Promoting mental wellbeing in pregnant women living in Pakistan with the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention: a randomized controlled trial.

BACKGROUND: The negative impact of adverse perinatal mental health extends beyond the mother and child; therefore, it is essential to make an early intervention for the management of mental illness during pregnancy. Resilience-building interventions are demonstrated to reduce depression and anxiety among expectant mothers, yet research in this field is limited. This study aims to examine the effect of the 'Safe Motherhood-Accessible Resilience Training (SM-ART)' on resilience, marital adjustment, depression, and pregnancy-related anxiety in a sample of pregnant women in Karachi, Pakistan. METHOD: In this single-blinded block randomized controlled study, 200 pregnant women were recruited and randomly assigned to either an intervention or a control group using computer-generated randomization and opaque sealed envelopes. The intervention group received the SM-ART intervention consisting of six, weekly sessions ranging from 60 to 90 min. Outcomes (Resilience, depression, pregnancy-related anxiety and marital harmony) were assessed through validated instruments at baseline and after six weeks of both intervention and control groups. RESULTS: The results revealed a significant increase in mean resilience scores (Difference:6.91, Effect size: 0.48, p-value < 0.05) and a decrease in depressive symptoms (Difference: -2.12, Effect size: 0.21, p-value < 0.05) in the intervention group compared to the control group. However, no significant change was observed in anxiety and marital adjustment scores. CONCLUSION: The SM-ART intervention has the potential to boost resilience scores and decrease depressive symptoms in pregnant women and offers a promising intervention to improve maternal psychological health. TRIAL REGISTRATION: NCT04694261, Date of first trial registration: 05/01/2021.

Development and Validation of Safe Motherhood-Accessible Resilience Training (SM-ART) Intervention to Improve Perinatal Mental Health.

Perinatal mental health issues in women can lead to a variety of health complications for both mother and child. Building resilience can strengthen coping mechanisms for pregnant women to improve their mental health and protect themselves and their children. The study aims to develop and validate the contextual and cultural appropriateness of the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention for pregnant women in Pakistan. A three-phase approach was used to develop and validate an intervention that promotes resilience in pregnant women. Phase I comprised a needs assessment with stakeholders (pregnant women and key informants) to elicit opinions regarding module content. In Phase II, an intervention to build resilience was developed with the help of a literature review and formative assessment findings, and Phase III involved the validation of the intervention by eight mental health experts. The experts assessed the Content Validity Index (CVI) of the SM-ART intervention on a self-developed checklist. The resultant SM-ART intervention consists of six modules with strong to perfect CVI scores for each of the modules. Qualitative responses endorsed the strengths of the intervention as having innovative and engaging activities, contextual and cultural relevance, and a detailed, comprehensive facilitator guide. SM-ART was successfully developed and validated and is now ready for testing to promote the resilience of pregnant women at risk of perinatal mental illness.

Resilience and prenatal mental health in Pakistan: a qualitative inquiry.

BACKGROUND: Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention. METHODS: The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A total of 17 semi-structured interviews were conducted with pregnant women, purposefully selected with heterogeneous characteristics to explore diverse perspectives, while symptoms of depression were quantified by the Edinburgh Postnatal Depression Scale before the interview. Verbatim transcriptions were coded openly and merged into categories and themes. RESULT: A total of six themes emerged from in-depth thematic analysis: 1) purpose of life, 2) dealing with emotions, 3) believing in yourself, 4) optimistic approach, 5) strengthening support and relationship and 6) spirituality and humanity. Women agreed that these characteristics could help them improve their mental health. CONCLUSION: In conclusion, these themes were the core components of pregnant women's resilience which ultimately could help to promote prenatal mental health. These pave a pathway towards developing culturally and contextually resilience interventions aimed at enhancing mental health of pregnant women which then may improve neonatal and family mental wellbeing.

Polish Version of the Resilience Scale (RS-14): A Validity and Reliability Study in Three Samples.

There has been a need for an instrument which not only can adequately evaluate trait-like resilience, but also can be applied to Polish adolescents and young adults. The purpose of this study was to validate the Resilience Scale RS-14 (Wagnild, 2009a,b). We aimed to examine and assess the psychometric properties of the Polish version in three different samples. The first sample was made up of adolescents aged 13-17 (N = 400).The second sample was made up of a problem group aged 13-18 (N = 656) who had special needs and attended either Probation Centers, Youth Sociotherapy Centers, or Youth Educational Centers. The third sample was made up of students in early adulthood aged 19-27 (N = 1,659). Exploratory and confirmatory factor-analytic methods were employed. CFA demonstrated a good fit of the factor structure in all three samples. The original one-dimensional structure of the RS short form was confirmed. All items loaded (>0.40) onto 1 factor, indicating cohesive structure for a 1-factor model explaining 35.02% of the variance in the whole sample, 34.62% in the young adolescent sample, 31.11% in the problem sample, and 38.51% in the early adulthood sample. Descriptive statistics, reliability (young adolescence α = 0.85, problem sampleα = 0.82 early adulthood α = 0.87) and validity data were calculated; test-retest showed good stability [r (40) = 0.88; p < 0.001]. The validity of the scale RS-14 was applied in two groups (the N = 382 early adulthood aged 19-27, and the N = 120 problem group aged 13-18) and was subsequently evaluated. The RS-14 correlated significantly, as expected, with measures of positive concepts (satisfaction with life). Results showed that resilience was negatively related with indexes of perceived stress and the dimension-of-depression. Findings support the RS-14 to be a valid and useful instrument for assessing resilience in diverse Polish adolescent groups, including those with special needs and those in early adulthood.

A confirmatory factor analysis of the Resilience Scale adapted to chronic pain (RS-18): new empirical evidence of the protective role of resilience on pain adjustment.

PURPOSE: Recent attention has focused on resilience as an important process in the experience and management of chronic pain. In this context, resilience is considered as a psychological factor that promotes adaptive responses to pain and pain-related life adversities. Current research suggests that it is a relevant variable in the prediction of pain adjustment among chronic pain patients. Recently, it was adapted the Resilience Scale to patients suffering chronic musculoskeletal pain (RS-18). The aims of this study were to confirm the internal structure of the RS-18 and to present new empirical evidence regarding its validity. METHODS: A sample of 592 patients with chronic musculoskeletal back pain completed a battery of instruments to assess resilience, anxiety sensitivity, catastrophizing, fear-avoidance beliefs, hypervigilance, pain acceptance, and pain adjustment variables (pain intensity, emotional distress, functional impairment, and daily functioning). RESULTS: Confirmatory factor analysis supported the validity of the RS-18 and a single-factor solution. A series of moderated multiple regression analysis showed that resilience is a relevant psychological variable that not only independently predicts better pain adjustment, but also moderates the relationships between several psychological pain-related variables and pain adjustment variables. CONCLUSIONS: These findings give empirical support to the consideration of resilience as a protective variable in chronic pain adjustment and highlight the consideration that improving resilient behaviour could be an important target for the treatment of pain patients.

Growing old with fibromyalgia: factors that predict physical function.

BACKGROUND: Fibromyalgia, a persistent, widespread pain condition, significantly limits physical function, threatening an older adult's health and ability to live independently. OBJECTIVES: The aim of the study was to identify predictors of physical function in older adults living with fibromyalgia and to examine the influence of resilience on the relationship between fibromyalgia pain and physical function. METHODS: This was a descriptive correlational, cross-sectional design using mailed questionnaires to analyze relationships between health-related variables and physical function in a convenience sample of community-dwelling older adults diagnosed with fibromyalgia (n = 224; age M = 62.1 years, SD = 6.75 years). Multiple regression was used to identify a priori predictors of physical function; hierarchical multiple regression was used to examine resilience as a moderator of pain and physical function. RESULTS: The sample was predominantly women, Caucasian, married, well educated, had moderate levels of income and tangible social support, and had low levels of physical function. Three-fourths were overweight or obese. Despite impaired physical function (Late Life Function and Disability Index, M = 51.5/100, SD = 9) and moderate levels of pain (Numeric Rating Scale, M = 5.47/10, SD = 2.6), resilience was moderately high (Resilience Scale, M = 137/175, SD = 20). An eight-variable disablement-based model accounted for 48% of variance in physical function: age, income, education, depressive symptoms, body mass index, and physical activity accounted for 31%; pain added 14%; and resilience contributed an additional 3%. Resilience was not a moderator of fibromyalgia pain and physical function; resilience did contribute uniquely to physical function variance. DISCUSSION: Resilience, a novel variable in fibromyalgia research, was a unique predictor of physical function. Further research is needed to learn more about the relationships between resilience, fibromyalgia impact, and the aging process.

Psychometric evaluation of the Dutch Resilience Scale RS-nl on 3265 healthy participants: a confirmation of the association between age and resilience found with the Swedish version.

The aim of this study was to complete a thorough psychometric evaluation of the 'RS-nl', a Dutch adaptation of the Wagnild and Young Resilience Scale. All of the 25 items of the original RS were retained, but a 4-point rather than a 7-point response was used and one item was reworded by removal of the negation. Psychometric analyses on 3265 healthy participants revealed a significant positive association between age and the total resilience score, confirming the findings with the Swedish version by Lundman et al. To a lesser extent, associations between education and the subscale 'Personal Competence' and between gender and the subscale 'Acceptance of Self and Life' was found. There was, however, no strong evidence for a five factor structure reflecting the five characteristics described by Wagnild and Young, mainly because of high secondary loadings. Therefore, in accordance with the 25-item RS, a two factor model (creating the subscales 'Personal Competence' and 'Acceptance of Self and Life') was maintained. The RS-nl seems to be a valid and useful screening instrument to detect persons at risk, who could benefit from closer and prolonged psychological help.

Assessing resilience.

As more studies reveal the positive relationships between resilience and aging well, mental health practitioners are increasingly interested in recognizing and strengthening resilience among aging Baby Boomers. Although there is much information on characteristics of resilience, there is very little research on assessing for resilience. This article presents a framework for assessing resilience among middle-aged and older adults that includes the Resilience Scale and open-ended questions to provide clients opportunities to reflect on and perhaps rediscover their resilience. This assessment framework may be useful for mental health practitioners using a strengths-based approach with their clients.

A review of the Resilience Scale.

The purpose of this article is to review 12 completed studies that have used the Resilience Scale (Wagnild & Young, 1993). Completed studies were identified through PubMed and CINAHL. Studies that identified Resilience Scale scores, sample descriptions, and tested relationships between the Resilience Scale and study variables were selected for inclusion. Cronbach's alpha coefficients ranged from .72 to .94 supporting the internal consistency reliability of the Resilience Scale. Hypothesized relationships between the Resilience Scale and study variables (e.g., forgiveness, stress, anxiety, health promoting activities) were supported strengthening the evidence for construct validity of the Resilience Scale. In the studies reported here, the Resilience Scale has been used with a variety of individuals of different ages, socioeconomic, and educational backgrounds. The Resilience Scale has performed as a reliable and valid tool to measure resilience and has been used with a wide range of study populations.

A telecommunications intervention for frontier patients with diabetes.

The purpose of this study was to determine whether a telecommunications diabetes self-management (DSM) intervention would improve health-related outcomes among frontier participants with diabetes. A one-group pre-test/post-test quasi-experimental design with two groups of participants was used. Differences between pre and post-test periods on measures of physical and emotional health, knowledge of diabetes, and self-care behaviors were measured. Overall, participants did better along measures of blood pressure, HbA(1c), self-efficacy, knowledge of diabetes, understanding of DSM, monitoring behaviors, and reported less personal and social disruption from diabetes. Six-month follow-up results showed continued positive outcomes.

Psychiatrists' satisfaction with telepsychiatry.

The purpose of this evaluation study was to learn more about psychiatrists' satisfaction with telepsychiatry. Telepsychiatry will succeed only if psychiatrists are satisfied with this service delivery method and offer it to their patients. While telepsychiatry appears to be effective and most patients report that they are satisfied with it, less information is available about factors that lead to psychiatrists' satisfaction. We interviewed psychiatrists who treat rural/frontier patients and asked them to describe factors that encouraged or discouraged their use of telepsychiatry. Only 4 were mostly satisfied with telepsychiatry and all offered suggestions for improving this delivery method. Most agreed that it was a hardship for many of their patients to travel 100 to 750 roundtrip miles over a 1-3 day period for a 20-minute consultation and that telepsychiatry could be a lifeline to many of them. Nevertheless, they identified significant technical and interpersonal barriers that discouraged their use of telepsychiatry.

Differences between frontier and urban elders with chronic heart failure.

The purpose of this study was to compare 136 frontier and 148 urban patients with chronic heart failure who were aged 60 years and older. Medical records from 2000 to 2002 were reviewed from a regional tertiary hospital in Montana. While the two groups did not differ with respect to New York Heart Association functional class and number of comorbid conditions, the frontier sample was more likely to be male, married, and younger. Frontier patients were more depressed and scored significantly lower on quality-of-life measures. Among those who had died, frontier patients survived an average of 7.7 months, in contrast to urban patients who survived an average of 13.4 months following index hospitalization. Frontier patients have few available health care services and providers may not treat patients as expertly or aggressively as urban providers. Frontier patients tend to be isolated due to illness, lack of transportation, travel distances, and weather-related barriers. Many may be falling through the cracks.

Resilience and successful aging. Comparison among low and high income older adults.

1 Resilience, a personality characteristic that moderates the negative effects of stress and promotes adaptation, has been associated with better health in prior studies. 2 Successful aging can be defined as the enjoyment of health and vigor of the mind, body, and spirit into middle age and beyond. 3 Individuals with lower incomes may be less likely to achieve successful aging because of a higher prevalence of health risk factors. 4 Resilience appears to be positively and significantly associated with indicators of successful aging regardless of income.