The efficacy of resilience training programs: a systematic review protocol

Diet Quality and Resilience through Adulthood: A Cross-Sectional Analysis of the WELL for Life Study

Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords' WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0-120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18-24), late young (25-34), middle (35-49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p < 0.001)) and within each age group (early young (β = 1.1 ± sd: 0.3, p < 0.001); late young (β = 1.2 ± sd: 0.3, p < 0.001); middle (β = 0.9 ± sd: 0.3, p < 0.001); and late adulthood (β = 1.0 ± sd: 0.3, p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults.

Resilience Building Practices for Women Physicians

Women now make up more than half of the physician workforce, but they are disproportionately plagued by burnout. Medicine is a fast-paced stressful field, the practice of which is associated with significant chronic stress due to systems issues, crowding, electronic medical records, and patient case mix. Hospitals and health care systems are responsible for mitigating system-based burnout-prone conditions, but often their best efforts fail. Physicians, particularly women, must confront their stressors and the daily burden of significant system strain when this occurs. Those who routinely exceed their cumulative stress threshold may experience burnout, career dissatisfaction, and second victim syndrome and, ultimately, may prematurely leave medicine. These conditions affect women in medicine more often than men and may also produce a higher incidence of health issues, including depression, substance use disorder, and suicide. The individual self-care required to maintain health and raise stress thresholds is not widely ingrained in provider practice patterns or behavior. However, the successful long-term practice of high-stress occupations, such as medicine, requires that physicians, especially women physicians, attend to their wellness. In this article, we address one aspect of health, resilience, and review six practices that can create additional stores of personal resilience when proactively integrated into a daily routine.

Patient Resilience Does Not Conclusively Affect Clinical Outcomes Associated With Arthroscopic Surgery but Substantial Limitations of the Literature Exist

Purpose

To determine whether low resilience is predictive of worse patient-reported outcomes (PROs) or diminished improvements in clinical outcomes after joint preserving and arthroscopic surgery.

Methods

A comprehensive search of PubMed, Medline, Embase, and Science Direct was performed on September 28, 2022, for studies investigating the relationship between resilience and PROs after arthroscopic surgery in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines.

Results

Nine articles (level II-IV studies) were included in the final analysis. A total of 887 patients (54% male, average age 45 years) underwent arthroscopic surgery, including general knee (n = 3 studies), ACLR-only knee (n = 1 study), rotator cuff repair (n = 4 studies), and hip (n = 1 study). The Brief Resilience Scale was the most common instrument measuring resilience in 7 of 9 studies (78%). Five of 9 studies (56%) stratified patients based on high, normal, or low resilience cohorts, and these stratification threshold values differed between studies. Only 4 of 9 studies (44%) measured PROs both before and after surgery. Three of 9 studies (33%) reported rates of return to activity, with 2 studies (22%) noting high resilience to be associated with a higher likelihood of return to sport/duty, specifically after knee arthroscopy. However, significant associations between resilience and functional outcomes were not consistently observed, nor was resilience consistently observed to be predictive of subjects' capacity to return to a preinjury level of function.

Conclusions

Patient resilience is inconsistently demonstrated to affect clinical outcomes associated with joint preserving and arthroscopic surgery. However, substantial limitations in the existing literature including underpowered sample sizes, lack of standardization in stratifying patients based on pretreatment resilience, and inconsistent collection of PROs throughout the continuum of care, diminish the strength of most conclusions that have been drawn.

Level of Evidence

Level IV, systematic review of level II-IV studies.

Mental Health of Royal Canadian Mounted Police at the Start of the Cadet Training Program

OBJECTIVE

Serving Royal Canadian Mounted Police (RCMP) have screened positive for one or more mental disorders based on self-reported symptoms with substantial prevalence (i.e., 50.2%). Mental health challenges for military and paramilitary populations have historically been attributed to insufficient recruit screening; however, cadet mental health when starting the Cadet Training Program (CTP) was unknown. Our objective was to estimate RCMP Cadet mental health when starting the CTP and test for sociodemographic differences.

METHOD

Cadets starting the CTP completed a survey assessing self-reported mental health symptoms (n = 772, 72.0% male) and a clinical interview (n = 736, 74.4% male) with a clinician or supervised trainee using the Mini-International Neuropsychiatric Interview to assess current and past mental health.

RESULTS

The percentage of participants screening positive for one or more current mental disorders based on self-reported symptoms (15.0%) was higher than the diagnostic prevalence for the general population (10.1%); however, based on clinical interviews, participants were less likely to screen positive for any current mental disorder (6.3%) than the general population. Participants were also less likely to screen positive for any past mental disorder based on self-report (3.9%) and clinical interviews (12.5%) than the general population (33.1%). Females were more likely to score higher than males (all ps<.01; Cohen's ds .23 to .32) on several self-report mental disorder symptom measures.

CONCLUSIONS

The current results are the first to describe RCMP cadet mental health when starting the CTP. The data evidenced a lower prevalence of anxiety, depressive, and trauma-related mental disorders than the general population based on clinical interviews, contrasting notions that more rigorous mental health screening would reduce the high prevalence of mental disorders among serving RCMP. Instead, protecting RCMP mental health may require ongoing efforts to mitigate operational and organizational stressors.

Evaluating resilience in terms of COVID-19 related behavioral health among Latinx adults during the coronavirus pandemic

The mental and behavioral health burden resulting from COVID-19 has disproportionately affected the Latinx population. Yet, no work has investigated the influence of resilience as a protective factor against COVID-19 related consequences. The aim of the current study was to evaluate resilience in relation to COVID-19 related fear, anxiety symptoms, COVID-19 anxiety-related sleep disturbances, and depression among Latinx persons (178 Latinx persons [31.5% female, Mage = 34.1 years, SD = 8.2]). It was hypothesized that greater levels of resilience would be associated with lower levels of all COVID-19 related behavioral health outcomes above and beyond the variance accounted for by years living in the United States (U.S.), degree of COVID-19 exposure, sex, age, education, and COVID-19 related work and financial troubles and home-life distress. Results indicated that greater levels of resilience were associated with lower levels of COVID-19 related fear (ΔR2 = .06, p < .001), anxiety symptoms (ΔR2 = .03, p = .005), COVID-19 anxiety-related sleep disturbances (ΔR2 = .06, p < .001), and depression (ΔR2 = .04, p = .001). Overall, the present study is the first to document the potential importance of resilience in relation to common and clinically significant COVID-19 behavioral health problems among Latinx persons.

Psychometric Properties of Scales Measuring Resilience in U.S. Latinx Populations: A Systematic Review

Objectives

Instruments used to measure resilience have typically been developed in European or Anglosphere countries and emphasize personal factors of resilience. In addition to being a quickly growing ethnic minority group in the United States, Latinx individuals face unique stressors and protective factors that may contribute to resilience. This review sought to determine the extent to which instruments measuring resilience have been validated in U.S. Latinx populations and what domains of resilience those scales capture.

Methods

A systematic literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and included studies describing psychometric properties of resilience scales for Latinx individuals living in the United States. Articles were assessed for quality of psychometric validation; scales used in the final studies were assessed for representation of domains of the social ecological resilience model.

Results

Nine studies were included in the final review examining eight separate resilience measures. The populations of these studies were heterogeneous geographically and demographically; more than half the studies only included Latinx populations as a subgroup. The breadth and quality of psychometric validation were variable across studies. The domains represented by the scales in the review most heavily assessed individual domains of resilience.

Conclusion

The literature to date on psychometric validation of resilience measures in Latinx populations in the United States is limited and does not robustly capture aspects of resilience that may be particularly meaningful for Latinx populations, such as community or cultural factors. Instruments that are developed with and for Latinx populations are necessary to better understand and measure resilience in this population.

Assessing the impact of the Royal Canadian Mounted Police (RCMP) protocol and Emotional Resilience Skills Training (ERST) among diverse public safety personnel

BACKGROUND

Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder.

METHODS

The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date.

DISCUSSION

The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers.

TRIAL REGISTRATION

Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022-Prospectively registered.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05530642. Registered 1 September 2022-Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP.

The Royal Canadian Mounted Police (RCMP) Study: protocol for a prospective investigation of mental health risk and resilience factors

The Royal Canadian Mounted Police (RCMP), like all public safety personnel (PSP), are frequently exposed to potentially psychologically traumatic events that contribute to posttraumatic stress injuries (PTSI). Addressing PTSI is impeded by the limited available research. In this protocol paper, we describe the RCMP Study, part of the concerted efforts by the RCMP to reduce PTSI by improving access to evidence-based assessments, treatments and training as well as participant recruitment and RCMP Study developments to date. The RCMP Study has been designed to (1) develop, deploy and assess the impact of a system for ongoing annual, monthly and daily evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; (4) augment the RCMP Cadet Training Program with skills to proactively mitigate PTSI; and (5) assess the impact of the augmented training condition (ATC) versus the standard training condition (STC). Participants in the STC (n = 480) and ATC (n = 480) are assessed before and after training and annually for 5 years on their deployment date; they also complete brief monthly and daily surveys. The RCMP Study results are expected to benefit the mental health of all participants, RCMP and PSP by reducing PTSI among all who serve.

Relationship between depressive symptoms and subjective occupational well-being among nursing home staff: the mediating role of resilience

OBJECTIVE

To assess the prevalence of depressive symptoms and subjective occupational well-being, and examine the mediating role of resilience between depressive symptoms and subjective occupational well-being among nursing home staff as well.

MATERIALS AND METHODS

The cross-sectional study involving 236 convenient nursing home staff with an average age of 25.73 years was conducted from November 2020 till January 2021 in Jinan and Heze city, Shandong Province. Participants filled out the questionnaires of demographic information, depressive symptoms, resilience and subjective occupational well-being. Descriptive analysis, Pearson correlations and mediation analysis based on PROCESS macro were conducted.

RESULTS

The study revealed that the prevalence of depressive symptoms among nursing home staff was 30.1%. Depressive symptoms were negatively related to subjective occupational well-being (r = -0.336, P < 0.001) and resilience (r = -0.373, P < 0.001), and resilience was positively correlated with subjective occupational well-being (r = 0.390, P < 0.001). Moreover, resilience mediated the relationship between depressive symptoms and subjective occupational well-being with the mediating effect accounting for 35.47% of the total effect.

CONCLUSION

Depressive symptoms were highly prevalent among nursing home staff. Resilience could mediate the association between depressive symptoms and subjective occupational well-being. It is advisable to pay more attention to mental health among nursing home staff and contribute to the development of effective resilience improvement interventions to enhance subjective occupational well-being.

Loneliness and frailty among nursing home older adults: the multiple mediating role of social support and resilience

BACKGROUND

Loneliness has been considered as a risk factor for frailty. Social support (as an external protective resource) and resilience (as an inner protective resource) might play protective roles on the association between loneliness and frailty. In this study, the mediating roles of social support and resilience between loneliness and frailty were explored among older adults living in nursing homes.

METHODS

Older adults (N = 210) from three nursing homes in China were recruited in this cross-sectional study. Information for sociodemographic variables, frailty, loneliness, social support and resilience were collected. The bootstrap analyses by PROCESS macro were conducted to test the multiple mediating role of social support and resilience between loneliness and frailty.

RESULTS

The prevalence of frailty was 34.8% among older adults in nursing homes. Also, social support and resilience mediated the association between loneliness and frailty, respectively. Furthermore, the multiple mediating testing results showed that social support and resilience played sequential mediating roles in the link of loneliness to frailty.

CONCLUSIONS

The findings underscore the protective role of social support and resilience of loneliness and frailty among nursing home older adults.

The Role of Resilience for Migrants and Refugees' Mental Health in Times of COVID-19

Migrants and refugees need international protection, particularly during a crisis such as the current health pandemic. The aim of this research was to examine the mental health and attitudes towards COVID-19 in migrants and refugees compared to the general Spanish population. Moreover, the nature of resilience was examined as a mixed component though life experiences. For this proposal, an interview was carried out in a sample of 245 participants who volunteered to participate in the study. The sample was divided into Spanish non-migrants, Spanish migrants, non-Spanish migrants and refugees. Attitudes towards COVID-19, resilience (based on BRCS) and mental health (based on DASS-21) were measured. The results obtained can be described as follows: (i) Migrant participants indicated worse mental health than non-migrants, and within the migrant group, refugees presented worse scores; (ii) No differences were found in attitudes towards COVID-19 in any of the subgroups; (iii) A moderating effect of group was found for the relationship between resilience and mental health but not between resilience and fear of COVID-19. These results might be of great interest in making visible the vulnerability of migrants and specifically refugees, and the proposal of intervention programs based on resilience training.

Effects of age on trait resilience in a population-based cohort and two patient cohorts

OBJECTIVE

We examined (i) the mean-level stability and change of trait resilience with age in three cohorts from a single study (population-based controls, depression patients, cardiovascular disease (CVD) patients), (ii) associations of sociodemographic, personality, and other factors (sex, education, Big Five, childhood trauma, depressive symptoms) with trait resilience, and (iii) the intra-individual stability across repeated trait resilience self-assessments.

METHODS

1544 participants from the BiDirect Study completed the Resilienzskala-11 (RS-11; German short version of the resilience scale 25) up to three times over about four years. The repeated-measures data were analyzed using linear mixed models, stratified by cohort. Outcome was the RS-11 score, the underlying time variable was age. All factors mentioned above were considered as fixed main effects. Bland-Altman plots assessed intra-individual stability of RS-11 scores.

RESULTS

(i) In the population-based control cohort, there was no association between age and trait resilience (est.: -0.01; 95%-CI: -0.06, 0.04). There were modest positive associations in the patient cohorts (depression: est.: 0.08; 95%-CI: -0.01, 0.16; CVD: est.: 0.15; 95%-CI: 0.03, 0.26). (ii) For all cohorts, female sex, high education, extraversion, openness, agreeableness, and conscientiousness (Big Five) were associated positively with trait resilience. Childhood trauma, depressive symptoms, and neuroticism were associated negatively with trait resilience. (iii) In all cohorts, the level of intra-individual stability was moderate.

CONCLUSION

We found that trait resilience was rather stable across decades of age in all cohorts, albeit intra-individual self-assessments agreed only moderately. We confirmed previous findings regarding negative and positive associations of personality and sociodemographic factors with trait resilience.

Playing sport injured is associated with osteoarthritis, joint pain and worse health-related quality of life: a cross-sectional study

BACKGROUND

Sports participants are faced with the decision to continue or cease play when injured. The implications of playing sport while injured on joint health and health-related quality of life (HRQoL) has not been investigated. The purpose of this study was to investigate the relationship between having played sport while injured and HRQoL, osteoarthritis, and persistent joint pain; and compare findings in elite and recreational cricketers.

METHODS

The Cricket Health and Wellbeing Study cohort was used for this study. Inclusion criteria were: age ≥ 18 years, played ≥1 cricket season. Questionnaire data collected included a history of playing sport injured, SF-8 (physical (PCS) and mental (MCS) component scores), physician-diagnosed osteoarthritis, and persistent joint pain (most days of the last month). Multivariable linear regressions and logistic regressions were performed. Continuous covariates were handled using fractional polynomials. Models were adjusted for age, sex, cricket-seasons played, playing status, joint injury, and orthopaedic surgery. All participants (n = 2233) were included in HRQoL analyses, only participants aged ≥30 years (n = 2071) were included in osteoarthritis/pain analyses.

RESULTS

Of the 2233 current and former cricketers (mean age: 51.7 SD 14.7, played 30 IQR 24 cricket seasons, 60% were current cricketers, 62% played recreationally; median PCS: 51.4 IQR 9.0; MCS: 54.3 IQR 8.6) 1719 (77%) had played sport while injured. People who had played sport injured reported worse adjusted PCS (Effect(95% CI): - 1.78(- 2.62, - 0.93) and MCS (- 1.40(- 2.25, - 0.54), had greater odds of osteoarthritis (adjusted OR(95% CI): 1.86(1.39, 2.51) and persistent joint pain (2.34(1.85, 2.96)), compared to people who had not played sport injured. Similar relationships were observed regarding PCS, osteoarthritis and pain in elite and recreational subgroups. Playing injured was only related to worse MCS scores for elite cricketers (- 2.07(- 3.52, - 0.63)); no relationship was observed in recreational cricketers (- 0.70(- 1.79, 0.39)).

CONCLUSION

Cricketers that had played sport injured had impaired HRQoL, increased odds of osteoarthritis and persistent joint pain, compared to those who had not played sport injured. Playing sport injured was only related to impaired mental-components of HRQoL in elite cricketers. The long-term impact of playing while injured on musculoskeletal health, should be considered when advising athletes on their ability to compete following injury.

Mental Health Promotion Intervention for Nurses Working in German Psychiatric Hospital Departments: A Pilot Study

This pilot study aimed to implement a mental health promotion program to support nurses working in Psychiatric hospital departments. Eighty-six nurses working in psychiatric hospitals were randomized to either an intervention group (IG) or a waitlist control group (WCG). The intervention took place in groups over a period of 12 weeks. Training content included, i.e. work-related stress management training, problem solving techniques, and solution-focused counseling. Outcomes were measured at four times (baseline and three follow-up measurements). Perceived stress, coping skills, emotion regulation skills and changes in patient relationships were included as outcome measurements. Psychiatric nurses in the IG reported significant changes in perceived job stress, emotion regulation skills, resilience, and self-efficacy after the intervention. In addition, scores on quality of patient-relationship were significantly higher after the intervention (e.g. support, conflict management; p < 0.05). No comparable results could be found in the WCG. A mental health promotion intervention for psychiatric nurses was successfully implemented. Further research is necessary to generalize these pilot study findings.

High Resiliency Linked to Short-Term Patient Reported Outcomes and Return to Duty Following Arthroscopic Knee Surgery

Introduction

Resilience is a psychometric construct of a patient’s ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes.

Materials and Methods

We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran’s Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared.

Results

We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group.

Conclusions

Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.

Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial

BACKGROUND

Caregivers of people with dementia experience high stress levels. Mindfulness-based cognitive therapy has been found to be effective in reducing stress and improving the psychological well-being of several populations.

OBJECTIVE

To explore the feasibility and preliminary effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia.

METHODS

In a single-blinded, parallel-group, randomized controlled trial, 36 caregivers of people with dementia were randomized to either the intervention group, receiving the 7-session modified mindfulness-based cognitive therapy in 10 weeks; or the control group, receiving the usual family care and brief education on dementia care. The brief education sessions were similar in frequency and duration to the intervention group. Various psychological outcomes of caregivers were assessed and compared at baseline, immediately post-intervention, and at the 3-month follow-up. A focus group with eight participants from the intervention group was conducted to identify the strengths, limitations, and difficulties of the intervention.

RESULTS

Intervention feasibility was established with a high completion rate of 83% (completing ≥5 out of the 7 sessions) and a low attrition rate of 11.1%. The duration of the average weekly home-based mindfulness practice of the caregivers was 180 minutes (S.D. = 283.8). The intervention group experienced a statistically significant decrease in stress levels (Z = -1.98, p = 0.05, Cohen's d = 0.7) and depressive symptoms (Z = -2.25, p = 0.02, Cohen's d = 0.8) at the post-test; and a decrease in stress (Z = -2.58, p = 0.01, Cohen's d = 0.9), depressive symptoms (Z = -2.20, p = 0.03, Cohen's d = 0.7), and burden (Z = - 2.74, p = 0.006, Cohen's d = 1.0), and improved quality of life (physical) (Z = -1.68, p = 0.09, Cohen's d = 0.6) at the 3-month follow-up compared to the controls. A focus group conducted immediately after the intervention revealed three major themes: Impacts on the family caregivers, Impacts on the people with dementia, and Difficulty in practicing mindfulness.

CONCLUSION

The findings support the feasibility and preliminary effects of the modified mindfulness-based cognitive therapy on reducing the stress of caregivers and improving their psychological well-being. Some potential effects on people with dementia (e.g., improvements in behavioral problems) were reported by the caregivers. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the modified mindfulness-based cognitive therapy and the impacts on people with dementia.

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders

Background

A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.

Objective

This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.

Methods

We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.

Results

Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).

Conclusions

The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

Resilience attenuates the association between neurocognitive functioning and everyday functioning in individuals aging with HIV in the Deep South

OBJECTIVES

Adults aging with HIV are at risk for poorer neurocognitive and daily functioning. Identifying factors to protect such outcomes is a significant research priority. The aim of this study was to explore the role of resilience in cognitive and everyday functioning in a largely African American and low socioeconomic status sample of adults and older adults with HIV in the Deep South.

METHODS/DESIGN

In this cross-sectional study 100 HIV+ middle-aged and older adults (range 40-73; 61% aged 50+) completed a comprehensive neurocognitive battery along with self-reported measures of resilience and everyday functioning.

RESULTS

Higher resilience was associated with better global neurocognitive functioning (rho = 0.31, P < 0.01), as well as better functioning in all domains (verbal fluency, executive functioning, speed of information processing, learning, working memory) except recall and motor skills. Resilience was also significantly associated with instrumental activities of daily living (IADL) dependence, with lower resilience observed in those with IADL dependence compared with those who were IADL independent (P < 0.01). In a multiple regression adjusting for data-driven covariates (verbal IQ, income, depression), and global neurocognitive impairment, resilience was the only significant (P = 0.02) correlate of IADL dependence. A follow-up mediation showed that the direct relationship between neurocognitive functioning and IADL declines was fully attenuated after accounting for shared variance with resilience.

CONCLUSIONS

Resilience is associated with better cognitive and functional outcomes in people aging with HIV. While further work is needed to understand these associations over time, results suggest interventions to build resilience may promote successful aging in this vulnerable population.

Resilience and protective factors among refugee children post-migration to high-income countries: a systematic review

Background

Increasing numbers of children have been forced to flee and seek asylum in high-income countries. Current research indicates that focussing on resilience and protective factors is an important long-term goal for positive mental health and psychological functioning of refugee children.

Methods

We performed a systematic review of quantitative literature regarding psychological and contextual factors that contribute to resilience in refugee children residing in high-income countries. Our procedure followed guidelines from the Centre for Reviews and Dissemination.

Results

We identified a number of protective factors as related to positive outcomes. They are drawn from several ecological domains and include age, self-esteem, maintenance of cultural identity, social support, belonging and safety and innovative social care services. A key overarching point reported by the studies we reviewed was that for refugee settlement specific policies and approaches to be beneficial, they were required to be embedded within a positive socially inclusive society. We also identified several limitations across the reported studies.

Conclusion

The factors we identified would assist clinicians to adopt a resilience-focussed approach. However, a continued pre-occupation with psychopathology was evident across the studies, which we argue as holding back the development of resilience-focussed approaches.

Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study

OBJECTIVES

Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians' health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine.

METHODS

In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months.

RESULTS

The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction.

CONCLUSION

The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management.

Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program

Background

The impact of mental illness on society is far reaching and has been identified as the leading cause of sickness absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable, and accessible, there is potential to deliver substantial economic benefits while improving the lives of individual workers. Academic and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of workers.

Objective

Our aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work Mindfulness program on measures of resilience and related skills.

Methods

The current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based resilience-training program and were administered questionnaires prior to training and directly after the program ended. Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement.

Results

Participants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t₁₄=1.84, P=.09). Compared to baseline, participants also reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20, t₁₃=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-samples t tests revealed a trend towards reduction in mean scores post training (P=.12).

Conclusions

This pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training program delivered wholly via the internet has been tested in the workplace.

Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions

OBJECTIVES

To synthesise the available evidence on interventions designed to improve individual resilience.

DESIGN

A systematic review and meta-analysis METHODS: The following electronic databases were searched: Ovid Medline, Ovid EMBASE, PsycINFO, Ovid Cochrane and WHO Clinical Trials Registry in order to identify any controlled trials or randomised controlled trials (RCTs) examining the efficacy of interventions aimed at improving psychological resilience. Pooled effects sizes were calculated using the random-effects model of meta-analysis.

OUTCOME MEASURES

Valid and reliable measures of psychological resilience.

RESULTS

Overall, 437 citations were retrieved and 111 peer-reviewed articles were examined in full. Seventeen studies met the inclusion criteria and were subject to a quality assessment, with 11 RCTs being included in the final meta-analysis. Programmes were stratified into one of three categories (1) cognitive behavioural therapy (CBT)-based interventions, (2) mindfulness-based interventions or (3) mixed Interventions, those combining CBT and Mindfulness training. A meta-analysis found a moderate positive effect of resilience interventions (0.44 (95% CI 0.23 to 0.64) with subgroup analysis suggesting CBT-based, mindfulness and mixed interventions were effective.

CONCLUSIONS

Resilience interventions based on a combination of CBT and mindfulness techniques appear to have a positive impact on individual resilience.

Latent classes of resilience and psychological response among only-child loss parents in China

Only-child loss parents in China recently gained extensive attention as a newly defined social group. Resilience could be a probable solution out of the psychological dilemma. Using a sample of 185 only-child loss people, this study employed latent class analysis (a) to explore whether different classes of resilience could be identified, (b) to determine socio-demographic characteristics of each class, and (c) to compare the depression and the subjective well-being of each class. The results supported a three-class solution, defined as 'high tenacity-strength but moderate optimism class', 'moderate resilience but low self-efficacy class' and 'low tenacity but moderate adaption-dependence class'. Parents with low income and medical insurance of low reimbursement type and without endowment insurance occupied more proportions in the latter two classes. The latter two classes also had a significant higher depression scores and lower subjective well-being scores than high tenacity-strength but moderate optimism class. Future work should care those socio-economically vulnerable bereaved parents, and an elastic economic assistance policy was needed. To develop targeted resilience interventions, the emphasis of high tenacity-strength but moderate optimism class should be the optimism. Moderate resilience but low self-efficacy class should be self-efficacy, and low tenacity but moderate adaption-dependence class should be tenacity.

Resilience correlates with outcomes after total shoulder arthroplasty

BACKGROUND

Resilience, characterized by an ability to bounce back or recover from stress, is increasingly recognized as a psychometric property affecting many outcomes' domains including quality of life, suicide risk in active-duty military personnel, and recovery in cancer patients. This study examines the correlation between resilience, as measured by the Brief Resilience Scale (BRS), and traditional outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn scores in patients undergoing total shoulder arthroplasty (TSA).

METHODS

Seventy patients undergoing primary anatomic TSA were followed up for a minimum of 2 years (mean, 30 ± 3 months). Patients were stratified into groups a priori, based on deviation from the mean of the BRS score, into low-resilience (LR), normal-resilience (NR), and high-resilience (HR) patients, and outcome scores were calculated for each group.

RESULTS

Postoperative BRS scores significantly correlated with ASES, Penn, and SANE scores (r = 0.41-0.44, P < .004 for all scores). When we evaluated patients based on resilience group, the LR group had a Penn score that was 34 points lower than that in the HR group. Likewise, the LR group had a SANE score that averaged 40 points lower than that in the HR group (SANE score of 53 points in LR group and 92 points in HR group, P = .05). When we evaluated ASES subscores, it appeared that the pain subscale was responsible for most of the difference between the LR and HR groups (29 points and 48 points [out of 50 points], respectively; P = .03).

CONCLUSIONS

Resilience is a major predictor of postoperative outcomes after TSA. Patients who are classified as having LR have outcome scores that are 30 to 40 points lower on traditional outcome scales than patients with HR.

Does psychosocial competency training for junior physicians working in pediatric medicine improve individual skills and perceived job stress

Pediatricians' job performance, work engagement, and job satisfaction are essential for both the individual physician and quality of care for their little patients and parents. Therefore, it is important to maintain or possibly augment pediatricians' individual and professional competencies. In this study, we developed and implemented a psychosocial competency training (PCT) teaching different psychosocial competencies and stress coping techniques. We investigated (1) the influence of the PCT on work-related characteristics: stress perception, work engagement, job satisfaction and (2) explored pediatricians' outcomes and satisfaction with PCT. Fifty-four junior physicians working in pediatric hospital departments participated in the training and were randomized in an intervention (n = 26) or a control group (n = 28). In the beginning, at follow-up 1 and 2, both groups answered a self-rated questionnaire on perceived training outcomes and work-related factors. The intervention group showed that their job satisfaction significantly increased while perceived stress scores decreased after taking part in the PCT. No substantial changes were observed with regard to pediatricians' work engagement. Participating physicians evaluated PCT with high scores for training design, content, received outcome, and overall satisfaction with the training.

CONCLUSION

Professional psychosocial competency training could improve junior pediatricians' professional skills, reduce stress perception, increase their job satisfaction, and psychosocial skills. In addition, this study indicates that the PCT is beneficial to be implemented as a group training program for junior pediatricians at work. What is Known: • Junior pediatricians often report experiencing high levels of job strain and little supervisory support. • High levels of job demands make pediatricians vulnerable for mental health problems and decreased work ability. What is New: • Development, implementation, and evaluation of a psychosocial competency training for junior pediatricians working in clinical settings • Psychosocial competency training has the potential to improve pediatricians' psychosocial skills and perceptions of perceived work-related stress and job satisfaction.

Anxiety, depression, resilience and self-esteem in individuals with cardiovascular diseases

Objectives:

to analyze the relationship between anxiety and depression symptoms, resilience and self-esteem with sociodemographic and clinical characteristics; correlate resilience and self-esteem with age and duration of the disease; check associations between anxiety and depression with measures of resilience and self-esteem among individuals with cardiovascular diseases.

Method:

correlational study conducted in a large university hospital in the interior of the state of São Paulo, Brazil. The population was composed of adult inpatients with cardiovascular diseases. A non-probabilistic consecutive sample was composed of 120 patients. Variables of interest were assessed using the Hospital Anxiety and Depression Scale, Resilience Scale, and Rosenberg Self-Esteem Scale.

Results:

anxiety and depression symptoms were present in 32.5% and 17.5% of the patients, respectively, and were associated with the female sex (p = 0.002; p = 0.022). Manifestations of depression were associated with the presence of comorbidities (p = 0.020). More resilient patients did not present depression symptoms (p < 0.001) and anxious women were more resilient (p = 0.042). The highest scores regarding self-esteem were present in patients with anxiety and depression. Men presented higher resilience and lower self-esteem compared to women.

Conclusion:

patients with anxiety and depression were less resilient but presented higher self-esteem.

Evaluation of self-care skills training and solution-focused counselling for health professionals in psychiatric medicine: a pilot study

OBJECTIVE

The purpose of this pilot study was to implement and to evaluate a self-care skills training with solution-focused counselling to support psychiatrists in handling their daily work challenges.

METHODS

A total of 72 psychiatrists working in a psychiatric clinic were randomised in a single-blind trial to either an intervention group or a control group. Outcomes were measured at baseline and at the end of the training (follow-up 1: after 3 months; follow-up 2: after 6 months). A validated questionnaire including the Perceived Stress Questionnaire, the Copenhagen Psychosocial Questionnaire, Brief Resilient Coping Scale, Self-Efficacy Scale and the Quality of Relationship Inventory was used.

RESULTS

Psychiatrists in the intervention group reached a significant reduction in perceived job stress (p = 0.01, d = 0.05), improvements in job satisfaction (p = 0.02, d = 0.04), resilience (p = 0.02, d = 0.04) and self-efficacy (p = 0.04, d = 0.02) from baseline to all follow-ups with no comparable results seen in the control group. Psychiatrists stated an improved quality of physician-patient relationship (e.g. support, conflict management; p < 0.05).

CONCLUSIONS

A self-care skills training, including solution-focused counselling, for psychiatrists was associated with significant improvements in perceived stress, job satisfaction, individual protective skills and quality of relationship to patients. This training is suitable to implement as a group training program for psychiatrists.

Resilience and Quality of Life

The construct of resilience is key to understanding adaptation to disability from a strengths-based perspective. The objective of this study was to examine the impact of factors identified in Kumpfer’s resilience model on quality of life (QOL) outcomes for adults with spinal cord injury (SCI), specifically taking into account injury characteristics, self-efficacy, resiliency characteristics, and social support using hierarchical regression analysis. Participants included 255 adults with SCI. Findings revealed that the overall model accounted for 75% of the variance in QOL outcomes. In particular, coexisting pain, participation self-efficacy, core self-evaluation, resiliency characteristics, cognitive strength, general health, and social support independently contributed to the variance in QOL scores. Implications of these findings for developing theory-driven, strengths-based approaches for improving rehabilitation outcomes for individuals with SCI are discussed.

Does the concept of resilience contribute to understanding good quality of life in the context of epilepsy?

A significant body of research highlights negative impacts of epilepsy for individual quality of life (QOL). Poor seizure control is frequently associated with reporting of poor QOL and good seizure control with good QOL; however, this is not a universal finding. Evidence suggests that some people enjoy good QOL despite ongoing seizures while others report poor QOL despite good seizure control. Understanding the factors that influence QOL for people with epilepsy and the processes via which such factors exert their influence is central to the development of interventions to support people with epilepsy to experience the best possible QOL. We present findings of a qualitative investigation exploring influences and processes on QOL for people with epilepsy. We describe the clinical, psychological, and social factors contributing to QOL. In particular, we focus on the value of the concept of resilience for understanding quality of life in epilepsy. Based on our analysis, we propose a model of resilience wherein four key component sets of factors interact to determine QOL. This model reflects the fluid nature of resilience that, we suggest, is subject to change based on shifts within the individual components and the interactions between them. The model offers a representation of the complex influences that act and interact to either mitigate or further compound the negative impacts of epilepsy on individual QOL.

Integrating Mental Health Concepts in the Care of Adults With Chronic Illnesses: A Curricular Enhancement

BACKGROUND

In the United States, inadequate attention has been given to the mental health needs of chronically ill adults, and the attempts to integrate mental health in primary care have fallen short.

METHOD

This article describes the beginning efforts of the faculty at Duke University School of Nursing to integrate mental health concepts into its adult-gerontological nurse practitioner and family nurse practitioner curricula.

RESULTS

Competency and course content mapping activities revealed opportunities for mental health enhancement. Five mental health concepts were identified for module development: spectrum of emotions, validation skills, self-management, resilience, and diversity. Mental health modules will be integrated in the nurse practitioner Physical Assessment and Diagnostic Reasoning course, as well as in various clinical courses.

CONCLUSION

Challenges and lessons learned, including efforts to foster active interprofessional learning among medical, physician assistant, and nurse practitioner students, are described.

An Evaluation of a Multicomponent Mental Competency and Stress Management Training for Entrants in Surgery Medicine

OBJECTIVE

Stress occurs in surgeons with a significantly higher prevalence than in the general population. At the same time, learning of coping techniques and improving personal skills how to handle the daily workload are not integral parts of the medical education or during adjustment to the job as a surgeon. In this pilot study, we developed a training course to teach different stress management and coping techniques and analyzed individual conditions of the surgeons before and after the course.

METHODS

In total, 68 junior surgeons in their first year at work participated in the training and were randomized in an intervention (n = 35) or a control group (n = 33). At the beginning and the end of the training, the intervention and the comparison group answered a standardized, validated questionnaire on job satisfaction, perceived stress, and personal skills (such as self-efficacy).

RESULTS

The surgeons showed a significant decline in perceived stress. Furthermore, they showed an improvement in self-reported resilience and self-efficacy. Job satisfaction increased at the same time. The comparison cohort of surgeons showed comparable scores for the specified outcome variables at the beginning but showed no progressive changes during time.

CONCLUSIONS

The study findings indicate that the training for junior surgeons in their first year at work is suitable to implement as a group training program. Moreover, the training provides statistically significant improvement in perceptions of distress and strengthens individual protective factors and job satisfaction.

The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials

Importance

Poor mental health places a burden on individuals and populations. Resilient persons are able to adapt to life’s challenges and maintain high quality of life and function. Finding effective strategies to bolster resilience in individuals and populations is of interest to many stakeholders.

Objectives

To synthesize the evidence for resiliency training programs in improving mental health and capacity in 1) diverse adult populations and 2) persons with chronic diseases.

Data Sources

Electronic databases, clinical trial registries, and bibliographies. We also contacted study authors and field experts.

Study Selection

Randomized trials assessing the efficacy of any program intended to enhance resilience in adults and published after 1990. No restrictions were made based on outcome measured or comparator used.

Data Extraction and Synthesis

Reviewers worked independently and in duplicate to extract study characteristics and data. These were confirmed with authors. We conducted a random effects meta-analysis on available data and tested for interaction in planned subgroups.

Main Outcomes

The standardized mean difference (SMD) effect of resiliency training programs on 1) resilience/hardiness, 2) quality of life/well-being, 3) self-efficacy/activation, 4) depression, 5) stress, and 6) anxiety.

Results

We found 25 small trials at moderate to high risk of bias. Interventions varied in format and theoretical approach. Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled SMD 0.37 (95% CI 0.18, 0.57) p = .0002; I² = 41%] within 3 months of follow up. Improvement in other outcomes was favorable to the interventions and reached statistical significance after removing two studies at high risk of bias. Trauma-induced stress-directed programs significantly improved stress [−0.53 (−1.04, −0.03) p = .03; I² = 73%] and depression [−0.51 (−0.92, −0.10) p = .04; I² = 61%].

Conclusions

We found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes. Further study is needed to better define the resilience construct and to design interventions specific to it.

Registration Number

PROSPERO #CRD42014007185