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1.  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
2.  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
3.  Self-rated health, life-style, and psychoendocrine measures of stress in healthy adult women 
Upsala Journal of Medical Sciences  2010;115(4):266-274.
Self-rated health (SRH) is a robust predictor of subsequent health outcome, independent of objective health measures and life-style-related health risk factors. However, the determinants of SRH are as yet largely unknown. In accordance with the prevailing stress theory, we hypothesized that SRH is associated with personal coping resources, psychological strain, life-style variables, and endocrine variables.
A total of 106 healthy women, 22–59 years of age, were followed for up to 3 years with annual blood sampling (cortisol, prolactin, testosterone) and written questionnaires in which information on SRH, psychological strain, coping resources, socio-economic and life-style variables was sought.
In bivariate, screening logistic regression analyses, intended to find candidate variables for a final analysis model, all coping resource variables (sense of coherence, mastery, and self-esteem) were significantly related to SRH, and so were two psychological strain variables (vital exhaustion, and sleep disturbances), one life-style variable (fitness), but none of the endocrine variables. In the final multivariate analysis model, including all candidate variables, only vital exhaustion (P < 0.0001), fitness (P = 0.0002), and sense of coherence (P = 0.0006) were independently associated with SRH, together explaining 74% of the SRH variance.
Some elements of the hypothesis, i.e. the effects of coping resources, psychological strain, and life-style variables on SRH, were supported by the results, while others, i.e. effects of endocrine measures on SRH, were not, indicating a possible gender difference.
PMCID: PMC2971485  PMID: 20977316
Cortisol; prolactin; self-rated health; sense of coherence; testosterone; vital exhaustion
4.  A Review on the Psychobiology of Dementia Caregiving: A Focus on Resilience Factors 
Current psychiatry reports  2011;13(3):219-224.
The recent aging trend in the United States has resulted in an exponential growth in the number of informal dementia caregivers. Caring for a family member with dementia has been associated with negative health outcomes likely associated with physiologic changes resulting from stress. Yet caregiving is not always associated with health morbidity. In this review, we highlight resilience factors that appear to have a beneficial relationship with health outcomes. We highlight eleven studies that examined the relationship of one of three broad resilience domains (personal mastery, self-efficacy, and coping style) to caregiver health outcomes. Our main findings were that higher levels of personal mastery and self-efficacy, and increased use of positive coping strategies appear to have a protective effect on various health outcomes in dementia caregivers. Continued research is warranted to help guide prospective directions for caregiver interventions focusing on increasing caregiver resilience and the corresponding impact on caregiver health.
PMCID: PMC3182821  PMID: 21312008
Biomarkers; caregivers; resilience; health; coping; stress; morbidity
5.  The CIET Aboriginal Youth Resilience Studies: 14 Years of Capacity Building and Methods Development in Canada 
Pimatisiwin  2008;6(2):65-88.
CIET started supporting Canadian Aboriginal community-based researchers of resilience in 1995. An evolving approach to Aboriginal resilience used a combination of standard instruments and questionnaires of local design. Over the years, CIET measured personal assets like sense of coherence, spirituality, knowledge, pride in one’s heritage, mastery or self-efficacy, self-esteem, low levels of distress, involvement in traditional ways and activities, church attendance. Other indicators reflected the social dimension of resilience: feeling supported; parental care and support; parental monitoring, attitudes, and example; peer support; and support from the wider community.
Pride in one’s heritage, self-esteem, low distress, and mastery were measurable personal assets of resilient Aboriginal youth in a variety of cultures and circumstances. Early efforts to link resilience with specific features of culture or spirituality did not meet with success — largely reflecting failure to ask the right questions. Parental care and support, parental monitoring, parental attitudes, and parental example clearly supported the resilient Aboriginal youth in most settings. But peers are an even stronger influence, critical in relation to different types of behaviour from smoking to drinking to substance abuse to violence, unsafe sex, and suicidal tendencies. More generally, having someone to confide in, to count on in times of crisis, someone to give advice and someone who makes one feel cared for are important factors in youth resilience and something that communities can help to provide even where the family is not the support it should be and where peers are more of a hindrance than a help.
CIET currently supports three resilience research projects involving Aboriginal youth in Canada: suicide prevention, reduction of HIV risk, and reduction of domestic violence. The latest resilience measurement tools include enculturation and revised approaches to Aboriginal spirituality.
PMCID: PMC2942846  PMID: 20862230 CAMSID: cams1051
6.  Adaptive Coping under Conditions of Extreme Stress: Multi-Level Influences on the Determinants of Resilience in Maltreated Children 
The study of resilience in maltreated children reveals the possibility of coping processes and resources on multiple levels of analysis, as children strive to adapt under conditions of severe stress. In a maltreating context, aspects of self-organization, including self esteem, self reliance, emotion regulation, and adaptable yet reserved personalities appear particularly important for more competent coping. Moreover, individual differences in biological processes ranging from gene by environment interactions to the HPA axis to brain organization related to emotion also are shown to influence the resilience in maltreated youth, highlighting the multi-faceted contributions to successful coping.
PMCID: PMC3713632  PMID: 19536787
7.  Coping and resilience in adolescents with type 1 diabetes 
Adolescents with type 1 diabetes (T1D) must cope with the ongoing stress of treatment management, so it is important to identify the most adaptive coping strategies. Previous studies, however, have typically measured broad categories of coping (e.g. approach/avoidance) and few used instruments specifically designed for this population.
This article aimed to use a developmentally sensitive coping measure to explore how the use of specific coping strategies impacts resilience (i.e. quality of life, competence and metabolic control) in adolescents with T1D.
Thirty adolescents with T1D between the ages of 10 and 16 and their mothers completed questionnaires on adolescents’ coping strategy use, competence and quality of life. Clinical data (i.e. HbA1c) were obtained from adolescents’ medical records.
Greater use of primary control coping strategies (e.g. problem solving, emotional expression) was associated with higher competence scores, better quality of life and better metabolic control. Secondary control coping strategies (e.g. acceptance, distraction) were related to higher social competence, better quality of life and better metabolic control. Finally, the use of disengagement coping strategies (e.g. withdrawal or denial) was linked with lower competence and poorer metabolic control.
The results of this study support the use of developmentally sensitive coping measures by researchers and clinicians to determine the most effective coping strategies for adolescents with T1D.
PMCID: PMC3134245  PMID: 21143270
adolescent development; diabetes mellitus; resilience; type 1
8.  Personality and Dietary Intake – Findings in the Helsinki Birth Cohort Study 
PLoS ONE  2013;8(7):e68284.
Personality traits are associated with health outcomes including non-communicable diseases. This could be partly explained by lifestyle related factors including diet. The personality traits neuroticism, extraversion, openness, agreeableness, and conscientiousness are linked with resilience, meaning adaptability in challenging situations. Resilient people usually comply with favorable health behaviors.
Our objective was to explore the associations between food and nutrient intake, personality traits and resilience.
A validated semi-quantitative food frequency questionnaire was used to measure diet and the NEO-personality inventory to assess personality in 1681 subjects. Linear regression analysis was used to explore diet-personality associations and cluster analysis to define resilient and non-resilient personality profiles.
Adjusting for age, education and energy intake, and applying Bonferroni corrections, openness in men was associated with higher vegetable (14.9 g/d for 1 SD increase in the personality score, PBonf <0.01) and lower confectionery and chocolate (−2.8 g/d, PBonf <0.01) intakes. In women, neuroticism was associated with lower fish (−4.9 g/d, PBonf <0.001) and vegetable (−18.9 g/d, PBonf <0.01) and higher soft drink (19.9 g/d, PBonf <0.001) intakes. Extraversion, in women, associated with higher meat (5.9 g/d, PBonf <0.05) and vegetable (24.8 g/d, PBonf<0.001) intakes, openness with higher vegetable (23.4 g/d, PBonf <0.001) and fruit (29.5 g/d, PBonf <0.01) intakes. Agreeableness was associated with a lower soft drink (−16.2 g/d, PBonf <0.01) and conscientiousness with a higher fruit (32.9 g/d, PBonf<0.01) intake in women. Comparing resilient and non-resilient subjects, we found resilience in women to be associated with higher intakes of vegetables (52.0 g/d, P<0.001), fruits (58.3 g/d, P<0.01), fish (8.6 g/d, P<0.01) and dietary fiber (1.6 g/d, P<0.01).
Personality traits are associated with dietary intake and especially subjects with resilient personality profiles had healthier dietary intakes. These associations were stronger in women than in men.
PMCID: PMC3715473  PMID: 23874573
9.  The relationship between resilience and personality traits in doctors: implications for enhancing well being 
PeerJ  2013;1:e216.
Objective. The health and well being of medical doctors is vital to their longevity and safe practice. The concept of resilience is recognised as a key component of well being and is an important factor in medical training to help doctors learn to cope with challenge, stress, and adversity. This study examined the relationship of resilience to personality traits and resilience in doctors in order to identify the key traits that promote or impair resilience.
Methods. A cross sectional cohort of 479 family practitioners in practice across Australia was studied. The Temperament and Character Inventory measured levels of the seven basic dimensions of personality and the Resilience Scale provided an overall measure of resilience. The associations between resilience and personality were examined by Pearson product-moment correlation coefficients, controlling for age and gender (α = 0.05 with an accompanying 95% confidence level) and multiple regression analyses.
Results. Strong to medium positive correlations were found between Resilience and Self-directedness (r = .614, p < .01), Persistence (r = .498, p < .01), and Cooperativeness (r = .363, p < .01) and negative with Harm Avoidance (r = .−555, p < .01). Individual differences in personality explained 39% of the variance in resilience [F(7, 460) = 38.40, p < .001]. The three traits which contributed significantly to this variance were Self-directedness (β = .33, p < .001), Persistence (β = .22, p < .001) and Harm Avoidance (β = .19, p < .001).
Conclusion. Resilience was associated with a personality trait pattern that is mature, responsible, optimistic, persevering, and cooperative. Findings support the inclusion of resilience as a component of optimal functioning and well being in doctors. Strategies for enhancing resilience should consider the key traits that drive or impair it.
PMCID: PMC3840414  PMID: 24282675
Temperament; Resilience; Character; Well being; Doctors
10.  How Does Anger Coping Style Affect Glycemic Control in Diabetes Patients? 
Although various forms of anger have been found to influence the psychological and physical health in many chronic illness populations, little is known about the effects of anger in diabetes patients.
Associations between anger coping style, diabetes-related psychological distress, and glycosylated hemoglobin (HbA1c) were examined in 100 diabetes patients.
Participants completed the Problem Areas in Diabetes and Coping Styles questionnaires, and had HbA1c assessments at study entry (Time 1=T1), six months (T2), and 12 months after T1 (T3).
Linear regression analyses revealed T1 anger coping associated with T3 HbA1c (β=.22, p<.05) but T1 HbA1c did not associate with T3 anger coping (β=.13, p=NS). After controlling for significant covariates (of gender, age, education, type and duration of diabetes), regression analyses revealed that T2 diabetes-related psychological distress partially mediated this association.
These results suggested that higher levels of anger coping may promote poorer HbA1c in diabetes patients by provoking greater diabetes-related distress. Areas of future research on this topic are discussed.
PMCID: PMC2900155  PMID: 18696309
anger coping; psychological distress; glycemic control; diabetes
11.  The efficacy of resilience training programs: a systematic review protocol 
Systematic Reviews  2014;3:20.
Resilience has been defined as the ability of individuals to manage and adapt to stress and life challenges. Training programs that develop and/or enhance resilience may have efficacy in improving health, well-being, and quality of life. Because patients with chronic conditions must reliably self-manage their health, strategies to bolster resilience in this population may be of particular value. The objectives of this systematic review are to synthesize the evidence of resilience training program efficacy in improving outcomes related to quality of life, self-efficacy and activation, and resilience and coping ability in: 1) diverse adult populations; and 2) patients with chronic conditions.
We will conduct a systematic review of randomized controlled trials assessing the efficacy of any program designed to enhance resilience in adults that measure any outcome against any comparator. We will search multiple electronic databases, trial registries, bibliographies, and will contact authors and experts to identify studies. We will use systematic review software to independently and in duplicate screen reports and extract data. We will extract characteristics of the study populations, interventions, comparators, outcomes, and quality/risk of bias. Primary, patient reported outcomes will be categorized into domains of quality of life, self-efficacy, and resilience. Secondary outcomes will be considered based on findings of the review. We will attempt meta-analysis by pooling standardized mean differences and minimally important differences (MIDs), when possible. Planned trial subgroup analyses are: 1) studies of patients with chronic conditions; 2) studies with placebo controls; 3) studies with similar intervention characteristics; and 4) studies with common lengths of follow-up.
This study is intended to accumulate the evidence for resilience training programs in improving quality of life, resilience, and self-efficacy for care management, particularly among adult patients with chronic conditions. Its findings will be valuable to policy-makers, funding agencies, clinicians, and patients seeking innovative and effective ways to achieve patient-centered care.
Trial registration
PROSPERO registration number: CRD42014007185.
PMCID: PMC3946765  PMID: 24602236
Resilience; Resilience training; Systematic review; Randomized controlled trials
12.  Intrinsic component of resilience among entry level medical students in the United Arab Emirates 
The Australasian Medical Journal  2011;4(10):548-554.
Resilience is the capacity to recover and to cope successfully with everyday challenges. Resilience has intrinsic and extrinsic components and an effort has been made to study the intrinsic component and its association with sociodemographic factors, among the entry level students of the Integrated Bachelor of Medicine and Bachelor of Surgery (MBBS) course.
The present study was conducted in Gulf Medical University, using a self-administered questionnaire, comprising of two parts, distributed to all the students who consented to participate. The first part contained questions on socio-demographic details while the second part contained questions on the intrinsic and extrinsic components of resilience of the students. The data collected was analysed using Predictive Analytic Software (PASW) 18.0 using frequency, mean, SD and median.
Among the 58 students who participated 24 (41.4%) were males and 34 (58.6%) females, of which 70.7% were < 20 years and 29.3% ≥ 20years. The mean score for the intrinsic component of resilience was 48.9 (SD, 5 and range 35–60). The median scores showed no significant variation (p<0.05) with age, gender, religion, nationality, family structure, highest education among parents, the person they share their feelings with or the number of friends. However, minimally higher scores were noted in the median scores of students from nuclear families, with Western nationality and those whose parents had a university level education, who shared their feelings with people of their own generation or outside their family and who have 5–9 friends.
The intrinsic component of resilience was found to be almost uniform for the study group and the level is high. A study has to further look into its effect on coping with the stresses encountered during the academic year.
PMCID: PMC3562876  PMID: 23386866
Intrinsic component of resilience; medical students; socio-demographiccharacteristics; number of friends; sharing feelings
13.  Coping Styles, Well-Being and Self-Care Behaviors Among African Americans With Type 2 Diabetes 
The Diabetes educator  2008;34(3):501-510.
The purpose of this study was to describe how coping styles among African Americans with type 2 diabetes relate to diabetes appraisals, self-care behaviors, and health-related quality of life or well-being.
This cross-sectional analysis of baseline measures from 185 African Americans with type 2 diabetes enrolled in a church-based randomized controlled trial uses the theoretical framework of the transactional model of stress and coping to describe bivariate and multivariate associations among coping styles, psychosocial factors, self-care behaviors, and well-being, as measured by validated questionnaires.
Among participants who were on average 59 years of age with 9 years of diagnosed diabetes, passive and emotive styles of coping were used most frequently, with older and less educated participants using more often passive forms of coping. Emotive styles of coping were significantly associated with greater perceived stress, problem areas in diabetes, and negative appraisals of diabetes control. Both passive and active styles of coping were associated with better diabetes self-efficacy and competence in bivariate analysis. In multivariate analysis, significant proportions of the variance in dietary behaviors and mental well-being outcomes (general and diabetes specific) were explained, with coping styles among the independent predictors. A positive role for church involvement in the psychological adaptation to living with diabetes was also observed.
In this sample of older African Americans with diabetes, coping styles were important factors in diabetes appraisals, self-care behaviors, and psychological outcomes. These findings suggest potential benefits in emphasizing cognitive and behavioral strategies to promote healthy coping outcomes in persons living with diabetes.
PMCID: PMC2668814  PMID: 18535323
14.  Personal Risk and Resilience Factors in the Context of Daily Stress 
This chapter focuses on the role that personal risk and resilience factors play as adults of all ages cope with the stressors encountered in everyday life. Theorists have suggested that researchers should focus on the effects of daily stress and coping rather than focusing exclusively on major life events and chronic stress and have proposed that understanding how adults cope with daily stress is a key aspect of understanding long-term well-being and adaptation in adulthood. After presenting a conceptual model outlining the major components of the daily stress process, the chapter reviews the existing empirical literature on personal risk and resilience factors in the context of daily stress. This research clearly suggests that there is no universal generalization that can be made regarding whether chronological age, in and of itself, confers greater vulnerability or resilience onto adults. Instead, we argue that researchers should ask when and under what conditions is age associated with greater vulnerability to daily stress and when and under what conditions is age associated with greater resilience to daily stress. Age differences in reactivity to daily stress are clearly embedded within a complex system of factors—structural, individual, and situational—that influence stress reactivity and stress recovery in several ways. This complexity should not be taken to mean that stress reactivity and recovery cannot be charted or understood. Researchers, however, will need to approach this complexity with a great deal of theoretical, methodological, and statistical rigor to move our understanding of the importance of age in shaping risk and resilience to daily stress forward. The final section of the chapter outlines several directions for future research in the area of aging and resilience. In particular, we argue that a focus on personal risk and resilience factors in the context of daily stress, in combination with the application of sophisticated statistical methods (e.g., dynamic systems modeling), will contribute to a more dynamic and person-centered understanding of processes of resilience.
PMCID: PMC3462024  PMID: 23049156
15.  Self-reported coping strategies in families of patients in early stages of psychotic disorder: An exploratory study 
Coping by families of patients with schizophrenia include “approach” strategies considered to be adaptive (eg reinterpretation) and potentially maladaptive “avoidant” strategies (denial/disengagement, use of alcohol and drugs). Little is known about coping strategies used by families of individuals with incipient or emergent psychosis.
Self-reported coping styles were assessed in family members of 11 ultra high risk and 12 recent-onset psychosis patients, using a modified version of Carver's Coping Orientations to Problems Experienced questionnaire.
Families reported moderate use of “approach” coping (eg planning, seeking social support, positive reinterpretation, acceptance, and turning to religion) and rare use of “avoidant” coping strategies (denial/disengagement and use of alcohol and drugs).
The greater endorsement of “approach” coping by these families is consistent with findings for families of first episode psychosis patients, and is in contrast to more prevalent “avoidant” coping by families of patients with more chronic psychotic illness. Early intervention could plausibly help families maintain the use of potentially more adaptive “approach” coping strategies over time.
PMCID: PMC3078580  PMID: 21272279
coping; psychosis; family; prodrome; risk
16.  Resiliency in Young Children Whose Mothers are Living with HIV/AIDS 
AIDS care  2008;20(3):284-291.
Resiliency was investigated among well children 6 - 11 years of age (N = 111) whose mothers are living with AIDS or are HIV symptomatic to determine if mother’s HIV status was a risk factor that could effect child resiliency, as well as investigate other factors associated with resiliency. Assessments were conducted with mother and child dyads over 4 time points (baseline, 6-, 12-, and 18-month follow-ups). Maternal illness was a risk factor for resiliency: as maternal viral load increased, resiliency was found to decrease. Longitudinally, resilient children had lower levels of depressive symptoms (by both mother and child report). Resilient children also reported higher levels of satisfaction with coping self-efficacy. A majority of the children were classified as non-resilient; implications for improving resiliency among children of HIV-positive mothers are discussed.
PMCID: PMC2422847  PMID: 18351474
HIV; Resiliency; Child; Maternal Illness
17.  Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training 
Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism, however, established training methods that change behavior and attitudes are too resource-intensive for widespread use. This study tests the feasibility and effectiveness of a less expensive alternative - an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic.
A "dose-finding" study compared pre-post changes in three different durations of training. We measured variables that are likely to mediate stress-responses in a pandemic before and after training: confidence in support and training, pandemic-related self-efficacy, coping style and interpersonal problems.
158 hospital workers took the course and were randomly assigned to the short (7 sessions, median cumulative duration 111 minutes), medium (12 sessions, 158 minutes) or long (17 sessions, 223 minutes) version. Using an intention-to-treat analysis, the course was associated with significant improvements in confidence in support and training, pandemic self-efficacy and interpersonal problems. Participants who under-utilized coping via problem-solving or seeking support or over-utilized escape-avoidance experienced improved coping. Comparison of doses showed improved interpersonal problems in the medium and long course but not in the short course. There was a trend towards higher drop-out rates with longer duration of training.
Computer-assisted resilience training in healthcare workers appears to be of significant benefit and merits further study under pandemic conditions. Comparing three "doses" of the course suggested that the medium course was optimal.
PMCID: PMC2851711  PMID: 20307302
18.  Psychological Resilience and Depressive Symptoms in Older Adults Diagnosed with Post-polio Syndrome 
Depression is a serious co-morbidity in persons with disability, yet few studies have focused on depressive symptoms in persons aging with post-polio syndrome (PPS). We used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (acceptance, self-efficacy, personal resources, interpersonal relationships, self-rated health, spiritual growth, and stress management) and depressive symptoms in a large sample (n = 630) of persons over age 65 who were diagnosed with PPS. A higher percentage (40%) of the sample scored ≥ 10 on the CES-D 10 than was previously cited in other studies; however, 53% of the sample had good or excellent self-rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms with spiritual growth representing the main predictor (β = −.26). The implications for rehabilitation nurses in developing a patient-strengths perspective in the assessment and counseling of individuals aging with PPS are discussed.
PMCID: PMC3432643  PMID: 20681392
19.  Development of a multi-dimensional measure of resilience in adolescents: the Adolescent Resilience Questionnaire 
The concept of resilience has captured the imagination of researchers and policy makers over the past two decades. However, despite the ever growing body of resilience research, there is a paucity of relevant, comprehensive measurement tools. In this article, the development of a theoretically based, comprehensive multi-dimensional measure of resilience in adolescents is described.
Extensive literature review and focus groups with young people living with chronic illness informed the conceptual development of scales and items. Two sequential rounds of factor and scale analyses were undertaken to revise the conceptually developed scales using data collected from young people living with a chronic illness and a general population sample.
The revised Adolescent Resilience Questionnaire comprises 93 items and 12 scales measuring resilience factors in the domains of self, family, peer, school and community. All scales have acceptable alpha coefficients. Revised scales closely reflect conceptually developed scales.
It is proposed that, with further psychometric testing, this new measure of resilience will provide researchers and clinicians with a comprehensive and developmentally appropriate instrument to measure a young person's capacity to achieve positive outcomes despite life stressors.
PMCID: PMC3204306  PMID: 21970409
20.  Personality-Related Risk and Resilience Factors in Coping with Daily Stress among Adult Cancer Patients 
Research in human development  2013;10(1):47-69.
We employed a diary design to study personality-related risk and resilience factors in adult cancer patients coping with daily stress. We focused on individuals’ self-concept incoherence (SCI) as a personality-related risk factor and on psychological well-being (PWB) at baseline and daily beliefs of control as resilience factors. Reactivity to daily stress was assessed in terms of negative daily mood. Multilevel modeling analyses yielded significant main effects of daily stress, PWB at baseline, and daily control. These main effects were qualified by significant two- and three-way interactions. The significant Stress X Control interaction indicated that individuals reported more negative mood in response to daily stress on low-control days compared to high-control days. Similarly, a significant SCI X Control interaction suggested that individuals with a more coherent self-concept benefited more from feeling in control in terms of experiencing less increase in negative mood compared to individuals with a more incoherent self-concept. Significant three-way interactions also indicated that the associations between stress, control and negative daily mood differed by level of SCI and level of PWB at the beginning of the study. Overall, the findings from this study show the complex associations between risk and resilience factors and daily emotional well-being in a sample of adults who were affected by a life-threatening illness.
PMCID: PMC3640793  PMID: 23646033
Adult personality; daily stress; risk and resilience factors; negative daily mood
21.  Evaluating the effectiveness of personal resilience and enrichment programme (PREP) for HIV prevention among female sex workers: a randomised controlled trial 
BMC Public Health  2013;13:683.
Female sex workers (FSWs) are often considered as the vector, if not reservoir, of HIV and other sexually transmitted infections. Building upon the existing evidence on the role of psychological health in sexual health, the aim of this protocol is to describe a trial investigating the effectiveness of the Personal Resilience and Enrichment Programme (PREP), a resilience-promoting intervention that targets at psychological well-being i.e. self-esteem, self-efficacy and coping, to facilitate adaptation and ultimately safe sexual practices among FSWs, which could be an innovative strategy in controlling the spread of these infections.
A total of 132 FSWs will be recruited and randomly assigned to either the intervention or usual care (control) groups in a multi-centred randomised controlled trial. Based on the resilience framework, this intervention is comprised of six weekly sessions focused on the awareness, expression and management of emotions, identifying roles and personal strengths, and effective problem-solving skills. Complex intervention assessment on both intervention process and effectiveness will be adopted when the primary outcome reduction of sexual risk behaviour and other psychological outcomes include their perceived stress, self-esteem, self-efficacy, coping overall resilience, and psychological distress will be measured at baseline, post-treatment and 3-month post-intervention and differences assessed by ANOVA. The relationship of resilience factors, psychological health and HIV preventive behaviours will be evaluated using structural equation modelling.
It is anticipated that this study will increase our understanding of the relationships between individual resilience attributes, positive adaptation, psychological health and sexual health practices. If successful, this programme will provide an innovative direction for HIV prevention by applying the personal resilience factors to promote both psychological well-being and safe sex for this high risk population.
Trial Registration
PMCID: PMC3733820  PMID: 23886280
Randomised controlled trial; Female sex workers; HIV prevention; Resilience; Protocol
22.  Are reported stress and coping style associated with frequent recurrence of genital herpes? 
Genitourinary Medicine  1997;73(4):263-266.
OBJECTIVES: This paper reports on the cross sectional data from the longitudinal study examining the impact of genital herpes simplex virus (HSV) infection on quality of life. In particular the report sought to study the relation between recurrence of genital HSV and coping style, mood, personality, and quality of life, among other factors. SETTING AND SUBJECTS: 116 patients with a known history of genital herpes simplex infection attending the Department of Genitourinary Medicine at Chelsea and Westminster Hospital. METHODS: Psychosocial factors (stress, anxiety, depression, health locus of control, personality, social support, coping skills, and quality of life) and the reported frequency of genital herpes episodes were measured using self administered questionnaires designed to examine the relation between psychosocial status and the frequency of genital HSV episodes. RESULTS: The number of recurrences reported by patients was significantly related to the style of coping skills used. Higher recurrences were less likely to use problem focused coping skills of planning and active coping, and the emotion focused coping skills of positive reinterpretation and growth. There was a significant difference in the number of patients who believed that psychological stress was related to the number of recurrences they experienced. This belief was related to neuroticism on the Eysenck Personality Questionnaire scale, and not to any of the other measures investigated. CONCLUSION: The findings suggest that it is the way individuals cope, and their personality characteristics rather than actual levels of psychological stress, that influence their belief in a link between recurrent genital HSV and stress. HSV may become the focus of existing concerns and be viewed as the physical manifestation of stress.
PMCID: PMC1195854  PMID: 9389946
23.  Coping, Self-Management, and Adaptation in Adolescents with Type 1 Diabetes 
Annals of Behavioral Medicine  2012;43(3):311-319.
Adolescents with type 1 diabetes experience stress related to treatment management, feeling different from peers, and deciding to tell others about their diabetes.
This study examined the relationship of stress reactivity and coping with self-management, quality of life, and metabolic control in an ethnically diverse sample of adolescents with type 1 diabetes.
Adolescents (n = 327) completed measures of coping and stress reactivity, self-management, and quality of life. Glycosylated hemoglobin data were collected from medical records.
Low-income and minority status were related to lower levels of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance), and higher levels of disengagement coping (e.g., avoidance). Self-management mediated the relationship between coping and stress reactivity with quality of life and metabolic control. Race/ethnicity and income moderated the relationship between coping and self-management goals.
Results indicate differences in coping related to income and race/ethnicity and demonstrate the impact of coping on self-management and health outcomes in adolescents with type 1 diabetes.
PMCID: PMC3350612  PMID: 22274724
Coping; Diabetes; Self-management
24.  A typology of pain coping in pediatric patients with chronic abdominal pain 
Pain  2007;137(2):266-275.
This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n = 699) were pediatric patients (ages 8–18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children’s pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n = 311) that replicated in Sample 2 (n = 388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients’ pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications.
PMCID: PMC2760309  PMID: 17928144
25.  Coping style and quality of life in patients with epilepsy: a cross-sectional study 
Journal of Neurology  2010;258(1):37-43.
Having epilepsy has a large impact on one's well-being, but often seizure frequency and severity do not explain self-reported quality of life. We hypothesized that one's personal coping style is more important. In this study, 105 patients attending the outpatient neurological clinic at the University Medical Centre in Utrecht, the Netherlands, with a diagnosis of partial epilepsy, aged 17–80 years, completed questionnaires. Demographic information, disease characteristics, health-related quality of life (HRQoL), and coping styles were obtained by postal-validated HRQoL questionnaires: the EQ5D and RAND-36 and the Utrecht Coping List. A passive coping style explained 45% of the variance in the mental component of HRQoL and was more important than ‘objective’ seizure-related measures. Confounders such as employment, gender, and side-effects of treatment explained another 6%. Passive coping style also influenced the physical component of the HRQoL, but here seizure-related factors predominated. Overall, epilepsy patients showed a more avoiding coping style, and female patients a less active coping style and more reassuring thoughts, compared to the Dutch population. The personal coping style of patients appears to be more important than seizure-related measures in predicting mental aspects of quality of life. Coping style characteristics rather than disease characteristics should guide clinical decision-making in patients with epilepsy. Further studies should investigate the effect on HRQoL of behavioral interventions to improve coping.
PMCID: PMC3016152  PMID: 20658245
Health related quality-of-life; Coping; Epilepsy; UCL; RAND-36

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