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Ye X, Yang G, Zhang W, Toussaint L, Zhao F. Relationship of negative life events with depression and anxiety in nursing students: a moderated mediation model of resilience and gender. BMC Nurs 2025; 24:58. [PMID: 39825328 PMCID: PMC11740486 DOI: 10.1186/s12912-024-02661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 12/24/2024] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND Compared to ordinary student in the same age group, nursing students experience notably higher rates of depression and anxiety. Negative life events (NLEs) and resilience were recognized as risk factors and protective factors, respectively. There is little literature on the complex interaction of these factors among nursing students. OBJECTIVES The study aims to explore the potential relationship of NLEs, resilience, and gender with symptoms of depression and anxiety among nursing students. METHODS A cross-sectional design was used for this study. A total of 568 participants from three universities in East, South and North China were recruited. Data collection instruments included socio-demographic characteristics, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder Scale, the 10-item Connor-Davidson Resilience Scale, the Adolescent Life Events Self-Rating Scale, and The Pittsburgh Sleep Quality Index. A moderated mediation model was used to analyze the data. RESULTS NLEs and resilience significantly related to depression and anxiety (r = -0.289 ~ 0.454, all ps < 0.01). NLEs had a direct effect on depression (B = 0.251, p < 0.001) and anxiety (B = 0.307, p < 0.001). Analysis of mediating effects revealed that NLEs influenced depression (B = 0.02, 95% CI : 0.004-0.041) and anxiety (B = 0.019, 95% CI : 0.004-0.040) through resilience pathways. Additionally, gender was found to have a moderating effect on the direct association of NLEs with anxiety (B = -0.031, p < 0.05), with males showing a greater association. CONCLUSIONS The findings suggest that improving resilience may help break the relationship of NLEs with depression and anxiety in nursing students. Additionally, the mental health of male nursing students needs more attention.
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Affiliation(s)
- Xiaoli Ye
- School of Nursing and Rehabilitation, Nantong University, Qixiu Road 19#, Nantong, 226001, Jiangsu, PR China
| | - Guihong Yang
- School of Nursing and Rehabilitation, Nantong University, Qixiu Road 19#, Nantong, 226001, Jiangsu, PR China
| | - Wei Zhang
- School of Nursing and Rehabilitation, Nantong University, Qixiu Road 19#, Nantong, 226001, Jiangsu, PR China
| | | | - Fangfang Zhao
- School of Nursing and Rehabilitation, Nantong University, Qixiu Road 19#, Nantong, 226001, Jiangsu, PR China.
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Xue J, Huang H, Zhou C, Feng W, Ge Y, Hu Y. Patterns of adverse childhood experiences and their associations with depression, life satisfaction and short-form video addiction in Chinese college students. CHILD ABUSE & NEGLECT 2024; 158:107091. [PMID: 39454405 DOI: 10.1016/j.chiabu.2024.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 09/09/2024] [Accepted: 10/07/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are widespread in East Asia, heightening the susceptibility to psychological and behavioral complications in adulthood. OBJECTIVE To identify polyvictimization patterns among Chinese college students and investigate the associations between diverse patterns and symptoms of depression, short-form video addiction (SVA), and life satisfaction. PARTICIPANTS AND SETTING This study encompassed 13,307 college students from four urban centers in China (Mage = 20.2; 46.4 % female). METHODS Latent class analysis (LCA) was employed to discern patterns of ACEs among college students. The three-step method (R3step) was utilized to explore the influence of demographic characteristics on the distribution of latent classes. Additionally, the automatic Bolck-Croon-Hagenaars (BCH) Method was deployed to investigate the latent classes effect on distal outcomes. RESULTS Left-behind experience was the most common ACE among Chinese college students. Four ACEs patterns were identified: 1) No/Very Low ACEs class (N = 8936, 67.2 %); 2) Parental Absence class (N = 430, 3.2 %); 3) Low/Moderate ACEs class (N = 3565, 26.8 %); and 4) High Violence and Left-behind class (N = 376, 2.8 %). The findings revealed a progressive escalation in healthy outcomes associated with the four ACEs patterns. Specifically, from the first class to the fourth, the severity of associated consequences (depression, life satisfaction and SVA) intensified. CONCLUSIONS Distinct ACEs patterns correlate with varying degrees of mental health issues. Compared to participants solely separated from parents, those exposed to abuse and neglect demonstrate more pronounced mental health challenges and addiction susceptibilities.
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Affiliation(s)
- Jiao Xue
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China; Wuhan Mental Health Center, Wuhan, China
| | - Hai Huang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China; Wuhan Mental Health Center, Wuhan, China.
| | - Chunyan Zhou
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China; Wuhan Mental Health Center, Wuhan, China
| | - Wenting Feng
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China; Wuhan Mental Health Center, Wuhan, China
| | - Yanwei Ge
- Mental Health Education Center, China Jiliang University, Hang Zhou, China
| | - Yue Hu
- Student Mental Health and Counseling Center, Sichuan International Studies University, Chongqing, China
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Liu H, Ho GW, Karatzias T, Shevlin M, Wong KH, Hyland P. Self-harm, Suicide, and ICD-11 Complex Posttraumatic Stress Disorder in Treatment-Seeking Adolescents with Major Depression. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:1057-1066. [PMID: 39686932 PMCID: PMC11646250 DOI: 10.1007/s40653-024-00655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 12/18/2024]
Abstract
Posttraumatic stress disorder (PTSD) is linked with self-harm and suicide, but few studies have examined these severe outcomes in relation to complex trauma. This study examined the associations between self-harm and suicide-related phenomena with ICD-11 complex PTSD (CPTSD) among treatment-seeking youths. A convenience sample of 109 adolescents with major depression (69.7% female; mean age = 15.24) were recruited from an outpatient psychiatric clinic. Participants completed measures for ICD-11 CPTSD, adverse childhood experiences (ACEs), self-harm behaviors, and past-year history of four suicide-related phenomena. Relationships between each self-harm and suicide-related variable with CPTSD were assessed at the symptom and diagnostic levels. Participants reported an average of three ACEs; 33.9% met diagnostic requirements for ICD-11 CPTSD. Past-year suicidal thought and attempt, but not self-harm, significantly associated with CPTSD status. At the symptom level, self-harm associated with CPTSD total symptom and all symptom clusters scores, with strongest associations found with symptoms of negative self-concept. CPTSD total symptom scores also associated strongly with past-year history of suicidal thought, plan, and attempt; the three core PTSD symptom clusters scores consistently and strongly linked with these suicide-related phenomena. For symptoms of complex trauma, relationship disturbances associated with having a suicide attempt, and negative self-concept associated with both having a plan and an attempt. Assessing and targeting ICD-11 CPTSD symptoms have potential to reduce self-harm and suicidality in young people experiencing mental distress, particularly for those with a trauma history and regardless of whether they meet criteria for a diagnosable trauma response.
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Affiliation(s)
- Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Grace W.K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Kwan Ho Wong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Liu SHY, Hsiao FH, Chen SC, Hsieh MH, Shiau SJ. Individual Resilience among Adult Children of Parents with Bipolar Disorder in Chinese Society: An Inductive and Deductive Content Analysis Approach. J Transcult Nurs 2024:10436596241290786. [PMID: 39462440 DOI: 10.1177/10436596241290786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024] Open
Abstract
INTRODUCTION Nurses can help children of parents with mental illness discover their resilience. However, previous studies have focused on their experience in Western settings and have limited understanding of a Chinese cultural context. This study aims to explore individual resilience emerging from adult children's experience of living with parents with bipolar disorder in Chinese society within the framework of character strengths and possible cultural components. METHODOLOGY A content analysis with both inductive and deductive approaches. Twenty adults participated in this study. Interviews were conducted while the participants' parents were hospitalized in an acute psychiatric hospital ward. RESULTS The framework of character strengths confirmed five emergent themes of individual resilience in this study: courage, temperance, humanity, knowledge and wisdom, and transcendence. DISCUSSION Character strengths are an adequate framework for understanding of individual resilience. Chinese adult children develop resilience by regulating their emotions, respecting their parents, engaging in self-discipline, and positively interpreting adversity.
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Affiliation(s)
- Sara Hsin-Yi Liu
- Department of Nursing, Deh Yu College of Nursing and Health, Keelung, Taiwan
| | - Fei-Hsiu Hsiao
- College of Medicine, School of Nursing, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shing-Chia Chen
- College of Medicine, School of Nursing, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hsien Hsieh
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Clinical Center for Neuroscience and Behavior, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Jen Shiau
- College of Medicine, School of Nursing, National Taiwan University, Taipei, Taiwan
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Fan N, Fan H, Luo R, Wang Y, Yan Y, Yang X, Wang M, Dou Y, Ni R, Wei J, Yang W, Ma X. The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China. Sci Rep 2024; 14:9797. [PMID: 38684905 PMCID: PMC11058193 DOI: 10.1038/s41598-024-60537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC(P < 0.001) and grade(P = 0.027), and positively with childhood trauma(P < 0.001) and male gender(P = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.
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Affiliation(s)
- Ningdan Fan
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huanhuan Fan
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ruiqing Luo
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
- Chongqing Mental Health Center, Chongqing, China
| | - Yu Wang
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yushun Yan
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiao Yang
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Min Wang
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yikai Dou
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Rongjun Ni
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jinxue Wei
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wanqiu Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
- School of Medicine, Yunnan University, Kunming, China
| | - Xiaohong Ma
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Ho GWK, Mui JHC, Wong R, Chien WT, Wong KH, Bressington D. Visitor characteristics and changes in mental health stigma after attending the Mind Space mental health experience exhibition. Front Psychiatry 2024; 15:1302799. [PMID: 38742134 PMCID: PMC11089183 DOI: 10.3389/fpsyt.2024.1302799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Mind Space is an experiential mental health exhibition in Hong Kong, aiming to raise public awareness and provide education regarding mental health. This prepost study aimed to 1) examine the relationships between visitors' characteristics and their mental health stigma at baseline, and 2) provide a preliminary evaluation of the effectiveness of Mind Space in reducing stigma and promoting help-seeking attitudes toward mental health conditions. Methods We analyzed data from all consenting visitors who attended Mind Space between September 2019 and December 2021. Visitors' attitudes toward mental health conditions and their willingness to seek professional psychological help were measured through online questionnaires before and after visits. Multiple linear regression was used to identify the demographic predictors of outcome variables at baseline. Changes in outcome variables after attending Mind Space were assessed using paired sample t-tests. Results A total of 382 visitors completed the baseline questionnaires, among which 146 also completed the post-test. At baseline, higher socioeconomic levels and personal contact with people with mental health conditions predicted more positive attitudes and understanding toward mental disorders. Tentatively, the results also showed that after attending Mind Space, a significant reduction in negative attitudes about mental illness (t=4.36, p=<.001; d=.361) and improvements in the propensity to seek professional help (t=-5.20, p<.001; d=-.430) were observed, along with decreases in negative attitudes toward stereotypes (t=4.71, p=<.001; d=.421) and restrictions (t=2.29, p=.024; d=.205) among healthcare professionals. Discussion Our findings highlight the need for mental health education for people with lower socioeconomic status and the importance of direct contact in public mental health education initiatives. The present study also suggests that Mind Space may be a useful model for public mental health education, but the exhibition requires further evaluation to ascertain if any reductions in stigma are maintained over time.
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Affiliation(s)
- Grace W. K. Ho
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Jolene Hang Chun Mui
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Raymond Wong
- Castle Peak Hospital, Hong Kong, Hong Kong SAR, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kwan Ho Wong
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Darwin, NT, Australia
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Elrefaay SMM, Elyzal AS. Adverse Childhood Experiences and Depression: The Mediating Role of Resilience and Emotional Regulation. J Psychosoc Nurs Ment Health Serv 2024; 62:45-54. [PMID: 37527517 DOI: 10.3928/02793695-20230726-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
The current study examined the mediating roles of resilience and emotional regulation in the association between childhood trauma and depressive symptoms among individuals who experienced adverse childhood experiences (ACEs). Data from 200 women aged 17 to 77 years who were psychiatric outpatients were collected using self-reported questionnaires assessing child adversity, depressive symptoms, resilience, and emotional regulation. A positive correlation was found between a subscale of the ACE-IQ and depression. Childhood trauma was associated with higher risk of depressive symptoms among participants with lower resilience (an association that was partly explained by resilience level [mediation]). Emotional regulation was not a significant mediator in the childhood trauma-depression association. Our findings indicate that resilience is a key mediator between childhood trauma and depression. Individuals who experienced childhood trauma may benefit from evidence-based interventions focused on strengthening resilience and improving coping strategies. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 45-54.].
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Bhattarai A, Dimitropoulos G, Bulloch AGM, Tough SC, Patten SB. Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study. BMC Public Health 2023; 23:2036. [PMID: 37853382 PMCID: PMC10585893 DOI: 10.1186/s12889-023-16935-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors. METHODS The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994-2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035). RESULTS During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM. CONCLUSION The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.
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Affiliation(s)
- Asmita Bhattarai
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Faculty of Social Work, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
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Wattick RA, Hagedorn RL, Olfert MD. Impact of resilience on college student mental health during COVID-19. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2184-2191. [PMID: 34448676 DOI: 10.1080/07448481.2021.1965145] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 06/29/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to investigate how the COVID-19 pandemic impacted college student mental health and alcohol use and to determine how resilience could alleviate negative outcomes. PARTICIPANTS Students attending an Appalachian university during spring 2020 were surveyed shortly after on-campus activities stopped. METHODS Survey items included resilience, demographics, self-rated health, and depression symptoms, anxiety symptoms, and alcohol use before and since COVID-19. RESULTS There was a significant increase in prevalence of severe depression, severe anxiety, and high stress, and a significant decrease in prevalence high risk for problem drinking before and since COVID-19. Four separate standard least squares regression models were conducted with each of the dependent variables. Self-rated health was the strongest predictor for changes in depression, anxiety, and stress in each of the models, displaying a negative relationship. CONCLUSIONS Universities should prepare students using resilience training and provide employment and other resources to mitigate effects of stressful situations.
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Affiliation(s)
- Rachel A Wattick
- West Virginia University, Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences, Morgantown, WV
| | - Rebecca L Hagedorn
- Meredith College, Department of Nutrition, Health, and Human Performance, Raleigh, NC
| | - Melissa D Olfert
- West Virginia University, Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences, Morgantown, WV
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Li S, Yin Y, Cui G, Zhang C, Zhu H, Yao Y. The mediating and moderating effects of resilience between childhood trauma and geriatric depressive symptoms among Chinese community-dwelling older adults. Front Public Health 2023; 11:1137600. [PMID: 37124808 PMCID: PMC10140585 DOI: 10.3389/fpubh.2023.1137600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/16/2023] [Indexed: 05/02/2023] Open
Abstract
Objective This study aims to examine the association between childhood traumatic events (CTEs), childhood trauma severity, and depressive symptoms, as well as to examine the mediating and moderating roles of resilience in these associations. Methods We conducted a cross-sectional study of 1,091 community-dwelling older adults in Jinan, China. The trauma history questionnaire (THQ) was used to measure CTEs and childhood trauma severity. CTEs were defined as the number of traumatic events before the age of 18. We calculated childhood trauma severity by multiplying the number of CTEs by the participants' self-perceived impact level of the events from the THQ. We then applied the 15-item Geriatric Depression Scale and 10-item Connor-Davidson Resilience Scale to assess participants' depressive symptoms and resilience, respectively. Linear regression models were used to examine the associations, and structural equation modeling was used to examine the mediating and moderating roles of resilience. Results Childhood traumatic events, childhood trauma severity, and resilience were all associated with depressive symptoms in older adults. Resilience mediated the relationship between childhood trauma severity and depressive symptoms (β = 0.082, 95% CI = 0.045-0.123), accounting for 26.6% of the overall effect (β = 0.308, 95% CI = 0.190-0.422). However, there was no evidence that resilience mediated the association between CTEs and depressive symptoms. In addition, we did not find that resilience played a moderating role in the associations of CTEs, childhood trauma severity with depressive symptoms. Conclusion Resilience plays a mediating role in the relationship between childhood trauma severity and depressive symptoms. Intervention measures on improving resilience may reduce childhood trauma severity associated with depression risk in older Chinese adults.
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Affiliation(s)
- Shaojie Li
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yongtian Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Beijing, China
| | - Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
- *Correspondence: He Zhu,
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
- Yao Yao,
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Lu L, Fei L, Ye Y, Liao M, Chang Y, Chen Y, Zou Y, Li X, Zhang R. Psychological Resilience May Be Related to Students' Responses to Victims of School Bullying: A Cross-Sectional Study of Chinese Grade 3-5 Primary School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16121. [PMID: 36498195 PMCID: PMC9740964 DOI: 10.3390/ijerph192316121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND School bullying is a major public health problem with a large impact on children's health. There is an increasing number of cases of school bullying reported in China. Studies have shown that the health consequences of different ways of responding to school bullying may be quite different and that psychological resilience is also closely related to aggressive behaviors. However, there has been little research on whether individuals with different psychological resilience levels respond differently. OBJECTIVE To explore the relationship between responses to school bullying and psychological resilience, which may provide new ideas and strategies to better prevent and intervene in school bullying. METHODS A random sample of 5425 primary school students aged 7-14 years were recruited in Luzhou, China. All students completed a questionnaire anonymously. The statistical significance of differences between groups was tested using the χ2 test or t test. Binary logistic regression was conducted to explore the relationship between responses and psychological resilience. RESULTS Over two-thirds of primary school students in this study reported experiencing bullying in the past year. The rate of positive responses among victims was 69.10% (2596/3757, 95% CI: 67.62~70.58%). There was a positive relationship between psychological resilience and positive responses. This relationship was observed for all victims (OR = 1.605, 95% CI: 1.254~2.055), especially male victims (OR = 2.300, 95% CI: 1.624~3.259). CONCLUSIONS There was a positive relationship between primary school bullying responses and psychological resilience among victims, with differences by sex. Therefore, increasing students' level of psychological resilience, possibly by improving their responses, is important for preventing school bullying. Meanwhile, effective interventions for school bullying should be developed from multiple perspectives, particularly sex, bullying roles, and psychological resilience.
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Affiliation(s)
- Lu Lu
- School of Public Health, Southwest Medical University, Luzhou 646000, China
| | - Liping Fei
- School of Public Health, Southwest Medical University, Luzhou 646000, China
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100000, China
| | - Yunli Ye
- School of Public Health, Southwest Medical University, Luzhou 646000, China
| | - Maoxu Liao
- Information and Education Technology Center, Southwest Medical University, Luzhou 646000, China
| | - Yuhong Chang
- Luzhou Center for Disease Control and Prevention, Luzhou 646000, China
| | - Yiting Chen
- School of Public Health, Southwest Medical University, Luzhou 646000, China
| | - Yanli Zou
- School of Public Health, Southwest Medical University, Luzhou 646000, China
| | - Xin Li
- School of Public Health, Southwest Medical University, Luzhou 646000, China
| | - Rong Zhang
- School of Public Health, Southwest Medical University, Luzhou 646000, China
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12
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Chen M, Tian N, Chang Q. Adverse childhood experiences, sexual orientation, and depressive symptoms among Chinese college students: An ecological framework analysis. CHILD ABUSE & NEGLECT 2022; 134:105881. [PMID: 36152533 DOI: 10.1016/j.chiabu.2022.105881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Extensive evidence has demonstrated that adverse childhood experiences (ACEs) predict a high risk of negative health and behavioral outcomes in later life. However, the influence of individuals' psychosocial characteristics and environmental stressors have been mostly omitted in previous research. OBJECTIVE This study aimed to examine the prevalence of ACEs among LGB (lesbian, gay, and bisexual) and heterosexual emerging adults, and the associations between different patterns of ACE exposure and depressive symptoms after adjusting for factors at different levels. PARTICIPANTS AND SETTING A representative sample of 928 college students in Xiamen city, China was recruited. METHODS Latent class analysis was applied to identify the patterns of ACEs. A series of regression analyses were conducted to examine the associations between ACEs and depression and whether ACEs interacted with sexual identity to influence depression, after controlling for individual characteristics, family, school, and society-level factors. RESULTS Over 35 % of the participants reported they had experienced at least one type of moderate to extreme childhood maltreatment, and those who identified as LGB reported a higher level of ACE exposure. Higher levels of ACE exposure based on score and clustering approaches were associated with higher risks of depression among Chinese emerging adults. However, the associations between ACEs and depression were not significantly moderated by sexual identity. CONCLUSIONS The findings highlighted the importance of early screening for ACEs particularly among sexual minorities and of delivering tailored interventions based on ecological backgrounds. Both the traditional scoring approach and a data-driven approach can be effective in detecting the cumulative effect of ACEs.
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Affiliation(s)
- Mengtong Chen
- Department of Social Work, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Naiqi Tian
- School of Sociology and Anthropology, Xiamen University, 422 Siming South Road, Siming District, Xiamen, Fujian, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, 422 Siming South Road, Siming District, Xiamen, Fujian, China; Institute of Artificial Intelligence, Xiamen University, 422 Siming South Road, Siming District, Xiamen, Fujian, China.
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13
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Chen W, Yu Z, Wang L, Gross D. Examining Childhood Adversities in Chinese Health Science Students Using the Simplified Chinese Version of the Adverse Childhood Experiences-International Questionnaire (SC-ACE-IQ). ADVERSITY AND RESILIENCE SCIENCE 2022; 3:335-346. [PMID: 36278243 PMCID: PMC9580443 DOI: 10.1007/s42844-022-00076-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
Adverse childhood experiences (ACEs) are prevalent, costly, and associated with poor health outcomes in adults. Little is known about ACE prevalence rates or strategies for measuring ACEs among young adults in Mainland China. The aims of this study were to (a) translate the ACE-International Questionnaire (ACE-IQ) into Simplified Chinese, (b) assess the psychometric strength of the Simplified Chinese version of the ACE-IQ (SC-ACE-IQ), and (c) compare SC-ACE-IQ scores calculated using binary and frequency scoring methods. The ACE-IQ was translated from English to Simplified Chinese and evaluated for content validity, criterion validity, and test–retest reliability. Chinese young adults (n = 566) aged 18–38 years who were health science students were recruited in Shanghai, China from May to August 2020. ACE exposures were compared using binary and frequency scoring methods, as proposed by the World Health Organization (WHO). The SC-ACE-IQ has good content validity (S-CVI = 0.89) and test–retest reliability (ICC = 0.88). SC-ACE-IQ scores were associated with depressive (binary: r = 0.26, frequency: r = 0.29; p < 0.001) and anxiety (binary: r = 0.22, frequency: r = 0.24; p < 0.001) symptoms. Higher proportion of participants reported exposure to at least one ACE and four or more ACEs when using the binary scoring method compared to the frequency scoring method. The SC-ACE-IQ is a valid and reliable ACE measure for Chinese health science students. Using frequency methods may underestimate exposure to ACEs among this population. Researchers should carefully select scoring methods for different study populations and purposes.
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Affiliation(s)
- Wenyi Chen
- School of Nursing, Johns Hopkins University, Baltimore, MD USA
| | - Zhiyuan Yu
- School of Nursing, Johns Hopkins University, Baltimore, MD USA
| | - Lin Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Deborah Gross
- School of Nursing, Johns Hopkins University, Baltimore, MD USA
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14
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Wang L, Yu Z, Chen W, Zhang J, Bettencourt AF. Higher exposure to childhood adversity associates with lower adult flourishing. BMC Public Health 2022; 22:612. [PMID: 35351105 PMCID: PMC8966170 DOI: 10.1186/s12889-022-13063-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are prevalent and associated with negative health and social outcomes. However, our understanding of how patterns of ACEs exposure relate to positive outcomes in adulthood remains limited. This study aims to identify patterns of ACEs and examine associations with flourishing in a sample of Chinese young adults. METHODS This cross-sectional study was conducted from August to November 2020. Young adults, ages 18-35, enrolled in undergraduate or graduate programs at universities in Mainland China were recruited through convenience and snowball sampling to participate in a survey. The exposure to ACEs was measured by the twelve-item Chinese version of the ACE-International Questionnaire. Additional measures included six domains of flourishing assessed using the Chinese version of the Flourishing Measure, and demographic covariates (i.e., gender, age, year in university, marital status). Descriptive statistical analysis and latent class analysis (LCA) were performed using SPSS 27 and Mplus 8.5. RESULTS Participants included 9468 young adults (mean age = 20.1 years). Majority of participants were female (75.3%), undergraduate students (96.4%), and single (79.8%). Approximately 56% of participants reported at least one ACE; 7.0% reported four or more ACEs. Emotional neglect (33.2%), household violence (20.6%), and parental separation/divorce (13.9%) were the most frequently reported ACEs. LCA identified three ACEs classes: multiple maltreatment and household violence (4.7%), emotional neglect and household violence (16.2%), and low ACEs (79.1%). Individuals in the low ACEs class had the highest level of flourishing whereas individuals in multiple maltreatment and household violence had the lowest level of flourishing in all six domains. There were no significant differences in flourishing between the multiple maltreatment and household violence and the emotional neglect and household violence classes except in the physical and mental health (means = 6.17 vs 6.51, p = 0.02) and the financial and material stability domains (means = 5.25 vs 5.66, p = 0.04). CONCLUSIONS Patterns of multiple ACEs exposures were associated with lower levels of flourishing. Our findings have implications for efforts to prevent ACEs exposure through monitoring and promoting family well-being and routine screening to identify those with ACEs exposure to prevent negative social and health sequelae.
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Affiliation(s)
- Lin Wang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Zhiyuan Yu
- Johns Hopkins School of Nursing, 525N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Wenyi Chen
- Johns Hopkins School of Nursing, 525N Wolfe Street, Baltimore, MD, 21205, USA
| | - Juan Zhang
- Departments of Nursing, School of Medicine, Shanghai Jiao Tong University, International Peace Maternity and Children Hospital of China Welfare Institution, Shanghai, China
| | - Amie F Bettencourt
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA
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15
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Li S, Wang R, Thomas E, Jiang Z, Jin Z, Li R, Qian Y, Song X, Sun Y, Zhang S, Chen R, Wan Y. Patterns of adverse childhood experiences and depressive symptom trajectories in young adults: A longitudinal study of college students in China. Front Psychiatry 2022; 13:918092. [PMID: 35958653 PMCID: PMC9358020 DOI: 10.3389/fpsyt.2022.918092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) tend to cluster together in daily life, and most studies focus on the level of depression at certain points, but the dynamic process of depression is often neglected. Thus, research is urgently needed to explore the relationship between ACEs pattern and trajectory of depressive symptom levels at multiple time points in order to provides early targeted interventions to those who are most at risk. OBJECTIVE We aimed to explore patterns of ACEs, including types and timing, associated with depression trajectories in college students. METHODS A school-based health survey was used to collect data as part of a longitudinal study in two medical college in Anhui province, China. Questionnaires were issued to 3,662 participants aged 17-22 and recorded details of ACEs (types and timing) and depression. Latent class analysis (LCA) was used to identify "patterns" of ACEs type and timing. Depressive symptom trajectories employed latent class growth analysis (LCGA). Multiple logistic regressions were employed to evaluate the relationships between ACEs patterns and depressive symptom trajectories. RESULTS We identified five ACEs patterns: "High neglect/emotional abuse/community violence," "High neglect/emotional abuse," "High neglect/family dysfunction," "High neglect," "Low ACEs." We traced three depression trajectories: "High depressive symptom" "Moderate depressive symptom," "Low depressive symptom." "High neglect/emotional abuse/community violence," "High neglect/emotional abuse" and "High neglect/family dysfunction" demonstrated a high risk for "High depressive symptom" and "Moderate depressive symptom." "High neglect" showed a high risk for "Moderate depressive symptom" but not for "High depressive symptom" (P < 0.05). CONCLUSIONS The findings address the need for a comprehensive consideration of exposure to childhood adversity associated with the risk of depression in young adults through identifying more problematic ACEs patterns amongst exposed children.
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Affiliation(s)
- Shuqin Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
| | - Rui Wang
- Teaching Affairs Office, Anqing Medical College, Anhui, China
| | - Erica Thomas
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Zhicheng Jiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
| | - Zhengge Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
| | - Ruoyu Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
| | - Yan Qian
- Teaching Affairs Office, Anqing Medical College, Anhui, China
| | - Xianbing Song
- Department of Human Anatomy, Histology and Embryology, Anhui Medical College, Anhui, China
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
| | - Shichen Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui, China
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16
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Leung DYL, Chan ACY, Ho GWK. Resilience of Emerging Adults After Adverse Childhood Experiences: A Qualitative Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:163-181. [PMID: 32588765 DOI: 10.1177/1524838020933865] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Even as children experience adversity, they can become resilient adults, in large part due to their social supports as emerging adults. OBJECTIVE Authors examine constructs of social support applied to the concept of resilience among emerging adults having experienced adverse childhood experiences (ACE). METHOD Authors conducted a meta-ethnography with six databases between January 1998 and October 2019. Inclusion criteria were as follows: (i) original peer-reviewed qualitative or mixed-method studies, (ii) sampling adults aged 18-35 years, (iii) reporting at least one ACE as defined by the World Health Organization, (iv) focused on resilience, and (v) in English. Data were collected from six electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science, and Google Scholar). Studies were appraised using the Critical Appraisal Skills Program Qualitative Checklist. Analysis drew on Bourdieu's constructs of capital following Noblit and Hare's methods. RESULTS Thirteen studies of 277 emerging adults, aged 18-35 years old (mean 23 years), from six countries, reported resilience as "self-righting" appraisals. These were interdependent of their social supports and within a culturally determined sense of self-reliance. Self-reliance appeared to be a precursor shaping resilience of emerging adults with ACE. Self-reliance may deter self-compassion and, as a self-righting appraisal/capacity, may inhibit accessing social support. CONCLUSION This review emphasizes the life stage of emerging adulthood regarding the development of self-righting appraisal skills, which, when enabled with reliance, others help to transform ACEs and allow resilience to grow.
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Affiliation(s)
- Doris Y L Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Athena C Y Chan
- Deparment of Family Social Science, University of Minnesota, Saint Paul, MN, USA
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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17
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Shen S, Chen Z, Qin X, Zhang M, Dai Q. Remote and adjacent psychological predictors of early-adulthood resilience: Role of early-life trauma, extraversion, life-events, depression, and social-support. PLoS One 2021; 16:e0251859. [PMID: 34166367 PMCID: PMC8224918 DOI: 10.1371/journal.pone.0251859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/04/2021] [Indexed: 11/27/2022] Open
Abstract
Resilience is important for people to maintain mental health after negative life-events. However, its longitudinal psychological and social predictors are poorly revealed. Based on the ecological system theory model, the current study aimed to determine the longitudinal temporal mechanism underlying the development of early-adulthood resilience using long-term (early-life trauma and personality), medium-term and short-term (life-events, social support, and depression) psychosocial predictors. A total of 505 university students were recruited at baseline (T1), 433 of whom took part in a three-year longitudinal investigation (T2). The results showed that at T1 and T2, the resilience scores of individuals were identically high (72.98 and 73.21, respectively). Pearson correlation analysis showed that early-adulthood resilience was negatively correlated with early-life trauma, psychoticism and neuroticism, depression, ad life-events, and positively correlated with extraversion, social-support, and resilience. Regression and structural equation models showed that extraversion had a direct positive effect on T1 resilience through the mediation of T1 life-events, depression, and social-support, while childhood emotional neglect (EN) had indirect negative effect and extraversion had direct positive effect on T2 resilience through the mediation of T1 resilience, and T2 depression and social-support. In conclusion, this study is among the first to reveal the longitudinal temporal process of the development of early-adulthood resilience using remote and adjacent psychosocial predictors. The findings confirm that childhood EN and extraversion have a remote impact on early-adulthood resilience through recent and current depression and social-support. Our results imply that early-life trauma does not hinder the development of early-adulthood resilience in a linear trend.
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Affiliation(s)
- Sitong Shen
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Zhaohua Chen
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Xuemei Qin
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Mengjia Zhang
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Qin Dai
- Department of Nursing Psychology, Army Medical University, Chongqing, China
- Department of Psychology, Army Medical University, Chongqing, China
- Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
- * E-mail:
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