origin. Governments need to strengthen intersectoral, rights-based responses and in particular, address the consequences of cognitive impairment associated with perinatal transmission.

Orphans and Vulnerable Children Affected by Human Immunodeficiency Virus in Sub-Saharan Africa

In Sub-Saharan Africa, 15.1 million children have been orphaned because of human immunodeficiency virus (HIV). They face significant vulnerabilities, including stigma and discrimination, trauma and stress, illness, food insecurity, poverty, and difficulty accessing education. Millions of additional children who have living parents are vulnerable because their parents or other relatives are infected. This article reviews the current situation of orphans and vulnerable children, explores the underlying determinants of vulnerability and resilience, describes the response by the global community, and highlights the challenges as the HIV pandemic progresses through its fourth decade.