Factors related to the resilience and mental health of adult cancer patients: a systematic review.

PURPOSE: It has been reported that maintaining the mental health of cancer patients is a critically important issue, and that resilience is related to mental health. This study conducted a systematic literature review in order to fully understand the relationships between resilience and anxiety, depression, and quality of life (QOL) in adult cancer patients, as well as identify factors associated with resilience. METHODS: The PubMed, CINAHL, Psychology Database, and ICHUSHI Web databases were searched for articles related to resilience in cancer patients published between 2014 and 2019 using the keywords "cancer" and "resilience," connected with "and." The extracted articles that met inclusion criteria were organized using a matrix. To understand the resilience status of adult cancer patients, meta-analyses were performed using resilience scores measured with the most commonly used resilience scale, Connor-Davidson Resilience Scale 25. RESULTS: Thirty-nine articles were included in the analysis. A higher resilience score is associated with lower anxiety and depression scores and higher QOL scores. Factors related to resilience include personal factors such as age and gender, disease-related factors such as the presence or absence and severity of physical symptoms, and internal factors such as self-efficacy and hopefulness. CONCLUSIONS: It was found that it is important for cancer patients to improve resilience to maintain mental health and QOL. The findings suggest that providing interventions for factors that will reduce resilience will provide support for patients with cancer.

Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial.

OBJECTIVE: In adolescents and young adults (AYAs) with cancer, we examined (1) the distribution and type of traumatic events (TEs) experienced prior to baseline assessment and (2) how a resilience intervention, Promoting Resilience in Stress Management (PRISM), impacted changes in patient-reported outcomes (PROs) for AYAs with and without TEs. METHODS: AYAs (12-25 years) within 1-10 weeks of diagnosis of new malignancy or ever diagnosed with advanced cancer were enrolled and randomly assigned to usual care (UC) with or without PRISM. To assess TEs, we screened medical records for traditionally defined adverse childhood experiences (ACEs) and medical traumatic events. Age-validated PROs assessed resilience, benefit-finding, hope, generic health-related quality of life (QoL), cancer-specific QoL, depression, and anxiety at enrollment and 6 months later. We calculated effect sizes (Cohen's d) for PRISM vs. UC effect on PRO score change at 6 months for 1+ TEs and 0 TE groups. RESULTS: Ninety-two AYAs enrolled and completed baseline surveys (44-UC, 48-PRISM; N = 74 at 6 months, 38-UC, 36-PRISM); 60% experienced 1+ TEs. PROs at baseline were similar across groups. PRISM's effect on score change was greater (Cohen's d ≥ 0.5) for the 1+ TE group on domains of benefit-finding and hope; and similar (d < 0.5) on domains of resilience, depression, anxiety, and both generic and cancer-specific QoL. CONCLUSIONS: In AYAs with cancer, TEs occurred at similar rates as the general population. PRISM may be particularly helpful for improving benefit-finding and hope for those who have experienced TEs.

Psychological and Physiological Predictors of Resilience in Navy SEAL Training.

This research examines resilience from both cognitive and physiological perspectives and the relative importance of resilience for progression within an extremely physical training environment for 116 individuals. Our study provides a unique contribution as an examination of the combined effects of psychological and physiological resilience in the success of individuals in the first phase of a military special operations training course, the Navy's Basic Underwater Demolition/SEAL (BUD/S) course. Our study used the Connor-Davidson Resilience Scale (CD-RISC) for the psychological assessment and a blood sample to measure the concentrations of cortisol, DHEA and BDNF, each associated with stress adaptation and neuronal integrity. Our contributions include: heeding the call for more extensive research for resilience, examining physiological markers as predictors in training situations, combining psychological and physiological resilience into a single metric to assess resilience, and providing empirical support for the vital role of resilience in both stamina and persistence in training. Our findings indicate that both psychological and physiological resilience can be important predictors of persistence individually, but combining the measures provides a more holistic view to predict the success of an individual in this intensive training program. The present study has implications not only for the military community, but also for those individuals seeking elite performance in a broad array of fields, like professional athletes, CEO's, and emergency response workers.

The Role of Prosocial Behavior in Promoting Physical Activity, as an Indicator of Resilience, in a Low-Income Neighborhood.

The purpose of this study was to examine the effect of prosocial behavior on physical activity, as an indicator of resilience, in a low-income neighborhood with adverse built environment and social conditions. Resilience is an important factor that promotes the ability for individuals to overcome hardships, and understanding resilience as it relates to health behavior is important in the efforts to improve the health and wellbeing of vulnerable communities. There are many constructs of resilience, and we selected physical activity as an indicator of resilience because of the role of physical activity in health promotion. A community based participatory research approach was utilized to conduct a door knock survey in a sample of 2,457 households in a low-income, historically African-American neighborhood. Fifty-seven percent of residents completed the survey. Physical activity was the dependent variable and we controlled for key demographics, resident health, primary mode of transportation and neighborhood safety. Prosocial behavior was the primary independent variable. We conducted descriptive, bivariate and multivariate analyses and found prosocial behavior was significantly correlated with moderate physical activity, despite adverse conditions. Our results indicate that prosocial behavior plays an important role in an individual's ability to engage in health-promoting behaviors, such as physical activity, despite challenges.

The Moderating Effect of Resilience on the Relationship between Adverse Childhood Experiences (ACEs) and Quality of Physical and Mental Health among Adult Sexual and Gender Minorities.

Sexual and gender minority (SGM) individuals experience a greater burden of poor mental health compared to heterosexual individuals. One factor that helps to explain this disparity is trauma experienced during childhood. SGM are more likely to report traumatic experiences during childhood contributing to this disparity. Previous research has shown that resilience moderates the relationship between childhood trauma and adults mental health outcomes. As part of the Strengthening Colors of Pride project, data on 463 SGM adults living in San Antonio were collected using surveys. A diverse recruitment strategy was used in conjunction with a community advisory board. The brief resilience scale (BRS) was used to assess intrapersonal level resilience to determine if there was an effect on the relationship between ACEs and quality of mental and physical health. Differences were noted for some items across low, normal, and high levels of resilience. Both ACEs and BRS significantly predicted quality of mental and physical health. We also noted a significant interaction between ACEs and BRS with regard to quality of mental health. Findings suggest there is a relationship between intrapersonal level resilience, ACEs, and quality of mental health.

"We Are Our Own Counselor": Resilience, Risk Behaviors, and Mental Health Service Utilization among Young African American Men.

Despite risk for trauma, subsequent mental health concerns, and poor health outcomes, young Black/African American men (YBM) are less likely to receive mental health services than other racial/ethnic groups. Despite the growing literature on resilience, there is less information on relationships between resilience, risk behaviors, and use of mental health services. This study sought to examine resilience, trauma-related risk behaviors, and receipt of mental health services among a sample of YBM who experienced trauma. Focus groups and a brief survey were conducted with YBM (N = 55) who had been exposed to at least one traumatic event (e.g., witnessing violence, experienced serious injury or illness) and were recruited from urban community settings (e.g., colleges/universities, barbershops, churches). Participants were an average age of 23 years (SD = 3.9; range 18-30) and experienced an average of 2 to 3 traumatic events (SD = 2.2). Trauma exposure was a significant predictor of risk factors (ß = .513, p < .01). However, resilience did not significantly moderate this relationship. Resilience also did not predict receipt of mental health services. Culturally relevant qualitative themes found to be related to resilience included maintaining resilience autonomously, preferred coping methods (e.g., friends, music), and habituating to adversity. This study has potential to inform the development of culturally tailored, relevant interventions to promote engagement in mental health services among YBM who've experienced trauma.

Resilience, Trauma, and Cultural Norms Regarding Disclosure of Mental Health Problems among Foreign-Born and US-Born Filipino American Women.

Resilience refers to a set of personal qualities and abilities that allow an individual to confront challenges, risks, or traumatic experiences in an integrated manner and to thrive in the face of significant adversities. This cross-sectional study explores resilience, posttraumatic stress disorder (PTSD), and family norms with disclosure of mental health problems (FNAD) in a sample of 182 Filipino American women (FAW). Participants completed survey measures of resilience, PTSD, and FNAD and open-ended questions about beliefs and reasons for (not) disclosing mental health problems outside the family. Previous research found that the rates of psychological trauma and depression among FAW are higher than those in other Asian ethnic groups, which makes it necessary to investigate the protective characteristic of resilience among FAW. According to our results, foreign-born FAW had a significantly lower PTSD and greater resilience as compared to their US-born counterparts. A significant negative relationship between PTSD and resilience was observed only among foreign-born FAW. We also found a conditional moderating effect of FNAD on the negative relationship between resilience and PTSD. The results of our qualitative analysis of the participants' responses to the open-ended questions of the survey showed that FAW's family norms of nondisclosure are related to the cultural value of "saving face," a salient cultural construct among Asian family members. Results suggest that protective properties of resilience against PTSD are influenced by cultural factors, such as FNAD. Taken together, our findings underscore the importance of considering the impact of collectivistic cultural values (e.g., FNAD) in future research on resilience among Asian Americans.

Building a Contextually-Relevant Understanding of Resilience among African American Youth Exposed to Community Violence.

Studies consistently demonstrate that African American youth experience disproportionate levels of community violence, which is associated with negative health and well-being outcomes among these youth. The frequency and severity of community violence exposure is a unique challenge for these youth and requires tailored approaches to promote resilience after community violence exposure. However, limited research exists that operationalizes resilience after community violence based on the unique context and lived experience of African American youth. Developing a more contextually relevant understanding of resilience is critical to reducing health inequities experienced by African American youth and promoting their well-being. Five focus groups were conducted with 39 African American adolescents (ages 13-18) exposed to community violence. Participants also completed a brief survey that included questions on demographics, adverse childhood experiences, social capital, and resilience. Focus-group transcripts were independently coded by two members of the research team and analyzed using an inductive approach. Youth highlighted key indicators of resilience including the ability to persevere, self-regulate, and change to adapt/improve. Youth also described family, peer, and cultural contexts that impact how resilience is produced and manifested, highlighting trust, perceived burdensomeness, self-determination, connectedness, and mental health stigma as key factors within these contexts. Results of this qualitative study support the development of health promotion programs for African American youth exposed to community violence that address unique risks and build on existing protective factors within family, peer, and cultural contexts.

Tapping into Community Resiliency in Rural Adolescent Pregnancy Prevention: An Implementation Sciences Approach.

Although rural youth experience marked inequities in adolescent pregnancy, there is little guidance for implementing evidence-based programs (EBPs) in rural settings. When implementation occurs in rural communities, it frequently focuses on deficits, rather than strengths or capacity for growth. Using the consolidated framework for implementation research (CFIR), we describe a resiliency-focused implementation of two middle school EBPs in rural Midwestern communities, including the intervention, outer and inner settings, individuals, implementation processes and preliminary outcomes. Data included program staff interviews, feedback from local partners, community meetings notes, and participant surveys. Using the CFIR, we describe the engagement of rural communities themselves in a resilience-based implementation of adolescent pregnancy prevention EPBs. Communities self-described as rural, traditional and religious. They identified adolescent pregnancy, substance use, and academic success as priorities. To address infrastructure needs and build on local strengths, funds were used to hire local partners to implement the program. As small communities, stakeholders were closely networked and wanted to address local needs. Local partners selected the EBP based upon community values and priorities. Champions, including local partner organizations and schools were locally based and were well connected. Intensive training of local staff and piloting with adaptation assured fidelity and sustainability, while increasing community implementation skills and comfort. In Clinton County, enrollment was 1946 with students receiving the program in 6th, 7th, and/or 8th grades. In Southern Indiana, 7275 students received the program once in either 6th, 7th, or 8th. We conclude that the CFIR can facilitate the implementation of a community resilience-focused adolescent pregnancy prevention intervention in rural communities.

Redefining Resilience and Reframing Resistance: Empowerment Programming with Black Girls to Address Societal Inequities.

Black girls in the U.S. experience high levels of discrimination and adversity. Resilience is a term used within social work, psychology, and health professions to indicate positive adaptation to adversity, trauma, or stress. This article examines traditional and alternative models of resilience through analyses of quantitative and qualitative data from an evaluation of a year-long empowerment program for 33 Black girls (mean age = 14.97 years). Based on critical consciousness theory and Black feminism, this program was designed to empower participants through critical reflection and development of positive gendered racial identity. Quantitative analyses found no change over time in traditional measures of individual resilience. However, alternative measures of collective resilience show positive change. Specifically, quantitative analyses reveal that participants developed increased awareness of structural inequalities faced by Black girls/women and decreased adherence to neoliberal ideologies of personal responsibility and individual striving. Additionally, qualitative analyses show that participants critically reflected on their experiences of oppression, developed mutual support and positive gendered racial identity, and engaged in collective action. These findings demonstrate positive effects of empowerment-based programing, challenge the utility of traditional, individually-focused models of resilience, and reframe Black girls' resistance to injustice as an alternative, collective form of resilience.

The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US.

Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.

"Hay que seguir en la lucha": An FQHC's Community Health Action Approach to Promoting Latinx Immigrants' Individual and Community Resilience.

Latinx immigrants have poorer access to health care, compared to non-Latinx Whites. Federally-Qualified Health Centers (FQHCs) provide clinical and community programing to address their clients' health needs. One mechanism by which FQHC's may strengthen Latinx immigrant well-being is by promoting their individual and community resilience. We partnered with La Clínica del Pueblo (La Clínica), an FQHC serving Latinx immigrants in Washington, DC and Prince George's County, Maryland. We conducted in-depth interviews in Spanish with 30 La Clínica clients to explore the daily adversities they faced, how they coped, and how La Clínica helped them cope. We conducted thematic analysis using Dedoose software. All participants were from Central America; 37% were undocumented. Participants were 18-78 years old, 70% cis-females, 23% cis-males (10% gay men), and 7% transgender. 57% reported a serious health issue, including diabetes. Participants identified three main adversities: immigration legal status, language, and isolation/depression. Residents of Prince George's, compared to DC, as well as sexual/gender minorities, reported more barriers to accessing health care. Sources of individual resilience for participants included fighting to improve their children's lives, relying on supportive networks, and using La Clínica as a safety net to overcome health access barriers. Sources of community resilience included La Clínica's safe spaces, support groups, referrals to outside legal service providers, and health promoter training. Latinx immigrants face multiple daily adversities, but we find evidence that La Clínica's community health action approach promotes their resilience. We offer a conceptual model for how FQHCs can foster resilience and strengthen immigrant health.

Correlates of Resilience in Hispanic Young Adults.

Research on health disparities among Hispanic/Latino populations has begun to look at resiliency as a key component to the health risk profile of Hispanics. However, there are still gaps in the research about the specific factors. This study sought to examine the relationship between factors in 4 primary domains-behavioral, psychological, social, and cultural-and resilience in Hispanic young adults. We used data from Project RED, which included 1503 Hispanic young adults. Results indicate that cultural factors (acculturation and cultural identity), psychological factors (depression, stress, and coping), and social connectedness are important determinants of resilience among Hispanic young adults.

A Resilience Model of Adult Native Hawaiian Health Utilizing a Newly Multi-Dimensional Scale.

Resilience has conventionally focused on an individual's ability to overcome adversity. Recent research expands on this definition, making resilience a multi-dimensional construct. Native Hawaiians experience health disparities compared to the general population of Hawai'i. Despite the pressing need to address health disparities, minimal research examines resilience factors that serve as buffers for adverse experiences of Native Hawaiians. The purpose of this study was to estimate psychometric properties of scales that measured resilience-based factors through multiple levels using higher-order confirmatory factor analyses (CFA) and ascertain if this construct of resilience mediated or moderated adversity experienced by a sample of Native Hawaiians. Participants included 125 adults who participated in the Hawaiian Homestead Health Survey. Based on higher-order CFA, resilience comprised internal assets measured by hope, satisfaction with life, and environmental mastery, and external resources measured by social support and Native Hawaiian cultural identity. Results of the structural equation models were consistent with literature focusing on resiliency and health. Findings emphasized the importance of enhancing resilience by considering strengths and resources on the individual, interpersonal, and community levels. Findings also demonstrated the need to address adversity factors directly, with a specific need of addressing socio-economic status factors. According to structural equation models, resilience slightly mediated and moderated the effect of adversity related to socio-economic status. These findings have implications for future research exploring resilience as a mediator or moderator of adversity among Native Hawaiians and emphasize a multi-faceted construct of resilience to promote better health outcomes.

Health Risk Behaviors and Resilience Among Low-Income, Black Primary Care Patients: Qualitative Findings From a Trauma-Informed Primary Care Intervention Study.

This study describes an intervention with low-income, Black primary care patients and their experience in changing a health risk behavior. Participant themes, including behavioral coping, personal values, accomplishments and strengths, barriers and strategies, and social support, are understood in relationship to health behavior theories. Two structured interviews were conducted 1 month apart. Content analysis was used to analyze responses from 40 participants. Participants were well equipped with resilience-based coping, self-efficacies, and informal social networks despite economic and social disadvantages. Findings from this study have the potential to improve behavioral health coping and reduce racial inequities in health prevalent for this population.

Measuring resilience prospectively as the speed of affect recovery in daily life: a complex systems perspective on mental health.

INTRODUCTION: There is growing evidence that mental disorders behave like complex dynamic systems. Complex dynamic systems theory states that a slower recovery from small perturbations indicates a loss of resilience of a system. This study is the first to test whether the speed of recovery of affect states from small daily life perturbations predicts changes in psychopathological symptoms over 1 year in a group of adolescents at increased risk for mental disorders. METHODS: We used data from 157 adolescents from the TWINSSCAN study. Course of psychopathology was operationalized as the 1-year change in the Symptom Checklist-90 sum score. Two groups were defined: one with stable and one with increasing symptom levels. Time-series data on momentary daily affect and daily unpleasant events were collected 10 times a day for 6 days at baseline. We modeled the time-lagged effect of daily unpleasant events on negative and positive affect after each unpleasant event experienced, to examine at which time point the impact of the events is no longer detectable. RESULTS: There was a significant difference between groups in the effect of unpleasant events on negative affect 90 min after the events were reported. Stratified by group, in the Increase group, the effect of unpleasant events on both negative (B = 0.05, p < 0.01) and positive affect (B = - 0. 08, p < 0.01) was still detectable 90 min after the events, whereas in the Stable group this was not the case. CONCLUSION: Findings cautiously suggest that adolescents who develop more symptoms in the following year may display a slower affect recovery from daily perturbations at baseline. This supports the notion that mental health may behave according to the laws of a complex dynamic system. Future research needs to examine whether these dynamic indicators of system resilience may prove valuable for personalized risk assessment in this field.

Depressive Symptoms and Resilience among Hispanic Emerging Adults: Examining the Moderating Effects of Mindfulness, Distress Tolerance, Emotion Regulation, Family Cohesion, and Social Support.

Emerging adulthood has been described as a difficult stage in life and may be particularly stressful for Hispanic emerging adults who are disproportionately exposed to adversity and chronic sociocultural stressors. To better prevent and treat depressive disorders among Hispanic emerging adults, more research is needed to identify and understand modifiable determinants that can help this population enhance their capacity to offset and recover from adversity and sociocultural stressors. As such, this study aimed to (1) examine the association between resilience and depressive symptoms among Hispanic emerging adults, and (2) examine the extent to which intrapersonal resources (e.g., mindfulness, distress tolerance, emotion regulation strategies) and interpersonal resources (e.g., family cohesion, social support) moderate the association between resilience and depressive symptoms. To examine these aims, 200 Hispanic emerging adults (ages 18-25) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey, and data were analyzed using hierarchical multiple regression and moderation analyses. Findings from the hierarchical multiple regression indicate that higher resilience was associated with lower depressive symptoms. Findings from the moderation analyses indicate that family cohesion, social support, and emotion regulation strategies (e.g., cognitive reappraisal and expressive suppression) functioned as moderators; however, mindfulness and distress tolerance were not significant moderators. Findings from this study add to the limited literature on resilience among Hispanics that have used validated measures of resilience. Furthermore, we advance our understanding of who may benefit most from higher resilience based on levels of intrapersonal and interpersonal resources.