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1.  A Pilot Study of a Family-Focused Intervention for Children and Families Affected by Maternal Depression 
Journal of family therapy  2011;33(1):3-19.
A non-experimental pilot study examined child, mother, and family outcomes of a 10-session multi-family group intervention designed to reduce risk and promote resilience for mothers with depression and their families. Positive changes following the Keeping Families Strong intervention included mother-reported decreases in child behavior and emotional problems, improvements in the quality of family interactions and routines, and improvements in their own well being and support from others. Children (9–16 years) reported decreased internalizing symptoms, improved coping, increased maternal warmth and acceptance, and decreased stressful family events. Attendance and mother-reported satisfaction were high, indicating the perceived value of the intervention.
PMCID: PMC3572863  PMID: 23420650
adult mental health; child and adolescent mental health; depression; multiple family approaches; outcome research
2.  Childhood Predictors of Adolescent Competence and Self-Worth in Rural Youth 
Urban children who become competent adults despite circumstances that place their development and mental health at risk are considered to be resilient. Less is known about the risk and protective factors that characterize resilience among Hispanic/Latinos living in rural areas.
Data for regression analyses were collected when children (N = 603; 54% Hispanic/Latino) enrolled in the study in fifth grade, (M=10.4 years of age) and again five years later when they were in high school (M=15 years of age).
Statistically significant predictors of competence and self-worth in high schoolers included gender, ethnicity, and mother’s education, as well as stress, temperament (task persistence), and competences measured in grade school.
Parents’ perceptions of child’s temperament is a significant predictor of future competence and self-worth among rural adolescents.
PMCID: PMC3490230  PMID: 23121139
adolescence; competence; self-worth; resilience
3.  Resilience to Maternal Depression in Young Adulthood 
Developmental Psychology  2010;46(4):805-814.
Using a prospective longitudinal design this study investigated factors associated with resilience in 20-year old offspring of depressed mothers (n=648). Resilient youth were operationally defined as those whose mothers were depressed, but who themselves had no history of recurrent depression, and currently evidenced adequate academic/work and romantic functioning, no Axis I psychopathology, and no clinically significant internalizing behavior problems. Low levels of perceived maternal psychological control (p=.02), and high child IQ (p<.01) acted as protective factors in the context of maternal depression. Low paternal psychological control (p=.02), high maternal warmth (p<.01), high self esteem (p<.01), and healthy peer social functioning (p<.01) all acted as resource factors predicting high functioning outcomes for young adults, regardless of mother depression status. Notably, high child IQ acted as a protective factor predicting resilient outcomes that persisted from adolescence to adulthood (p<.01), and low maternal psychological control acted as a protective factor predicting resilient outcomes that emerged in early adulthood (p=.03). Interventions focused on these two protective factors might yield the strongest benefits for offspring of depressed mothers as they transition to early adulthood.
PMCID: PMC3375903  PMID: 20604603
maternal depression; resilience; young adulthood
4.  Physical Health of Mothers with HIV/AIDS and the Mental Health of Their Children 
A longitudinal study was conducted on the psychological well-being of 81 young children (mean age = 8.8 years) living with mothers with AIDS or HIV-infected mothers with symptomatic disease. The relationship between mothers’ physical health and children’s psychological well-being was investigated. The children were assessed at seven time points over approximately 6 years. Individual growth models were estimated for children’s depression, anxiety, and aggressiveness in relation to: mothers’ viral load (medical records) and physical functioning, number of HIV-related physical symptoms, and medical visits due to illness (self-report). Results showed significant linear declines in children’s depression, anxiety, and aggressiveness over time. Lower levels of physical functioning and more physical symptoms among mothers were associated with higher levels of children’s depression, anxiety, and aggressiveness at baseline. Lower levels of physical functioning and more physical symptoms among mothers were associated with initially high but more rapidly decreasing levels of depression among children. However, mothers who began the study in better health appear to have changed in health more quickly than mothers who began the study in poorer health. Thus, stability in mothers’ health appears to be associated with a more rapid improvement in children’s mental health over time. Our findings suggest that the measures representing observable levels of, and changes in, mothers’ health that are most likely to be directly experienced by themselves and their children are the measures that are most predictive of changes in children’s mental health over time.
PMCID: PMC2276144  PMID: 17041275
HIV/AIDS; mother health/child psychological well-being
5.  Personality, adrenal steroid hormones, and resilience in maltreated children: A multi-level perspective 
Development and psychopathology  2007;19(3):787-809.
In this multi-level investigation, resilience in adaptive functioning among maltreated and nonmaltreated low-income children (N = 677) was examined in relation to the regulation of two stress-responsive adrenal steroid hormones, cortisol and dehydroepiandosterone (DHEA), as well as the personality constructs of ego resiliency and ego control. Maltreatment status was not related to differences in average levels of morning or afternoon cortisol or DHEA. However, lower morning cortisol was related to higher resilient functioning, but only in nonmaltreated children. In contrast, among physically abused children, high morning cortisol was related to higher resilient functioning. Morning and afternoon DHEA was negatively related to resilient functioning. Although diurnal change in cortisol was not related to resilience, for DHEA, maltreated children with high resilience showed an atypical rise in DHEA from morning to afternoon. Morning and afternoon cortisol/DHEA ratios were positively related to resilient functioning, but did not interact with maltreatment status. Ego resiliency and ego control strongly differentiated maltreated and nonmaltreated children, and the personality variables were substantially predictive of resilience. When considered together, demonstrated effects of personality, cortisol, and DHEA maintained independent contributions in predicting resilience among high-risk youth.
PMCID: PMC3409470  PMID: 17705903
6.  Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study 
BMC Public Health  2012;12:27.
The authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread.
This cross-sectional study was carried out in 2007 using random sampling of kindergartens in order to select 350 preschoolers. Binary logistic regression was used to compare resilient (adequate nutrition) and vulnerable (stunted) groups with those with moderate nutrition.
Approximately 37% of the subjects demonstrated nutritional resilience and 15% were vulnerable. Factors associated with nutritional resilience were child younger age, normal birth weight, actively hand- or spoon-feeding when the child was below two years, and residential stability in the past two years. The only factor associated with nutritional vulnerability was lower total score on the mother's General Health Questionnaire, which we interpret as a marker of maternal mental health.
Children with low-birth weight and older children had worse nutritional resiliency outcomes. Further, poorer outcomes for children were associated with lower maternal mental health status, as well as increased family residential instability. Our results add to the large literature on the pervasive effects of violence and instability on children and underscore the need for resources for early intervention and for the urgent resolution of the Palestinian and other armed conflicts.
PMCID: PMC3268107  PMID: 22236142
7.  Mental Health and Resilience in HIV/AIDS-Affected Children: A Review of the Literature and Recommendations for Future Research 
To date, research on mental health in HIV-affected children (children who have an HIV-positive caregiver or live with the virus themselves) has focused on risk factors associated with the disease. However, simultaneous identification of factors that contribute to resilience in the face of risks is also needed. A greater understanding of modifiable protective processes that contribute to resilience in the mental health of children affected by HIV can inform the design of interventions that bolster naturally-occurring supports and contribute to early prevention or better management of risks.
We reviewed the recent literature on mental health and resilience in children and adolescents affected by HIV/AIDS. Literature searches of PsycInfo and PubMed were conducted during July-December 2011 consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Qualitative and quantitative studies were included for review if primary research questions pertained to mental health and coping or protective processes in children and families affected by HIV/AIDS. All studies subject to full review were evaluated for quality using a modified Systematic Assessment of Quality in Observational Research (SAQOR) rating system.
171 unique studies were returned from online searches of the literature and bibliography mining. Of these, 29 were evaluated as pertaining directly to mental health and resilience in families and children living with HIV/AIDS. Eight studies presented qualitative analyses. Ten quantitative studies examined individual resources contributing to child resilience and four quantitative studies looked at family-level resources. Ten studies also investigated community-level interactions. Four presented findings from resilience-focused interventions.
There is a clear need for rigorous research on mental health and resilience in HIV-affected children and adolescents. The evidence base would greatly benefit from more standardized and robust approaches to thinking about resilience from an ecological perspective inclusive of resources at multiple levels and their interactions.
PMCID: PMC3656822  PMID: 22943414
HIV/AIDS; Children; Families; Resilience; Mental Health
8.  Genotype and Neuropsychological Response Inhibition as Resilience Promoters for ADHD, ODD, and CD under Conditions of Psychosocial Adversity 
Development and psychopathology  2007;19(3):767-786.
Whereas child personality, IQ, and family factors have been identified as enabling a resilient response to psychosocial adversity, more direct biological resilience factors have been less well delineated. This is particularly so for child ADHD, which has received less attention from a resilience perspective than have associated externalizing disorders. Children from two independent samples were classified as resilient if they avoided developing ADHD, ODD, or CD in the face of family adversity. Two protective factors were examined for their potential relevance to prefrontal brain development: neuropsychological response inhibition, as assessed by the Stop task, and a composite catecholamine genotype risk score. Resilient children were characterized in both samples by more effective response inhibition, although the effect in the second sample was very small. Genotype was measured in Sample 1, and a composite high risk genotype index was developed by summing presence of risk across markers on three genes expressed in prefrontal cortex: dopamine transporter, dopamine D4 receptor, and noradrenergic alpha 2 receptor. Genotype was a reliable resilience indicator against development of ADHD and CD, but not ODD, in the face of psychosocial adversity. Results illustrate potential neurobiological protective factors related to development of prefrontal cortex that may enable children to avoid developing ADHD and CD in the presence of psychosocial adversity.
PMCID: PMC2291356  PMID: 17705902
9.  Parental Protectiveness and Unprotected Sexual Activity Among Latino Adolescent Mothers and Fathers 
AIDS Education and Prevention  2009;21(5 Suppl):88-102.
Latino pregnant and parenting adolescents living in inner cities are one of the populations at risk for acquiring HIV. Although teen parenthood has been predominantly looked at with a focus on potential adverse physical, emotional, and socioeconomic outcomes for the mother and child; a growing body of literature has documented the strengths and resiliency of young parents. Respeto/Proteger: Respecting and Protecting Our Relationships is a culturally rooted couple-focused and asset-based HIV prevention program developed for young Latino parents. In this program, parental protectiveness (defined as the parent-child emotional attachment that positively influences parental behavior) is viewed as an intrinsic and developing critical factor that supports resiliency and motivates behavioral change. The primary purpose of this article is to describe the longitudinal randomized study evaluating the effect of this intervention on unprotected vaginal sex 6 months post intervention and to determine whether parental protectiveness had a moderating effect on the intervention. The unique features of our database allow for examination of both individual and couple outcomes.
PMCID: PMC3368270  PMID: 19824837
10.  Impact of Early-Life Stress and Resilience on Patients with Major Depressive Disorder 
Yonsei Medical Journal  2012;53(6):1093-1098.
Early-life stress (ELS) has a long-lasting effect on affective function and may entail an increased risk for major depressive disorder (MDD). However, resilience can play a protective role against developing psychopathology. In this study, we investigated the relationships of depressive symptoms with ELS and resilience in MDD.
Materials and Methods
Twenty-six patients with MDD as well as age- and gender-matched healthy controls were included in this study. Each subject was assessed concerning ELS, resilience, and depressive symptom severity with self-report questionnaires. Independent samples t-test and Mann-Whitney test were performed to compare ELS and resilience between the patient and control groups. Spearman correlation analyses and linear regression analysis were conducted to investigate significant ELS and resilience factors associated with depressive symptoms.
In the MDD patient group, subjects reported greater exposure to inter-parental violence, and five factor scores on the resilience scale were significantly lower in comparison to the control group. In linear regression analysis, in regards to resilience, depressive symptom score was significantly associated with self-confidence and self-control factors; however, ELS demonstrated no significant association with depressive symptoms.
Among resilience factors, self-confidence and self-control may ameliorate depressive symptoms in MDD. ELS, including inter-parental violence, physical abuse and emotional abuse, might be a risk factor for developing depression. Assessment of early-life stress and intervention programs for increasing resilience capacity would be helpful in treating MDD.
PMCID: PMC3481369  PMID: 23074107
Resilience; self-confidence; self-control; inter-parental violence; depressive disorder
11.  Resiliency and survival skills among newly homeless adolescents: Implications for future interventions 
Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between HIV-related risk factors and resiliency (survival skills) of homeless adolescents over a 2-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.
PMCID: PMC3248916  PMID: 22216061
homeless adolescents; resiliency; survival skills
12.  A Longitudinal Examination of Support, Self-esteem, and Mexican-origin Adolescent Mothers’ Parenting Efficacy 
Journal of marriage and the family  2013;75(3):10.1111/jomf.12019.
Guided by a risk and resilience framework, this study used a prospective longitudinal, multiple-reporter design to examine how social support from a mother figure during pregnancy interacted with Mexican-origin adolescent mothers’ self-esteem to inform their parenting efficacy when their children were 10 months old. Using reports of perceived social support by adolescent mothers (Mage = 16.24, SD =099) and their mother figures (Mage = 40.84, SD = 7.04) in 205 dyads, and controlling for demographic factors (i.e., adolescent age, adolescent nativity, family income, mothers’ educational attainment, adolescent-mother coresidence) and adolescents’ social support from a significant other, findings indicated that social support during pregnancy was positively associated with adolescent mothers’ future parenting efficacy when adolescent mothers had relatively lower self-esteem. Findings were consistent for adolescents’ and mothers’ reports, and emphasize the value of social support from a mother figure among adolescent mothers with lower self-esteem. Implications for interventions are presented.
PMCID: PMC3828037  PMID: 24244049
adolescent mothers; Latino; Mexican-origin; parenting efficacy; social support
13.  Acculturation and Life Satisfaction Among Immigrant Mexican Adults 
Advances in social work  2013;14(1):49-64.
The numbers of Mexican Americans living in the United States, many of whom are first generation immigrants, are increasing. The process of immigration and acculturation can be accompanied by stress, as an individual attempts to reconcile two potentially competing sets of norms and values and to navigate a new social terrain. However, the outcomes of studies investigating the relationship between levels of acculturation and well-being are mixed. To further investigate the dynamic of acculturation, this article will address the impact of acculturation and familismo, on reported life satisfaction and resilience among Mexican American adults living in the Southwest (N=307), the majority (89%) of which are immigrants. The findings indicate that bilingual individuals report significantly higher levels of life satisfaction and resilience than their Spanish-speaking counterparts do. Speaking primarily English only predicted higher levels of resilience but not life satisfaction. Implications for social work practice with Mexican American immigrants are discussed.
PMCID: PMC3881437  PMID: 24403865
Acculturation; Mexican-American; life satisfaction; resilience
14.  Resilience, an Evolving Concept: A Review of Literature Relevant to Aboriginal Research 
Pimatisiwin  2008;6(2):7-23.
Resilience has been most frequently defined as positive adaptation despite adversity. Over the past 40 years, resilience research has gone through several stages. From an initial focus on the invulnerable or invincible child, psychologists began to recognize that much of what seems to promote resilience originates outside of the individual. This led to a search for resilience factors at the individual, family, community — and, most recently, cultural — levels. In addition to the effects that community and culture have on resilience in individuals, there is growing interest in resilience as a feature of entire communities and cultural groups. Contemporary researchers have found that resilience factors vary in different risk contexts and this has contributed to the notion that resilience is a process. In order to characterize the resilience process in a particular context, it is necessary to identify and measure the risk involved and, in this regard, perceived discrimination and historical trauma are part of the context in many Aboriginal communities. Researchers also seek to understand how particular protective factors interact with risk factors and with other protective factors to support relative resistance. For this purpose they have developed resilience models of three main types: “compensatory,” “protective,” and “challenge” models. Two additional concepts are resilient reintegration, in which a confrontation with adversity leads individuals to a new level of growth, and the notion endorsed by some Aboriginal educators that resilience is an innate quality that needs only to be properly awakened.
The review suggests five areas for future research with an emphasis on youth: 1) studies to improve understanding of what makes some Aboriginal youth respond positively to risk and adversity and others not; 2) case studies providing empirical confirmation of the theory of resilient reintegration among Aboriginal youth; 3) more comparative studies on the role of culture as a resource for resilience; 4) studies to improve understanding of how Aboriginal youth, especially urban youth, who do not live in self-governed communities with strong cultural continuity can be helped to become, or remain, resilient; and 5) greater involvement of Aboriginal researchers who can bring a nonlinear world view to resilience research.
PMCID: PMC2956753  PMID: 20963184 CAMSID: cams387
15.  Gene by Environment Interaction and Resilience: Effects of Child Maltreatment and Serotonin, Corticotropin Releasing Hormone, Dopamine, and Oxytocin Genes 
Development and psychopathology  2012;24(2):411-427.
In this investigation, gene-environment interaction effects in predicting resilience in adaptive functioning among maltreated and nonmaltreated low-income children (N = 595) were examined. A multi-component index of resilient functioning was derived and levels of resilient functioning were identified. Variants in four genes, 5-HTTLPR, CRHR1, DRD4 -521C/T, and OXTR, were investigated. In a series of ANCOVAs, child maltreatment demonstrated a strong negative main effect on children’s resilient functioning, whereas no main effects for any of the genotypes of the respective genes were found. However, gene-environment interactions involving genotypes of each of the respective genes and maltreatment status were obtained. For each respective gene, among children with a specific genotype, the relative advantage in resilient functioning of nonmaltreated compared to maltreated children was stronger than was the case for nonmaltreated and maltreated children with other genotypes of the respective gene. Across the four genes, a composite of the genotypes that more strongly differentiated resilient functioning between nonmaltreated and maltreated children provided further evidence of genetic variations influencing resilient functioning in nonmaltreated children, whereas genetic variation had a negligible effect on promoting resilience among maltreated children. Additional effects were observed for children based on the number of subtypes of maltreatment children experienced, as well as for abuse and neglect subgroups. Finally, maltreated and nonmaltreated children with high levels of resilience differed in their average number of differentiating genotypes. These results suggest that differential resilient outcomes are based on the interaction between genes and developmental experiences.
PMCID: PMC3684053  PMID: 22559122
16.  Resilience and the course of daily parenting stress in families of young children with intellectual disabilities 
Parenting stresses have consistently been found to be higher in parents of children with intellectual disabilities (ID); yet, some families are able to be resilient and thrive in the face of these challenges. Despite the considerable research on stress in families of ID, there is still little known about the stability and compensatory factors associated with everyday parenting stresses.
Trajectories of daily parenting stress were studied for both mothers and fathers of children with ID across child ages 36–60 months, as were specific familial risk and resilience factors that affect these trajectories, including psychological well-being of each parent, marital adjustment and positive parent–child relationships.
Mothers’ daily parenting stress significantly increased over time, while fathers’ daily parenting stress remained more constant. Decreases in mothers’ daily parenting stress trajectory were associated with both mother and father’s well-being and perceived marital adjustment, as well as a positive father–child relationship. However, decreases in fathers’ daily parenting stress trajectory were only affected by mother’s well-being and both parents’ perceived marital adjustment.
Parenting stress processes are not shared entirely across the preschool period in parents of children with ID. Although individual parent characteristics and high-quality dyadic relationships contribute to emerging resilience in parents of children with ID, parents also affect each others’ more resilient adaptations in ways that have not been previously considered.
PMCID: PMC2796238  PMID: 19874449
fathers; intellectual disability; mothers; parenting stress; resilience
17.  Motivation, Management, and Mastery: A Theory of Resilience in the Context of HIV Infection 
Clients with HIV infection have been conceptualized as a resilient population. Although a few researchers have documented resilience among clients with HIV infection, a theory of resilience in the context of HIV infection has not been developed. The purpose of this study was to describe the process by which resilience occurs for clients in the context of HIV infection.
Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews with adults with HIV infection. Data were collected until saturation was reached.
A theory, motivation, management, and mastery, a description of the process by which resilience occurs in the context of HIV infection, emerged from the data.
Many clients living with HIV infection are resilient, despite the physical, psychological, and social challenges of this chronic illness. Nursing interventions to promote resilience among clients with HIV infection should be directed toward identification of client motivation factors and disease management strategies that may influence health outcomes of people living with HIV infection.
PMCID: PMC3773721  PMID: 23392433
AIDS; HIV infection; resilience
18.  The mental health of children affected by armed conflict: Protective processes and pathways to resilience 
This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain ‘invulnerable’ children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology.
PMCID: PMC2613765  PMID: 18569183
19.  A Whole Community Approach toward Child and Youth Resilience Promotion: A Review of Resilience Literature 
A literature review of child and youth resilience with a focus on: definitions and factors of resilience; relationships between resilience, mental health and social outcomes; evidence for resilience promoting interventions; and implications for reducing health inequities. To conduct the review, the first two following steps were conducted iteratively and informed the third step: 1) Review of published peer-review literature since 2000; and 2) Review of grey literature; and 3) Quasi-realist synthesis of evidence. Evidence from three perspectives were examined: i) whether interventions can improve ‘resilience’ for vulnerable children and youth; ii) whether there is a differential effect among different populations; and, iii) whether there is evidence that resilience interventions ‘close the gap’ on health and social outcome measures. Definitions of resilience vary as do perspectives on it. We argue for a hybrid approach that recognizes the value of combining multiple theoretical perspectives, epistemologies (positivistic and constructivist/interpretive/critical) in studying resilience. Resilience is: a) a process (rather than a single event), b) a continuum (rather than a binary outcome), and c) likely a global concept with specific dimensions. Individual, family and social environmental factors influence resilience. A social determinants perspective on resilience and mental health is emphasized. Programs and interventions to promoting resilience should be complimentary to public health measures addressing the social determinants of health. A whole community approach to resilience is suggested as a step toward closing the public health policy gap. Local initiatives that stimulate a local transformation process are needed. Recognition of each child’s or youth’s intersections of gender, lifestage, family resources within the context of their identity markers fits with a localized approach to resilience promotion and, at the same time, requires recognition of the broader determinants of population health.
PMCID: PMC3913859  PMID: 24523668
Resilience; Child; Youth; Mental Health Promotion; Social Determinants of Health; Health Equity; Literature Review
20.  Determinants of resilience to cigarette smoking among young Australians at risk: an exploratory study 
Numerous researchers studied risk factors associated with smoking uptake, however, few examined protective factors associated with smoking resilience. This study therefore aims to explore determinants of smoking resilience among young people from lower socioeconomic backgrounds who are at risk of smoking.
Overall, 92 out of 92 vocational education students accepted invitation to participate in this exploratory study. The Adelaide Technical and Further Education (TAFE) Arts campus was chosen for the study given the focus on studying resilience in young people of lower socioeconomic status i.e. resilient despite the odds. A self-report questionnaire comprising a measure of resilience: sense of coherence, sense of humour, coping styles, depression, anxiety and stress, and family, peers and community support, was distributed among participants aged 15 to 29. Additional factors researched are parental approval and disapproval, course type, and reasons for not smoking. Using the Statistical Package for the Social Sciences (SPSS, version 13.0), analyses were undertaken using frequencies, means, standard deviations, independent sample t-tests, correlations, analysis of variance, logistic regression, and chi-square test.
Twenty five (27%) out of 92 students smoked. Young people with peer support tended to smoke (p < .05). A relationship between daily smoking and depression, anxiety and stress was also found (p < .05). When both mothers and fathers disapproved of their children smoking, it had a greater influence on females not smoking, compared with males. The majority of students chose 'health and fitness' as a reason for not smoking. Students in the Dance course tended to not smoke.
The current study showed that most students chose 'health and fitness' as the reason for not smoking. Single anti-smoking messages cannot be generalised to all young people, but should recognise that people within different contexts, groups and subcultures will have different reasons for choosing whether or not to smoke. Future studies should use larger samples with a mixed methods design (quantitative and qualitative).
PMCID: PMC2914043  PMID: 20609260
21.  Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: A cumulative stressors model 
Child abuse & neglect  2007;31(3):231-253.
Children who are physically maltreated are at risk of a range of adverse outcomes in childhood and adulthood, but some children who are maltreated manage to function well despite their history of adversity. Which individual, family, and neighborhood characteristics distinguish resilient from non-resilient maltreated children? Do children’s individual strengths promote resilience even when children are exposed to multiple family and neighborhood stressors (cumulative stressors model)?
Data were from the Environmental Risk Longitudinal Study which describes a nationally-representative sample of 1,116 twin pairs and their families. Families were home-visited when the twins were 5 and 7 years old, and teachers provided information about children’s behavior at school. Interviewers rated the likelihood that children had been maltreated based on mothers’ reports of harm to the child and child welfare involvement with the family. Results: Resilient children were those who engaged in normative levels of antisocial behavior despite having been maltreated. Boys (but not girls) who had above-average intelligence and whose parents had relatively few symptoms of antisocial personality were more likely to be resilient versus non-resilient to maltreatment. Children whose parents had substance use problems and who lived in relatively high crime neighborhoods that were low on social cohesion and informal social control were less likely to be resilient versus non-resilient to maltreatment. Consistent with a cumulative stressors model of children’s adaptation, individual strengths distinguished resilient from non-resilient children under conditions of low, but not high, family and neighborhood stress.
These findings suggest that for children residing in multi-problem families, personal resources may not be sufficient to promote their adaptive functioning.
PMCID: PMC1978062  PMID: 17395260
Resilient maltreated children; Non-resilient maltreated children; Cumulative stressors model
22.  The role of resilience on psychological adjustment and physical health in patients with diabetes 
British journal of health psychology  2007;13(Pt 2):311-325.
This study used a longitudinal design to investigate the buffering role of resilience on worsening HbA1c and self-care behaviours in the face of rising diabetes-related distress.
A total of 111 patients with diabetes completed surveys and had their glycosylated hemoglobin (HbA1c) assessed at baseline and 1-year follow-up. Resilience was defined by a factor score of self-esteem, self-efficacy, self-mastery, and optimism. Diabetes-related distress and self-care behaviours were also assessed.
Baseline resilience, diabetes-related distress, and their interaction predicted physical health (HbA1c) at 1-year. Patients with low, moderate, and high resilience were identified. Those with low or moderate resilience levels showed a strong association between rising distress and worsening HbA1c across time (r=.57, .56, respectively). However, those with high resilience scores did not show the same associations (r=.08). Low resilience was also associated with fewer self-care behaviours when faced with increasing distress (r= −.55). These correlation coefficients remained significant after controlling for starting points.
In patients with diabetes, resilience resources predicted future HbA1c and buffered worsening HbA1c and self-care behaviours in the face of rising distress levels.
PMCID: PMC2899486  PMID: 17535497
23.  The association between resilience and survival among Chinese elderly 
Demographic research  2010;23(5):105-116.
Based on the unique longitudinal data of the elderly aged 65+ with a sufficiently large sub-sample of the oldest-old aged 85+ from the Chinese Longitudinal Healthy Longevity Survey, we construct a resilience scale with 7 indicators for the Chinese elderly, based on the framework of the Connor-Davidson Resilience Scale. Cox proportional hazards regression model estimates show that, after controlling for socio-demographic characteristics and initial health status, the total resilience score and most factors of the resilience scale are significantly associated with reduced mortality risk among the young-old and oldest-old. Although the causal mechanisms remain to be investigated, effective measures to promote resilience are likely to have a positive effect on longevity of the elderly in China.
PMCID: PMC2990503  PMID: 21113419
24.  Maternal drug abuse versus maternal depression: Vulnerability and resilience among school-age and adolescent offspring 
Development and psychopathology  2007;19(1):205-225.
In this study of 360 low-income mother-child dyads, our primary goal was to disentangle risks linked with commonly co-occurring maternal diagnoses: substance abuse and affective/anxiety disorders. Variable- and person-based analyses suggest that, at least through children’s early adolescence, maternal drug use is no more inimical for them than is maternal depression. A second goal was to illuminate vulnerability and protective processes linked with mothers’ everyday functioning, and results showed that negative parenting behaviors were linked with multiple adverse child outcomes. Conversely, the other parenting dimensions showed more domain specificity; parenting stress was linked with children’s lifetime diagnoses, and limit setting and closeness with children’s externalizing problems and everyday competence, respectively. Results are discussed in terms of implications for resilience theory, interventions, and social policy.
PMCID: PMC1933495  PMID: 17241491
25.  Early School Outcomes for Children of Postpartum Depressed Mothers: Comparison with a Community Sample 
Previous studies of the long-term effects of maternal postpartum depression (PPD) on child development have mostly focused on a limited set of outcomes, and have often not controlled for risk factors associated with maternal depression. The present study compared children of postpartum depressed mothers (n = 29) with children from a community sample (n = 113) in terms of a broad range of developmental outcomes in the early school period. Controlling for risk factors associated with maternal depression, we found that children of postpartum depressed mothers had lower ego-resiliency, lower peer social competence, and lower school adjustment than the community sample children. In addition, girls of postpartum depressed mothers showed lower verbal intelligence, and, unexpectedly, showed fewer externalizing problems than their counterparts in the community sample. Results show that children’s capacities to deal with stress and interact with peers in the early school period may be particularly affected by their mothers’ PPD.
PMCID: PMC3303034  PMID: 22011810
Maternal depression; Postpartum depression; Early school age; Child development

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