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1.  Resilience measurement in later life: a systematic review and psychometric analysis 
Objectives
To systematically review and examine the psychometric properties of established resilience scales in older adults, i.e. ≥60 years.
Methods
A systematic review of Scopus and Web of Science databases was undertaken using the search strategy “resilience” AND (ageing OR aging)”. Independent title/abstract and fulltext screening were undertaken, identifying original peer-reviewed English articles that conducted psychometric validation studies of resilience metrics in samples aged ≥60 years. Data on the reliability/validity of the included metrics were extracted from primary studies.
Results
Five thousand five hundred nine studies were identified by the database search, 426 used resilience psychometrics, and six psychometric analysis studies were included in the final analysis. These studies conducted analyses of the Connor Davidson Resilience Scale (CD-RISC) and its shortened 10-item version (CD-RISC10), the Resilience Scale (RS) and its shortened 5- (RS-5) and 11- (RS-11) item versions, and the Brief Resilient Coping Scale (BRCS). All scales demonstrated acceptable levels of internal consistency, convergent/discriminant validity and theoretical construct validity. Factor structures for the RS, RS-11 and CD-RISC diverged from the structures in the original studies.
Conclusion
The RS, RS-5, RS-11, CD-RISC, CD-RISC10 and BRCS demonstrate psychometric robustness adequate for continued use in older populations. However, results from the current study and pre-existing theoretical construct validity studies most strongly support the use of the RS, with modest and preliminary support for the CD-RISC and BRCS, respectively. Future studies assessing the validity of these metrics in older populations, particularly with respect to factor structure, would further strengthen the case for the use of these scales.
doi:10.1186/s12955-016-0418-6
PMCID: PMC4730639  PMID: 26821587
2.  Reliability and validity of the Spanish version of the 10-item Connor-Davidson Resilience Scale (10-item CD-RISC) in young adults 
Background
The 10-item Connor-Davidson Resilience Scale (10-item CD-RISC) is an instrument for measuring resilience that has shown good psychometric properties in its original version in English. The aim of this study was to evaluate the validity and reliability of the Spanish version of the 10-item CD-RISC in young adults and to verify whether it is structured in a single dimension as in the original English version.
Findings
Cross-sectional observational study including 681 university students ranging in age from 18 to 30 years. The number of latent factors in the 10 items of the scale was analyzed by exploratory factor analysis. Confirmatory factor analysis was used to verify whether a single factor underlies the 10 items of the scale as in the original version in English. The convergent validity was analyzed by testing whether the mean of the scores of the mental component of SF-12 (MCS) and the quality of sleep as measured with the Pittsburgh Sleep Index (PSQI) were higher in subjects with better levels of resilience. The internal consistency of the 10-item CD-RISC was estimated using the Cronbach α test and test-retest reliability was estimated with the intraclass correlation coefficient.
The Cronbach α coefficient was 0.85 and the test-retest intraclass correlation coefficient was 0.71. The mean MCS score and the level of quality of sleep in both men and women were significantly worse in subjects with lower resilience scores.
Conclusions
The Spanish version of the 10-item CD-RISC showed good psychometric properties in young adults and thus can be used as a reliable and valid instrument for measuring resilience. Our study confirmed that a single factor underlies the resilience construct, as was the case of the original scale in English.
doi:10.1186/1477-7525-9-63
PMCID: PMC3173284  PMID: 21819555
Resilience; 10-item CD-RISC; Young adults; Reliability; Validity; Questionnaire
3.  Development of a multi-dimensional measure of resilience in adolescents: the Adolescent Resilience Questionnaire 
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1471-2288-11-134
PMCID: PMC3204306  PMID: 21970409
4.  The student resilience survey: psychometric validation and associations with mental health 
Background
Policies, designed to promote resilience, and research, to understand the determinants and correlates of resilience, require reliable and valid measures to ensure data quality. The student resilience survey (SRS) covers a range of external supports and internal characteristics which can potentially be viewed as protective factors and can be crucial in exploring the mechanisms between protective factors and risk factors, and to design intervention and prevention strategies. This study examines the validity of the SRS.
Methods
7663 children (aged 11–15 years) from 12 local areas across England completed the SRS, and questionnaires regarding mental and physical health. Psychometric properties of 10 subscales of the SRS (family connection, school connection, community connection, participation in home and school life, participation in community life, peer support, self-esteem, empathy, problem solving, and goals and aspirations) were investigated by confirmatory factor analysis (CFA), differential item functioning (DIF), differential test functioning (DTF), Cronbach’s α and McDonald’s ω. The associations between the SRS scales, mental and physical health outcomes were examined.
Results
The results supported the construct validity of the 10 factors of the scale and provided evidence for acceptable reliability of all the subscales. Our DIF analysis indicated differences between boys and girls, between primary and secondary school children, between children with or without special educational needs (SEN) and between children with or without English as an additional language (EAL) in terms of how they answered the peer support subscale of the SRS. Analyses did not indicate any DIF based on free school meals (FSM) eligibility. All subscales, except the peer support subscale, showed small DTF whereas the peer support subscale showed moderate DTF. Correlations showed that all the student resilience subscales were negatively associated with mental health difficulties, global subjective distress and impact on health. Random effects linear regression models showed that family connection, self-esteem, problem solving and peer support were negatively associated with all the mental health outcomes.
Conclusions
The findings suggest that the SRS is a valid measure assessing these relevant protective factors, thereby serving as a valuable tool in resilience and mental health research.
Electronic supplementary material
The online version of this article (doi:10.1186/s13034-016-0132-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s13034-016-0132-5
PMCID: PMC5093941  PMID: 27822304
Resilience; School surveys; Mental health; Quality of life; Psychometrics
5.  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
6.  Resilience and Quality of Life in Breast Cancer Patients 
BACKGROUND:
Many studies have shown that a relationship exists between quality of life (QoL) and resilience in breast cancer patients, but few studies present information on the nature of this relationship of resilience on QoL. Our aim was to examine the relationship between resilience and quality of life in breast cancer patients.
METHODS:
QoL was measured in 218 consequent breast cancer patients, with EORTC - QLQ Core 30 questionnaire, and EORTC QLQ-BR23. The resilience was measured with Connor Davidson Resilience Scale.
RESULTS:
The global quality of life was positively correlated with the levels of resilience (R = 0.39 p < 0.001). All functional scales (physical, role, emotional, cognitive and social functioning was in a positive correlation with resilience. The symptoms severity (fatigue, nausea and vomitus, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, financial difficulties) was in negative correlation with resilience. Less resilient breast cancer patients reported worse body image and future perspective and suffered from more severe adverse effects of systemic therapy, and arm/breast symptoms.
CONCLUSION:
Our findings show that psychological resilience affects different aspects of health-related quality of life. More resilient patients have significantly better quality of life in almost all aspects of QoL.
doi:10.3889/oamjms.2015.128
PMCID: PMC4877917  PMID: 27275317
resilience; quality of life; breast cancer; Connor Davidson Resilience Scale; EORTC QLQ-C30
7.  “I know it when I see it.” The complexities of measuring resilience among parents of children with cancer 
Purpose
Promoting parent resilience may provide an opportunity to improve family-level survivorship after pediatric cancer; however, measuring resilience is challenging.
Methods
The “Understanding Resilience in Parents of Children with Cancer” was a cross-sectional, mixed-methods study of bereaved and non-bereaved parents. Surveys included the Connor-Davidson Resilience scale, the Kessler-6 psychological distress scale, the Post-Traumatic Growth Inventory, and an open-ended question regarding the on-going impact of cancer. We conducted content analyses of open-ended responses and categorized our impressions as “resilient,” “not resilient,” or “unable to determine.” “Resilience” was determined based on evidence of psychological growth, lack of distress, and parent-reported meaning/purpose. We compared consensus-impressions with instrument scores to examine alignment. Analyses were stratified by bereavement status.
Results
Eighty-four (88%) non-bereaved, and 21 (88%) bereaved parents provided written responses. Among non-bereaved, 53 (63%) were considered resilient, 15 (18%) were not. Among bereaved, 11 (52%) were deemed resilient, 5 (24%) were not. All others suggested a mixed or incomplete picture. Rater-determined “resilient” parents tended to have higher personal resources and lower psychological distress (p=<0.001–0.01). Non-bereaved “resilient” parents also had higher post-traumatic growth (p=0.02). Person-level analyses demonstrated that only 50–62% of parents had all 3 instrument scores aligned with our impressions of resilience.
Conclusions
Despite multiple theories, measuring resilience is challenging. Our clinical impressions of resilience were aligned in 100% of cases; however, instruments measuring potential markers of resilience were aligned in approximately half. Promoting resilience therefore requires understanding of multiple factors, including person-level perspectives, individual resources, processes of adaptation and emotional well-being.
doi:10.1007/s00520-014-2249-5
PMCID: PMC4264630  PMID: 24756554
Cancer; Oncology; Pediatrics; Parents; Resilience; Psychosocial Outcomes
8.  Reliability and validity of the Khmer version of the 10-item Connor-Davidson Resilience Scale (Kh-CD-RISC10) in Cambodian adolescents 
BMC Research Notes  2016;9:297.
Background
Resilience has been characterized as a defensive factor against the refinement of mental health problems. This study adapted the Connor–Davidson Resilience Scale (Kh-CD-RISC10) for use in Khmer adolescents and subsequently investigates its psychometric properties.
Methods
Using stratified random sampling, this cross-sectional study sampled Cambodian adolescents from high schools selected randomly within three provinces (Phnom Penh, Battambang and Mondulkiri)—location (rural, urban) combinations. Parallel analysis was used to identify the number of component(s), and the structure of the single factor was subsequently explored using principal axis factoring. A confirmatory factor analysis was then performed to establish the fit of the Kh-CD-RISC10 to another sample. To assess convergent validity, the factor scores of the Khmer version of Connor–Davidson Resilience Scale were categorized into three levels, and then the general negative affectivity (GNA) and physiological hyperarousal (PH) scales (derived from the DASS 21) were compared among the three resilience groups.
Results
Of the 798 participants who responded (responded rate = 82.26 %), 440 (41.23 %) were female and the age ranged from 14 to 24 years old (mean = 17.36, SD = 1.325). The internal consistency of the Khmer 10-item CD-RISC was also shown to be high in Cambodian adolescents (Cronbach’s alpha = 0. 82). Confirmatory factor analysis revealed the single factor model fit data adequately (χ2 = 100.103, df = 35, p < 0.001, CFI = 0.9484, RMSEA = 0.0384). We found that there were significant differences in both General Negative affectivity and Physiological Hyperarousal among the three resilience groups (FGNA = 12. 84, df = 2, p < 0.001; FPH = 13. 01, df = 2, p < 0.001).
Conclusion
The results from the present study indicate that the Khmer version of CD-RISC shows good psychometric properties in Cambodian adolescents. Our result confirms that a single dimension underlay the 10 items on the CD-RISC scale of this population, and can be used to assess the resilience comparing to the level of PTSD symptoms in general Khmer adolescent.
doi:10.1186/s13104-016-2099-y
PMCID: PMC4898380  PMID: 27278796
Resilience; 10-item CD-RISC; Cambodian adolescent; Reliability; Validity
9.  Resilience, Health, and Quality of Life among long-term survivors of Hematopoietic Cell Transplant 
Cancer  2015;121(23):4250-4257.
Background
Low patient-reported resilience is associated with ongoing risk of poor health and psychosocial outcomes. Using a large cross-sectional sample of survivors of Hematopoietic Cell Transplantation (HCT), we explored associations between patient-reported resilience, psychological distress, post-traumatic growth, and health-related quality of life
Methods
Between July 1, 2013 and June 30, 2014, the annual Fred Hutchinson Cancer Research Center (FHCRC) post-transplant survivorship survey queried patient-reported health and functional status, and included instruments assessing psychosocial outcomes: the 10-item Connor-Davidson Resilience Scale, the Post-Traumatic Growth Inventory, the Cancer and Treatment Distress measure, and the Medical Outcomes Study Short-Form 12 quality of life scale. Multivariate linear and logistic regression models included demographic and health covariates extracted from the FHCRC research database
Results
1,823 (39%) of 4,643 adult survivors of HCT responded after a single mailing and subsequent reminder letter. Participants’ median age was 59 years (IQR 50–66); 52.3% were male, most were non-Hispanic, white. The median time since HCT was 9 years (IQR 3–18). Lower patient-reported resilience was associated with higher severity chronic graft-versus-host disease, lower performance scores, missing work due to health, and permanent disability (all p<0.0001). After adjustment for demographic and health characteristics, patients reporting low resilience scores had higher odds of psychological distress (OR 3.0, 95% CI 2.1–4.3) and being in the lowest quartile of mental health-related quality of life (OR 5.9, 95% CI 4.4–8.0).
Conclusions
Patient-reported resilience is independently associated with health and psychosocial outcomes. Future studies must determine whether interventions can bolster resilience and improve survivorship outcomes.
doi:10.1002/cncr.29651
PMCID: PMC4666727  PMID: 26288023
Resilience; survivorship; psychosocial factors; quality of life; bone marrow transplantation; outcomes studies
10.  Hedonic and eudaimonic well-being: the role of resilience beyond fluid intelligence and personality traits 
Frontiers in Psychology  2015;6:1367.
Resilience is a key factor in the well-being of individuals. The present study set out to analyze the role of fluid intelligence, personality traits, and resilience in hedonic and eudaimonic well-being (EWB) in order to determine the incremental validity of resilience with respect to fluid intelligence and personality traits in 168 Italian high school students. The Advanced Progressive Matrices, the Big Five Questionnaire, the Connor-Davidson Resilience Scale, the Satisfaction With Life Scale, the Positive and Negative Affect Schedule, the Meaningful Life Measure, the Authenticity Scale were administered to the participants in the study. The results showed that resilience added a significant percentage of incremental variance with respect to fluid intelligence and personality traits in relation to life satisfaction, positive affect, life meaning, and authenticity. These results underline the value of resilience in both hedonic and EWB, thus offering new perspectives for research and intervention.
doi:10.3389/fpsyg.2015.01367
PMCID: PMC4566034  PMID: 26441743
fluid intelligence; personality traits; resilience; hedonic well-being; eudaimonic well-being
11.  The Psychometric Evaluation of the Connor-Davidson Resilience Scale Using a Chinese Military Sample 
PLoS ONE  2016;11(2):e0148843.
This study examined the psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) with a Chinese military population with the aim of finding a suitable instrument to quantify resilience in Chinese military service members. The confirmatory factor analysis results did not support the factorial structure of the original or the Chinese community version of the CD-RISC, but the exploratory factor analysis results revealed a three-factor model (composed of Competency, Toughness, and Adaptability) that seemed to fit. Moreover, the repeat confirmatory factory analysis replicated the three-factor model. Additionally, the CD-RISC with a Chinese military sample exhibited appropriate psychometric properties, including internal consistency, test-retest reliability, and structural and concurrent validity. The revised CD-RISC with a Chinese military sample provides insight into the resilience measurement framework and could be a reliable and valid measurement for evaluating resilience in a Chinese military population.
doi:10.1371/journal.pone.0148843
PMCID: PMC4747584  PMID: 26859484
12.  Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure 
Journal of affective disorders  2010;126(3):411-414.
Background
Influences of resilience on the presence and severity of depression following trauma exposure are largely unknown. Hence, we examined effects of resilience on depressive symptom severity in individuals with past childhood abuse and/or other trauma exposure.
Methods
In this cross-sectional study of 792 adults, resilience was measured with the Connor–Davidson Resilience Scale, depression with the Beck Depression Inventory (BDI), childhood abuse with the Childhood Trauma Questionnaire, and other traumas with the Trauma Events Inventory.
Results
Multiple linear regression modeling with depression severity (BDI score) as the outcome yielded 4 factors: childhood abuse (β=2.5, p<0.0001), other trauma (β=3.5, p<0.0001), resilience (β=−0.5, p<0.0001), and other trauma×resilience interaction term (β=−0.1, p=0.0021), all of which were significantly associated with depression severity, even after adjusting for age, sex, race, education, employment, income, marital status, and family psychiatric history. Childhood abuse and trauma exposure contributed to depressive symptom severity while resilience mitigated it.
Conclusions
Resilience moderates depressive symptom severity in individuals exposed to childhood abuse or other traumas both as a main effect and an interaction with trauma exposure. Resilience may be amenable to external manipulation and could present a potential focus for treatments and interventions.
doi:10.1016/j.jad.2010.04.009
PMCID: PMC3606050  PMID: 20488545
Resilience; Trauma; Childhood abuse; Depression; Moderating effects
13.  Dispositional mindfulness and employment status as predictors of resilience in third year nursing students: a quantitative study 
Nursing Open  2016;3(4):212-221.
Abstract
Background
Nursing students will graduate into stressful workplace environments and resilience is an essential acquired ability for surviving the workplace. Few studies have explored the relationship between resilience and the degree of innate dispositional mindfulness, compassion, compassion fatigue and burnout in nursing students, including those who find themselves in the position of needing to work in addition to their academic responsibilities.
Aim
This paper investigates the predictors of resilience, including dispositional mindfulness and employment status of third year nursing students from three Australian universities.
Design
Participants were 240 undergraduate, third year, nursing students. Participants completed a resilience measure (Connor–Davidson Resilience Scale, CD‐RISC), measures of dispositional mindfulness (Cognitive and Affective Mindfulness Scale Revised, CAMS‐R) and professional quality of life (The Professional Quality of Life Scale version 5, PROQOL5), such as compassion satisfaction, compassion fatigue and burnout.
Method
An observational quantitative successive independent samples survey design was employed. A stepwise linear regression was used to evaluate the extent to which predictive variables were related each to resilience.
Results
The predictive model explained 57% of the variance in resilience. Dispositional mindfulness subset acceptance made the strongest contribution, followed by the expectation of a graduate nurse transition programme acceptance, with dispositional mindfulness total score and employment greater than 20 hours per week making the smallest contribution. This was a resilient group of nursing students who rated high with dispositional mindfulness and exhibited hopeful and positive aspirations for obtaining a position in a competitive graduate nurse transition programme after graduation.
doi:10.1002/nop2.56
PMCID: PMC5050545  PMID: 27708832
Combined study; compassion fatigue; quantitative study; resilience; stress
14.  A Comparative Analysis of Disaster Risk, Vulnerability and Resilience Composite Indicators 
PLoS Currents  2016;8:ecurrents.dis.453df025e34b682e9737f95070f9b970.
Introduction: In the past decade significant attention has been given to the development of tools that attempt to measure the vulnerability, risk or resilience of communities to disasters. Particular attention has been given to the development of composite indices to quantify these concepts mirroring their deployment in other fields such as sustainable development. Whilst some authors have published reviews of disaster vulnerability, risk and resilience composite indicator methodologies, these have been of a limited nature. This paper seeks to dramatically expand these efforts by analysing 106 composite indicator methodologies to understand the breadth and depth of practice.
Methods: An extensive search of the academic and grey literature was undertaken for composite indicator and scorecard methodologies that addressed multiple/all hazards; included social and economic aspects of risk, vulnerability or resilience; were sub-national in scope; explained the method and variables used; focussed on the present-day; and, had been tested or implemented. Information on the index construction, geographic areas of application, variables used and other relevant data was collected and analysed.
Results: Substantial variety in construction practices of composite indicators of risk, vulnerability and resilience were found. Five key approaches were identified in the literature, with the use of hierarchical or deductive indices being the most common. Typically variables were chosen by experts, came from existing statistical datasets and were combined by simple addition with equal weights. A minimum of 2 variables and a maximum of 235 were used, although approximately two thirds of methodologies used less than 40 variables. The 106 methodologies used 2298 unique variables, the most frequently used being common statistical variables such as population density and unemployment rate. Classification of variables found that on average 34% of the variables used in each methodology related to the social environment, 25% to the disaster environment, 20% to the economic environment, 13% to the built environment, 6% to the natural environment and 3% were other indices. However variables specifically measuring action to mitigate or prepare for disasters only comprised 12%, on average, of the total number of variables in each index. Only 19% of methodologies employed any sensitivity or uncertainty analysis and in only a single case was this comprehensive.
Discussion: A number of potential limitations of the present state of practice and how these might impact on decision makers are discussed. In particular the limited deployment of sensitivity and uncertainty analysis and the low use of direct measures of disaster risk, vulnerability and resilience could significantly limit the quality and reliability of existing methodologies. Recommendations for improvements to indicator development and use are made, as well as suggested future research directions to enhance the theoretical and empirical knowledge base for composite indicator development.
doi:10.1371/currents.dis.453df025e34b682e9737f95070f9b970
PMCID: PMC4807925  PMID: 27066298
15.  The presence of resilience is associated with a healthier psychological profile in ICU nurses: Results of a national survey 
Objective
ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses.
Design
Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale.
Measurements and Main Results
Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p < 0.001), and a lower prevalence of burnout syndrome (p < 0.001).
Conclusions
The presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile.
doi:10.1016/j.ijnurstu.2011.09.015
PMCID: PMC3276701  PMID: 21974793
Resilience; posttraumatic stress disorder; burnout syndrome; ICU nurses
16.  Reliability and validity of the Italian version of the 14-item Resilience Scale 
Background
In recent years resilience has gained clinical relevance in sociological, psychological, and medical disciplines, and a lot of scales measuring resilience have been developed and have been utilized in the western countries. The aim of the study was to assess the psychometric properties of the Italian version of the 14-item Resilience Scale (RS-14), by describing its validity and reliability. As agreed with the authors of the original English version of the RS-14, it was translated into Italian. Then the standard procedure for back-translation was followed.
Methods
In total, 150 participants among the nursing and professional education students of the University of Insubria of Varese and health workers of the “ASST dei Sette Laghi-Ospedale di Circolo” of Varese were enrolled. The responses to the questionnaires were collected only from the students and the health workers between the ages of 18 and 65 years who gave their consent to participate in the study from April to September 2015. A subsample of 26 students and health workers was retested on the RS-14, 5 weeks after the first assessment. The questionnaires were handed out to 214 people, and 150 sets of questionnaires (70%) were returned, of which eight were subsequently removed because >60% of the answers were missing. In order to ensure anonymity, every completed questionnaire was identified only via a code.
Results
No significant differences were found between the mean values of the resilience scores between women (76.1) and men (76.3), with unpaired t-test = −0.08 and P=0.93. Similarly, no difference between resilience scores were found between mean age group of 18–25 years (75.3) and 26–65 years (78.7), with t-test = 1.6. The overall Cronbach’s alpha of the RS-14 is 0.88, P=0.10. The RS-14 is negatively correlated with the Beck Depression Inventory-Primary Care Version and the 12-item General Health Questionnaire and positively correlated with the World Health Organization Quality of Life-Brief Version. The test-retest reliability, assessed on the 26 subjects 5 weeks after the first evaluation, highlighted an intraclass correlation coefficient value equal to 0.65. Factor analysis retains three factors, and it considers the factor loadings >0.40: RS-14-06 (‘I am determined’) is loaded on all the factors and RS-14-12 (‘In an emergency, I am someone people can generally rely on’) is not loaded on any factor.
Conclusion
This study demonstrates that the Italian RS-14 has psychometric properties with a good level of internal consistency (Cronbach’s alpha = 0.88), an adequate concurrent validity, verified by relationships with the other scales and as it was expected from literature, and an acceptable test-retest reliability.
doi:10.2147/PRBM.S115657
PMCID: PMC5055039  PMID: 27757055
resilience; measuring scales; psychometrics; factor analysis; adolescence; adulthood
17.  Ego-Resiliency Reloaded: A Three-Component Model of General Resiliency 
PLoS ONE  2015;10(3):e0120883.
Ego-resiliency (ER) is a capacity that enables individuals to adapt to constantly changing environmental demands. The goal of our research was to identify components of Ego-resiliency, and to test the reliability and the structural and convergent validity of the refined version of the ER11 Ego-resiliency scale. In Study 1 we used a factor analytical approach to assess structural validity and to identify factors of Ego-resiliency. Comparing alternative factor-structures, a hierarchical model was chosen including three factors: Active Engagement with the World (AEW), Repertoire of Problem Solving Strategies (RPSS), and Integrated Performance under Stress (IPS). In Study 2, the convergent and divergent validity of the ER11 scale and its factors and their relationship with resilience were tested. The results suggested that resiliency is a double-faced construct, with one function to keep the personality system stable and intact, and the other function to adjust the personality system in an adaptive way to the dynamically changing environment. The stability function is represented by the RPSS and IPS components of ER. Their relationship pattern is similar to other constructs of resilience, e.g. the Revised Connor-Davidson Resilience Scale (R-CD-RISC). The flexibility function is represented by the unit of RPSS and AEW components. In Study 3 we tested ER11 on a Hungarian online representative sample and integrated the results in a model of general resiliency. This framework allows us to grasp both the stability-focused and the plasticity-focused nature of resiliency.
doi:10.1371/journal.pone.0120883
PMCID: PMC4376776  PMID: 25815881
18.  Psychometric Properties of Self-Report Concussion Scales and Checklists 
Journal of Athletic Training  2012;47(2):221-223.
Reference/Citation:
Alla S, Sullivan SJ, Hale L, McCrory P. Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. Br J Sports Med. 2009;43 (suppl 1):i3–i12.
Clinical Question:
Which self-report symptom scales or checklists are psychometrically sound for clinical use to assess sport-related concussion?
Data Sources:
Articles available in full text, published from the establishment of each database through December 2008, were identified from PubMed, Medline, CINAHL, Scopus, Web of Science, SPORTDiscus, PsycINFO, and AMED. Search terms included brain concussion, signs or symptoms, and athletic injuries, in combination with the AND Boolean operator, and were limited to studies published in English. The authors also hand searched the reference lists of retrieved articles. Additional searches of books, conference proceedings, theses, and Web sites of commercial scales were done to provide additional information about the psychometric properties and development for those scales when needed in articles meeting the inclusion criteria.
Study Selection:
Articles were included if they identified all the items on the scale and the article was either an original research report describing the use of scales in the evaluation of concussion symptoms or a review article that discussed the use or development of concussion symptom scales. Only articles published in English and available in full text were included.
Data Extraction:
From each study, the following information was extracted by the primary author using a standardized protocol: study design, publication year, participant characteristics, reliability of the scale, and details of the scale or checklist, including name, number of items, time of measurement, format, mode of report, data analysis, scoring, and psychometric properties. A quality assessment of included studies was done using 16 items from the Downs and Black checklist1 and assessed reporting, internal validity, and external validity.
Main Results:
The initial database search identified 421 articles. After 131 duplicate articles were removed, 290 articles remained and were added to 17 articles found during the hand search, for a total of 307 articles; of those, 295 were available in full text. Sixty articles met the inclusion criteria and were used in the systematic review. The quality of the included studies ranged from 9 to 15 points out of a maximum quality score of 17. The included articles were published between 1995 and 2008 and included a collective total of 5864 concussed athletes and 5032 nonconcussed controls, most of whom participated in American football. The majority of the studies were descriptive studies monitoring the resolution of concussive self-report symptoms compared with either a preseason baseline or healthy control group, with a smaller number of studies (n = 8) investigating the development of a scale.
The authors initially identified 20 scales that were used among the 60 included articles. Further review revealed that 14 scales were variations of the Pittsburgh Steelers postconcussion scale (the Post-Concussion Scale, Post-Concussion Scale: Revised, Post-Concussion Scale: ImPACT, Post-Concussion Symptom Scale: Vienna, Graded Symptom Checklist [GSC], Head Injury Scale, McGill ACE Post-Concussion Symptoms Scale, and CogState Sport Symptom Checklist), narrowing down to 6 core scales, which the authors discussed further. The 6 core scales were the Pittsburgh Steelers Post-Concussion Scale (17 items), Post-Concussion Symptom Assessment Questionnaire (10 items), Concussion Resolution Index postconcussion questionnaire (15 items), Signs and Symptoms Checklist (34 items), Sport Concussion Assessment Tool (SCAT) postconcussion symptom scale (25 items), and Concussion Symptom Inventory (12 items). Each of the 6 core scales includes symptoms associated with sport-related concussion; however, the number of items on each scale varied. A 7-point Likert scale was used on most scales, with a smaller number using a dichotomous (yes/no) classification.
Only 7 of the 20 scales had published psychometric properties, and only 1 scale, the Concussion Symptom Inventory, was empirically driven (Rasch analysis), with development of the scale occurring before its clinical use. Internal consistency (Cronbach α) was reported for the Post-Concussion Scale (.87), Post-Concussion Scale: ImPACT 22-item (.88–.94), Head Injury Scale 9-item (.78), and Head Injury Scale 16-item (.84). Test-retest reliability has been reported only for the Post-Concussion Scale (Spearman r = .55) and the Post-Concussion Scale: ImPACT 21-item (Pearson r = .65). With respect to validity, the SCAT postconcussion scale has demonstrated face and content validity, the Post-Concussion Scale: ImPACT 22-item and Head Injury Scale 9-item have reported construct validity, and the Head Injury Scale 9-item and 16-item have published factorial validity.
Sensitivity and specificity have been reported only with the GSC (0.89 and 1.0, respectively) and the Post-Concussion Scale: ImPACT 21-item when combined with the neurocognitive component of ImPACT (0.819 and 0.849, respectively). Meaningful change scores were reported for the Post-Concussion Scale (14.8 points), Post-Concussion Scale: ImPACT 22-item (6.8 points), and Post-Concussion Scale: ImPACT 21-item (standard error of the difference = 7.17; 80% confidence interval = 9.18).
Conclusions:
Numerous scales exist for measuring the number and severity of concussion-related symptoms, with most evolving from the neuropsychology literature pertaining to head-injured populations. However, very few of these were created in a systematic manner that follows scale development processes and have published psychometric properties. Clinicians need to understand these limitations when choosing and using a symptom scale for inclusion in a concussion assessment battery. Future authors should assess the underlying constructs and measurement properties of currently available scales and use the ever-increasing prospective data pools of concussed athlete information to develop scales following appropriate, systematic processes.
PMCID: PMC3418135  PMID: 22488289
mild traumatic brain injuries; evaluation; reliability; validity; sensitivity; specificity
19.  Measurement properties of the brief resilient coping scale in patients with systemic lupus erythematosus using rasch analysis 
Bacground
Resilience has been defined as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma. To capture to what extent an individual copes with stress in a resilient fashion the Brief Resilient Coping Scale (BRCS) was developed. This tool was validated in people with chronic disease, such as rheumatoid arthritis using standard psychometric techniques of classical test theory, but not yet in patients with Systemic lupus erythematosus (SLE). The aim of this study was to explore the psychometric properties of the Brief Resilient Coping Scale in patients with SLE using Rasch analysis.
Method
This study used cross-sectional data. The BRCS was administered to 232 patients with systemic lupus erythematosus. The aspects analyzed were unidimensionality, local independence and differential item functioning (DIF) to construct an interpretative scale of scores with the Rasch model.
Results
Rating scale mode (RSM) showed that the four categories used in the items of the BRCS are properly ordered. The four items provided a good fit to the polytomous Rasch model. Moreover, the parameters were sufficiently separated to measure resilience in patients with SLE. BRCS is a unidimensional scale (eigenvalue = 1.843) of resilience and the items were locally independent. There was no DIF between males and females in the sample. Only marginally significant differences depending on the level of education were found. The BRCS showed adequate discriminant validity between groups of scores.
Conclusions
BRCS is a suitable scale for measuring resilience in patients with SLE. This scale might be useful for clinicians to obtain information concerning the degree of resilience that each patient has, allowing individuals with low resilience to be identified who need interventions aimed at developing coping skills.
doi:10.1186/s12955-016-0534-3
PMCID: PMC5020451  PMID: 27619635
Systemic lupus erythematosus; Resilient coping; Rasch analysis; Quality of life
20.  Validity and reliability of the Spanish version of the 10-item CD-RISC in patients with fibromyalgia 
Background
No resilience scale has been validated in Spanish patients with fibromyalgia. The aim of this study was to evaluate the validity and reliability of the 10-item CD-RISC in a sample of Spanish patients with fibromyalgia.
Methods
Design: Observational prospective multicenter study. Sample: Patients with diagnoses of fibromyalgia recruited from primary care settings (N = 208). Instruments: In addition to sociodemographic data, the following questionnaires were administered: Pain Visual Analogue Scale (PVAS), the 10-item Connor-Davidson Resilience scale (10-item CD-RISC), the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ), and the Mindful Attention Awareness Scale (MAAS).
Results
Regarding construct validity, the factor solution in the Principal Component Analysis (PCA) was considered adequate, so the KMO test had a value of 0.91, and the Barlett’s test of sphericity was significant (χ2 = 852.8; gl = 45; p < 0.001). Only one factor showed an eigenvalue greater than 1, and it explained 50.4% of the variance. PCA and Confirmatory Factor Analysis (CFA) results did not show significant differences between groups. The 10-item CD-RISC scale demonstrated good internal consistency (Cronbach’s alpha = 0.88) and test-retest reliability (r = 0.89 for a six-week interval). The 10-item CD-RISC score was significantly correlated with all of the other psychometric instruments in the expected direction, except for the PVAS (−0.115; p = 0.113).
Conclusions
Our study confirms that the Spanish version of the 10-item CD-RISC shows, in patients with fibromyalgia, acceptable psychometric properties, with a high level of reliability and validity.
doi:10.1186/1477-7525-12-14
PMCID: PMC3922630  PMID: 24484847
Resilience; Fibromyalgia; Validation; 10-item CD-RISC
21.  An in-depth psychometric analysis of the Connor-Davidson Resilience Scale: calibration with Rasch-Andrich model 
Background
The Connor-Davidson Resilience Scale (CD-RISC) is inarguably one of the best-known instruments in the field of resilience assessment. However, the criteria for the psychometric quality of the instrument were based only on classical test theory.
Method
The aim of this paper has focused on the calibration of the CD-RISC with a nonclinical sample of 444 adults using the Rasch-Andrich Rating Scale Model, in order to clarify its structure and analyze its psychometric properties at the level of item.
Results
Two items showed misfit to the model and were eliminated. The remaining 22 items form basically a unidimensional scale. The CD-RISC has good psychometric properties. The fit of both the items and the persons to the Rasch model was good, and the response categories were functioning properly. Two of the items showed differential item functioning.
Conclusions
The CD-RISC has an obvious ceiling effect, which suggests to include more difficult items in future versions of the scale.
doi:10.1186/s12955-015-0345-y
PMCID: PMC4580216  PMID: 26395870
22.  The efficacy of resilience training programs: a systematic review protocol 
Systematic Reviews  2014;3:20.
Background
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.
Methods/Design
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.
Discussion
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.
doi:10.1186/2046-4053-3-20
PMCID: PMC3946765  PMID: 24602236
Resilience; Resilience training; Systematic review; Randomized controlled trials
23.  The Cedar Project: resilience in the face of HIV vulnerability within a cohort study involving young Indigenous people who use drugs in three Canadian cities 
BMC Public Health  2015;15:1095.
Background
Indigenous scholars have long argued that it is critical for researchers to identify factors related to cultural connectedness that may protect against HIV and hepatitis C infection and buffer the effects of historical and lifetime trauma among young Indigenous peoples. To our knowledge, no previous epidemiological studies have explored the effect of historical and lifetime traumas, cultural connectedness, and risk factors on resilience among young, urban Indigenous people who use drugs.
Methods
This study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effects models (LME) estimated the effect of study variables on mean change in resilience scores between 2011-2012.
Results
Among 191 participants, 92 % had experienced any form of childhood maltreatment, 48 % had a parent who attended residential school, and 71 % had been in foster care. The overall mean resilience score was 62.04, with no differences between the young men and women (p = 0.871). Adjusted factors associated with higher mean resilience scores included having grown up in a family that often/always lived by traditional culture (B = 7.70, p = 0.004) and had often/always spoken their traditional language at home (B = 10.52, p < 0.001). Currently knowing how to speak a traditional language (B = 13.06, p = 0.001), currently often or always living by traditional culture (B = 6.50, p = 0.025), and having recently sought drug/alcohol treatment (B = 4.84, p = 0.036) were also significantly associated with higher mean resilience scores. Adjusted factors associated with diminished mean resilience scores included severe childhood emotional neglect (B = −13.34, p = 0.001), smoking crack daily (B = −5.42, p = 0.044), having been sexual assaulted (B = −14.42, p = 0.041), and blackout drinking (B = −6.19, p = 0.027).
Conclusions
Young people in this study have faced multiple complex challenges to their strength. However, cultural foundations continue to function as buffers that protect young Indigenous people from severe health outcomes, including vulnerability to HIV and HCV infection.
doi:10.1186/s12889-015-2417-7
PMCID: PMC4625636  PMID: 26510467
Indigenous young people; Resilience; Trauma; HIV and HCV vulnerability
24.  The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health 
Background
Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health.
Methods
We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health.
Results
The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens.
Conclusions
While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.
doi:10.1186/s12939-016-0349-1
PMCID: PMC4822231  PMID: 27048319
LGBTQ; Health promotion; Health measurement; Resilience; Health research
25.  Resilience among women with HIV: Impact of silencing the self and socioeconomic factors 
Sex roles  2014;70(5-6):221-231.
In the U.S., women account for over a quarter of the approximately 50,000 annual new HIV diagnoses and face intersecting and ubiquitous adversities including gender inequities, sexism, poverty, violence, and limited access to quality education and employment. Women are also subjected to prescribed gender roles such as silencing their needs in interpersonal relationships, which may lessen their ability to be resilient and function adaptively following adversity. Previous studies have often highlighted the struggles encountered by women with HIV without focusing on their strengths. The present cross-sectional study investigated the relationships of silencing the self and socioeconomic factors (education, employment, and income) with resilience in a sample of women with HIV. The sample consisted of 85 women with HIV, diverse ethnic/racial groups, aged 24 – 65 enrolled at the Chicago site of the Women’s Interagency HIV Study in the midwestern region of the United States. Measures included the Connor-Davidson Resilience Scale -10 item and the Silencing the Self Scale (STSS). Participants showed high levels of resilience. Women with lower scores on the STSS (lower self-silencing) reported significantly higher resilience compared to women with higher STSS scores. Although employment significantly related to higher resilience, silencing the self tended to predict resilience over and above the contributions of employment, income, and education. Results suggest that intervention and prevention efforts aimed at decreasing silencing the self and increasing employment opportunities may improve resilience.
doi:10.1007/s11199-014-0348-x
PMCID: PMC4051411  PMID: 24932061
resilience; silencing the self; HIV; women; socioeconomic factors

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