Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence

Growing Up on the Edge: A Community-Based Mental Health Intervention for Children in Gaza

The Gaza Strip is a notoriously high-conflict area, but few large-scale studies have examined the rates of psychiatric distress and emotional/behavioral problems among Gaza youth, and there are few trauma-informed, scaleable intervention options. Studies in existence have used smaller samples or have examined focal problems such as posttraumatic stress disorder (PTSD) or aggression. Here, we examine the mental health burden of young individuals (ages 8-13) in Gaza across a broad range of symptoms, and demonstrate the impact of a community-based, trauma-informed program, Eye to the Future. At the outset of this supportive youth program, over 2000 children and adolescent youth and their parents reported on child well-being using standardized measures with established global norms (the Child Behavior Checklist and Youth Self Report). These measures examine symptoms broadly (e.g. anxiety, depression, social problems, attention problems, aggression, etc.). Relative to U.S. population estimates, children in Gaza had between 2.5- and 17-times higher point prevalence of clinical mental health problems. The most significant clinical concern was anxiety, but overall, their symptoms were not confined to posttraumatic stress as a disorder and were instead broadly dispersed. However, these concerns were responsive to intervention: over the course of a six-month community psychosocial program, symptoms ameliorated, with approximately 50-70% showing reliable improvement at post-program (varying by measure). These gains were maintained in a 9-month follow-up. Future work should consider the broader mental health impact, beyond PTSD and aggression, and incorporate community supports into addressing mental health among children in the region.

Adult Maltese Women's Understanding of How Childhood Domestic Violence Has Impacted Their Relationships with Their Parents and Siblings: A Grounded Theory Study

Most of the literature that has looked at children's relationships with their parents in the domestic violence context has focused solely on the children's relationship with one parent or is studied from the perspective of one parent, usually the mother. Sibling relationships in the same context are also under-studied. This paper explores in more detail the complexity of children's relationships with their mothers, fathers, and siblings over time from the perspective of adult women and survivors of childhood domestic violence. Methods: A grounded theory methodology was used to analyse the interviews with 15 women aged twenty to forty-three years of age living in Malta. Results: the analysis showed that the domestic violence context remains significant in these important relationships for these women. The relationship with the father remains strongly influenced by the dynamics of fear, love, and retaliation, with cycles of cut-off and connection from the adult daughter's end. The relationship with the mother is complicated-feelings of love that are seen as having been limited and complicated by betrayal if there was abuse from the mother. Similarly, for the siblings, the roles of the early family of origin remain persistent and significant. However, in some of these relationships, there has been transformation, reconciliation, and forgiveness. The article offers implications for therapeutic practice for dealing with the complexity of these relationships and ideas for future research.

Examining the causal effects of exposure to violence on crime among youth involved in the justice system: Experienced, witnessed, and experienced-witnessed violence

Previous studies on exposure to violence lack a nuanced understanding of the causal effects of different exposure types on offending behaviors. This study, drawing on Pathways to Desistance Study (PDS) data tracking 1354 adjudicated youths aged 14-18 over 7 years, explores the contemporaneous (cross-sectional), acute (after 1 year), enduring (after 3 years), and long-term (after 6 years) causal effects of violence exposure on property and violent offending. The sample, predominantly male (86%), consisted of White (20%), Black (42%), and other (38%) individuals. The generalized propensity score is used to match unbalanced covariates across multiple exposure types, namely noninvolved (n = 392), witnessed (n = 577), experienced (n = 31), and experienced-witnessed violence (n = 305). Results demonstrate the contemporaneous, acute, enduring, and long-term effects of violence exposure on both violent and property offending, with varying durations and strengths across exposure types. The most pronounced risk effects are immediate, diminishing over time and potentially reversing in the long term as youth transition into adulthood. Among exposure types, experienced-witnessed violence exhibits the most potent effects on offending, followed by witnessed violence and then experienced violence-a pattern consistent across the observed time points. Noteworthy is the finding that the impact of violence exposure is more pronounced for violent offending, diminishing more rapidly compared to the effects on property offending.

Spirituality in Oncology: Relations between Spirituality, Its Facets, and Psychological and Demographic Factors in Cancer Patients in Germany

INTRODUCTION

Cancer diagnoses are constantly increasing in clinical practice. Therefore, more and more patients are interested in how they can actively participate in the process of treatment. Spirituality represents a hidden issue of the population, which counts as a branch of complementary and alternative treatment. Therefore, the aim of our study was to investigate whether there are associations between spirituality and demographic and psychosocial factors, as well as religious beliefs, in cancer patients.

METHODS

We conducted a survey with 451 participants in 10 oncology centers between March and July 2021. A composition of the following 9 different questionnaires was used to collect data on spirituality, demographics, resilience, self-efficiency, life satisfaction, and sense of coherence: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp12), General Life Satisfaction Short Scale (L-1), Resilienzskala Kurzform (RS-13), Sense of Coherence Scale - Leipziger Kurzform (SOC-L9), Allgemeine Selbstwirksamkeit Kurzskala (AKSU), Adolescent Food Habits Checklist, Likert-Scale of daily activities, questionnaire of the Working group Prävention und Integrative Onkologie (PRiO), and personal opinion on the cause of the disease. Calculated data and analyzed group differences using ANOVA Bonferroni were used to test associations between spirituality and the variables studied. For more detailed examination of spirituality, we took a closer look at the different components of spirituality - peace, meaning, and faith - and their relation to each other (three-factor spirituality analyses).

RESULTS

Higher spirituality scores in total as well as meaning, peace, and faith were each associated with higher levels of resilience and life satisfaction. Higher religious belief was found to be associated with higher spiritual attitudes. High personal self-efficiency was found in people with higher spiritual beliefs in general as well as higher meaning and peace. Meaning and peace emerge as essential components of spiritual well-being and show a stronger association with expressions of general spirituality than faith.

CONCLUSION

Spirituality takes a crucial role among the resources of life-threatening diseases. As such, further research is needed to expand and integrate patient options into a modernized concept of care. Our data indicate that higher spiritual well-being is associated with a more tolerant approach to illness. Thus, addressing spiritual needs in therapy is associated with better psychological adjustment to the individual situation and reduces negative distress. To promote spiritual needs in the future, cognitive as well as affective components of spirituality should be emphasized.

Adverse Childhood Experiences, Acculturation, and Risky Sexual Behaviors in Hispanic Young Adults: Findings from Project RED

While adverse childhood experiences (ACE) are well-documented predictors of maladaptive behaviors in adulthood, including risky sexual behaviors (RSB), the influence of acculturation in this association remains unknown. Although Hispanics are a rapidly growing population in the United States and are disproportionately affected by adverse sexual health outcomes, there is a paucity of research examining the interplay of ACE, acculturation, and RSB in this population. We observed the ACE-RSB association and how this relationship varies across U.S. and Hispanic acculturation levels, in a sample of Hispanic young adults (n = 715). Data for this study were from Project RED, a longitudinal study of Hispanic health. We ran regression models to test associations between ACE (0, 1-3, 4+) and several RSB (e.g., early sexual initiation (≤14 years), condomless sex, lifetime sexual partners, and alcohol/drug use before intercourse), and assessed moderation by U.S./Hispanic acculturation. Compared with those without ACE, individuals with 4 + ACE had higher odds of early sexual initiation (AOR: 2.23), alcohol/drug use before last intercourse (AOR: 2.31), and condomless sex (AOR: 1.66), as well as a higher number of lifetime sexual partners (β: 0.60). For those reporting 4 + ACE, high U.S. acculturation was protective in the association between ACE and using alcohol/drugs before intercourse. Future research implications are discussed.

Effects of resilience and timing of adverse and adaptive experiences on interpersonal behavior: a transdiagnostic study in a clinical sample

Adverse childhood experiences (ACE) have been linked to less prosocial behavior during social exclusion in vulnerable groups. However, little is known about the impact of the timing of ACE and the roles of protective factors. Therefore, this study investigated the association of the behavioral response to experimental partial social exclusion with adverse and adaptive experiences across age groups and resilience in clinical groups with persistent depressive disorder and borderline personality disorder, i.e., groups with high ACE, and in healthy controls (HC) (N = 140). Adverse and adaptive experiences during childhood, youth, and adulthood were assessed with the Traumatic Antecedents Questionnaire, and resilience was measured with the Connor Davidson Resilience Scale. A modified version of the Cyberball paradigm was used to assess the direct behavioral response to partial social exclusion. In patients, adverse events during youth (B = - 0.12, p = 0.016) and adulthood (B = - 0.14, p = 0.013) were negatively associated with prosocial behavior, whereas in the HC sample, adaptive experiences during youth were positively associated with prosocial behavior (B = 0.25, p = 0.041). Resilience did not mediate these effects. The findings indicate that critical events during youth may be particularly relevant for interpersonal dysfunction in adulthood.

Impact of childhood maltreatment on adult resilience

BACKGROUND

Previous studies suggested that childhood maltreatment is associated with poor health outcomes. While not everyone who experiences abuse as a child goes on to experience poor mental health, some traumatized people are grown to be more resilient than others. Few studies have examined the association between childhood maltreatment and adult resilience. This study aimed to determine different relationships between specific types and features of childhood maltreatment with adult resilience among Chinese with Major Depressive Disorder (MDD) and healthy controls (HCs).

METHODS

A total of 101 patients with MDD and 116 participants in the healthy control (HC) group from Zhumadian Psychiatric Hospital and its nearby communities were included in this analysis. Childhood maltreatment was assessed retrospectively using Childhood Trauma Questionnaire (CTQ). Adults' resilience was assessed by the Connor-Davidson Resilience Scale (CD-RISC). Generalized linear models were applied between childhood maltreatment (specific types and features) and resilience adjusting for covariates.

RESULTS

The total score of CD-RISC and factor scores of strength, optimism, and tenacity in the HC group were higher than those in the MDD group. CTQ total score had a negative association with optimism score among participants in MDD (β=-0.087, P < 0.001) and HC (β=-0.074, P = 0.023) groups. Higher emotional neglect (EN) score (β=-0.169, P = 0.001) and physical neglect (PN) score (β=-0.153, P = 0.043) were related to a worse optimism score in MDD group. Emotional abuse (EA) score was associated with a worse tenacity score (β=-0.674, P = 0.031) in MDD group. For participants in HC group, higher EN and PN scores were related to worse resilience scores (tenacity, strength, and optimism).

CONCLUSIONS

Patients with MDD showed lower optimism than HCs. Childhood maltreatment, especially childhood negect, independently contributed to optimism, with more severe childhood maltreatment predictive of worse performance of optimism. EA in childhood was also linked to worse tenacity in adult patients with MDD.

Longitudinal examination of resilience among child welfare-involved adolescents: The roles of caregiver-child relationships and deviant peer affiliation

Despite growing attention to resilience following childhood maltreatment, it remains unclear how the development of resilience unfolds over time among child welfare-involved adolescents. Further, little is known about the immediate and enduring effects of two important attachments in children's lives, namely caregiver-child relationship and deviant peer affiliation, on resilience development over time. This study sought to examine the ways in which caregiver-child relationships and deviant peer affiliation shape developmental trajectories of resilience among child welfare-involved youth. Data were drawn from the National Survey of Child and Adolescent Well-Being. Latent growth curve modeling was conducted on a sample of 711 adolescents. The results revealed that adolescents' resilience increased across a 36-month period since initial contact with Child Protective Services. Better caregiver-child relationships were associated with a higher initial level of resilience among adolescents, whereas higher deviant peer affiliation was associated with a lower initial level of resilience. Significant lagged effects were also found; caregiver-child relationship quality and deviant peer affiliation at baseline were associated with resilience at 18 months after. The findings suggest that interventions that aim to promote positive caregiver-child relationships and prevent deviant peer relationships may help foster resilience among adolescents who have experienced child maltreatment.

Mapping Individual, Relational, and Contextual Factors onto Posttraumatic Stress Symptoms and Resilience

Posttraumatic stress symptoms (PTSS) and resilience are two well-established outcomes following trauma exposure, but little work has examined the unique associations between these outcomes and factors across the social ecology. This theoretically grounded study assessed how individual, relational, and contextual social ecological factors relate to PTSS and resilience. Participants included 606 college students (18-25 years, M_age = 20.79, SD = 1.86; 82.51% Female; 56.60% White, 29.37% Black or African American, 5.78% Asian, 8.25% Other races) with exposure to at least one traumatic event. Two hierarchical linear regression models examined associations between individual (i.e., emotion dysregulation, anger severity), relational (i.e., family support, friend support), and contextual (i.e., community cohesion, community disorder) factors, and PTSS and resilience. At the individual level, higher emotion dysregulation was associated with higher PTSS and lower resilience; anger severity was not related to either outcome. At the relational level, more friend support was negatively associated with PTSS. Friend and family support were positively related to resilience. At the contextual level, community cohesion was positively associated with resilience, but not PTSS, and community disorder was unrelated to both outcomes. Findings demonstrate unique factors across the social ecology that differentially relate to PTSS and resilience. Variables at all three ecological levels were associated with resilience, whereas only individual and relational variables were related to PTSS. Replication with longitudinal data could inform treatments for trauma-exposed individuals that may mitigate PTSS and bolster resilience.

Adults with a child maltreatment history: Narratives describing individual strengths that promote positive wellbeing

BACKGROUND

Child maltreatment often has negative impacts, but some individuals have strengths that lead to better outcomes.

OBJECTIVE

Describe the narratives of adults who experienced childhood maltreatment, all of whom had positive psychosocial wellbeing at average age 18 years.

PARTICIPANTS AND SETTING

A purposive sample of 21 adults (mean age 27.8 years SD = 1.0) who were part of a longitudinal study on the effects of childhood maltreatment. The sample was self-described as 85.7 % female, 14.3 % male, 42.9 % Black, 33.3 % Latinx, 19.0 % White, and 4.8 % multiracial.

METHODS

This descriptive qualitative study, which is part of a sequential mixed method study, used semi-structured interviews and a narrative analysis approach. Four coders completed: (1) initial reading of sample interviews (2) generating codes independently and discussion, (3) creating a codebook, (4) reviewing 10-11 transcripts each (5) reconvening to discuss/resolve differences in coding, (6) identifying themes.

RESULTS

There were four themes. The first theme was seeing oneself in a good light, highlighting self-worth and helper roles. The second theme, moving forward, included letting go of their past and a future orientation. Coping with life, the third theme, included boundaries for people around them, routines, and self-sufficiency. Meaning making, the fourth theme, included insights on the effect of their maltreatment and foster care, and reflections on appreciating life and adapting to changing circumstances.

CONCLUSIONS

Findings describe varied strengths that promote positive functioning after childhood maltreatment. Study themes highlight how these strengths allow adults to make meaning of their experiences and move forward successfully in life.

Mentorship in adolescence and subsequent depression and adiposity among child maltreatment survivors in a United States nationally representative sample

Child maltreatment (CM) is associated with multiple adverse health outcomes. Hence, there is a great need to identify factors that promote resilience in CM survivors. Mentorship may promote positive coping in CM survivors, but this may vary by health outcome and mentor/mentee characteristics. Among participants in a United States nationally representative sample, the National Longitudinal Study of Adolescent to Adult Health, who retrospectively reported any CM before age 18 (sexual, emotional or physical, abuse or neglect; N = 3364), we examined associations between mentorship during adolescence and body mass index (BMI), obesity, and depressive symptoms at ages 24-32 (in 2008-2009). We utilized linear regression and predictive margins with complex sample weighting. Models were stratified by sex and race/ethnicity. Thirty-one percent and 40% of participants' most influential mentor was inside and outside the family, respectively, and 29% reported no mentor. Any mentorship was associated with decreased depressive symptoms in females (adjusted beta for any mentor = -0.78, 95% CI:-1.54,-0.02). By contrast, any mentorship was associated with increased adiposity, namely among Latinas (adjusted beta for BMI = 2.23, 95% CI:0.45,4.02, adjusted risk ratio for obesity = 1.42, 95% CI:1.03,1.97). The influence of mentorship in CM survivors is heterogeneous. While mentorship was associated with reduced psychopathology, it was also linked with worse physical health, underscoring that mentoring does not necessarily promote long-term resilience to physical health outcomes, particularly in minorities. A better understanding of how mentors influence specific mentee behaviors may be important in informing how mentors can promote better physical health and lower obesity risk among CM survivors.

Examining the Associations Between Childhood Trauma, Resilience, and Depression: A Multivariate Meta-Analysis

TOPIC OF REVIEW

Childhood trauma has been associated with increased depression; however, resilience has been found to reduce this association.

METHOD OF REVIEW

Present analyses were based on multivariate meta-analytical techniques, an extension of univariate meta-analysis. All computations were performed using the metafor package and the metaRmat package from R. Bivariate associations (r) between trauma, resilience, and depression were utilized as the pooled effect sizes.

CRITERIA FOR INCLUSION

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were coded based on the following inclusion criteria: (a) sample participants had a history of childhood trauma; (b) studies included one of the four instruments of trait resilience; (c) studies included measures of individual outcomes of depression; (d) studies were published in peer-reviewed journals, dissertations, book chapters since 2009, or provided by leading scholars who had yet to publish their data; (e) all manuscripts were written in English; and (f) studies included the Pearson Product Moment Correlation Coefficient (r) for the effect size.

CRITERIA FOR REVIEW

We systematically coded for the following items for each study: year of publication, type of report, peer-reviewed, funding, sampling strategy, sample size, gender, mean age, country of study, measure of resilience, measure depression, and measure of childhood trauma.

MAJOR FINDINGS

The pooled correlations indicate that trauma, resilience, and depression are significantly associated. There were no significant differences in symptoms of depression for high versus low reports of resilience for individuals with a history of trauma. Year of publication was a significant moderator for the associations between trauma, resilience, and depression. Resilience significantly mediated the association between trauma and depression.

Two-Year Utilization and Expenditures for Children After a Firearm Injury

INTRODUCTION

Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury.

METHODS

A retrospective cohort study was conducted between 2020 and 2022 of children aged 0-18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests.

RESULTS

Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p<0.001), and 10,228 total encounters in the second year (p<0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p<0.001) and a $0.8 million decrease 2 years after the firearm injury (p=0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury.

CONCLUSIONS

Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.

The Moderating Roles of Resilience and Coping Strategy on Well-Being of Victimized Forensic Workers

Previous research on workplace victimization has often disregarded forensic psychiatric populations and not yet been extended to the coronavirus pandemic. The present study expected the isolation of the government-issued lockdown to increase aggressive behavior in forensic patients, ultimately decreasing the general well-being of victimized forensic workers. Possible buffering protective factors (resilience and active coping) and enhancing risk factors (avoidant coping and passive coping) were investigated with the intention of optimizing the general well-being of at-risk forensic workers. The valid sample (N = 311) consisted of Dutch and Belgian forensic workers (74.6% females) with at least 9 hours of weekly patient contact, and with a mean age of 37.99 (SD = 12.20). Participants reported the number of violent incidents in the past 2 months, as well as completed a questionnaire battery including measures of well-being, resilience, and coping strategies. A significant increase of victimization during the lockdown compared to after it was lifted was found, however, the study did not find evidence to support that this negatively influenced the worker's general well-being. Active coping was found to be a significant moderator and protective factor for the general well-being of victimized forensic workers. In contrast, resilience, avoidant and passive coping were not significant moderators in this association. The present study has valuable clinical implications that could lead to preparatory and preventative measures for forensic workers at risk of being victimized. Future research may investigate constructs such as life satisfaction and post-traumatic growth, as well as be broadened into prison populations.

“It's Just Kind of This Thing That I Need to Navigate”: Young Women's Stories of Recoveries After Domestic Abuse in Childhood

Those who experience parental domestic abuse in childhood are affected in multiple ways, but existing research uses a narrow lens, relying on psychotherapeutic and neuroscientific understandings. This article uses a dialogical theory to explore women's recovery stories. Interviews were conducted with 10 women in England and a voice-centered narrative analysis was used. This article attends to gendered, psychotherapeutic, and neoliberal narrative resources that shaped participants’ stories. It concludes that recoveries after domestic abuse in childhood can be considered as dynamic processes that are individual, as well as shaped by social, political, and relational contexts that shape storytelling practices.

Role of Individual, Family, and Community Resilience in Moderating Effects of Adverse Childhood Experiences on Mental Health Among Children

OBJECTIVE

Mental health outcomes such as attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety, depression, and adverse childhood experiences (ACEs) are common disorders among children in the United States. Little is known on how potential resilient factors may moderate the relationship between exposure to ACEs and mental health outcomes. This study examines associations between ACEs and resilience on mental health outcomes using the 2018 National Survey of Children's Health (N = 26,572).

METHOD

Logistic regression and interactions examined the association between ACEs, resilience, and mental health outcomes. ACE exposure and low resiliency were associated with an increased likelihood of mental health outcomes.

RESULTS

There were significant interactions between exposure to ACEs and family resilience as well as significant interactions between ACE exposure and community resilience. On stratification, the presence of individual resilience and having all resilience measures decreased the odds of ADHD, behavioral disorders, anxiety, and depression and the presence of community resilience decreased the odds of depression among individuals who had experienced 4 or more ACEs.

CONCLUSION

These results illustrate the need to promote resilience measures for tackling mental health problems and reducing the negative effect of trauma in children.

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey

OBJECTIVES

Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood.

DESIGN

Cross-sectional population-based study carried out from November 2011 to March 2012.

SETTING

Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample.

PARTICIPANTS

A total of 3378 adults (aged 19 years and above) were included.

PRIMARY AND SECONDARY OUTCOMES MEASURES

The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models.

RESULTS

Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship.

CONCLUSIONS

Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Bullying Experiences, Depression, and the Moderating Role of Resilience Among Adolescents

Introduction

Resilience refers to the ability to adapt to difficult situation or adversity. Resilience is what gives people the psychological strength to cope with stress and hardship. Previous studies have investigated the relationship between resilience and bullying victimization and mental health problems. But whether the moderating effect of resilience against depression varies among victims of different types of bullying victimization remains unknown.

Methods

The study used data from the Taiwan Adolescent to Adult Longitudinal Study (TAALS), which was a school based, nationwide, longitudinal study conducted among adolescents in Taiwan. Between 2015 and 2019, the survey was repeated three times to capture changes in health behaviors. Meanwhile, our study is a cross-sectional study focusing on the 2nd follow-up survey of the TAALS, where we recruited 4,771 Grade 7 (12-13 years) and Grade 10 (15-16 years) students who had experienced bullying at school.

Results

This study confirms the protective effect of resilience on depression among adolescents who have experienced bullying. The mode resilience score was used as a reference group. Compared to the reference group, victims of verbal bullying from the lowest resilience group were at the greatest risk of depression (OR = 5.91, CI = 4.38-7.99). Compared to the reference group, victims of cyber bullying from the highest resilience group had the lowest risk of depression (OR = 0.72, CI = 0.57-0.90).

Conclusion

Regardless of the type of bullying victimization, resilience has been shown to offer protection against depression. Specifically, higher resilience levels offer the greatest protection against depression for victims of cyber bullying compared to other three types of bullying victimization. Early interventions to reduce negative effects of bullying victimization may start with increasing an individual's resilience during adolescence.

Afghan children and adolescents: The burden of poor mental health in contexts of widespread poverty, social inequality and persistent violence

In Afghanistan, the burden of poor mental health arises in contexts of widespread poverty, social inequality, and persistent violence. Generations of Afghans were born during the conflict, and some never knew peace. Children make up more than half (57%) of the population in need of emergency humanitarian assistance in Afghanistan. Recent assessments indicate that more than a third of children have been exposed to psychological distress due to the loss of family and community members and the constant risk of death and injury. Children and teens are struggling with anxieties and fears, desperately in need of mental health support. The lack of social support manifested itself in various forms of suffering in both children and adolescents. The quality of the environment where children and adolescents grow up shapes their well-being and development.

Examining the Post-High School Effects of a Primary Prevention Program on Exposure to Bullying and Sexual Violence among Emerging Adults

Emerging adulthood (EA) is a time of self-exploration as new opportunities for independence and autonomy arise. Yet, for some youth, this may also contribute to instability, uncertainty, and anxiety. Consequently, evidence suggests that rates of exposure to various forms of violence increase in EA. This study examined changes in experiences of bullying and sexual violence (SV) victimization among a sample of post-high school emerging adults who were exposed to a primary prevention program, Sources of Strength (Sources). We also examined whether Sources skills (e.g., healthy coping and help-seeking) buffer against these experiences. Participants were 102 emerging adults (73.5% identifying as female, 36.3% as Latinx, and 22.6% as LGBQ), who completed surveys at three time points: 1 month prior to graduation and at 6- and 12-months post-graduation. Results suggest that as youth transition into emerging adulthood, experiences of bullying victimization were relatively low and slightly decreased whereas experiences of SV were also relatively low, but stable over time. Notably, bullying victimization was lower when female-identifying participants, relative to males, had higher levels of healthy coping. In addition, SV victimization for participants identifying as non-white was higher at lower levels of coping than those identifying as white; however, at higher levels of coping, non-white participants reported lower rates of SV victimization, while rates were relatively stable for white participants at high and low levels of coping. These findings provide some support for the Sources program model where engaging in healthy coping may protect young women from bullying exposure and buffer against SV victimization for racial and ethnic minoritized young adults. Implications for violence prevention are discussed.

Eight-year trajectories of behavior problems and resilience in children exposed to early-life intimate partner violence: The overlapping and distinct effects of individual factors, maternal characteristics, and early intervention

Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6-8 months (N = 71) and 6-8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.

The Daily Spiritual Experience Scale: Empirical Relationships to Resiliency-Related Outcomes, Addictions, and Interventions

The Daily Spiritual Experience Scale (DSES) is a 16-item self-report measure designed to assess a set of experiences that may occur in the context of daily life for many different kinds of people. These include awe, a merciful attitude, giving other-centered love, deep inner peace, finding strength, guidance, or consolation from a transcendent source, among others. The DSES includes theistic and non-theistic language and alternatives, and has proven useful for those from many religions and for the unaffiliated. Since its original publication, it has been translated into over 40 languages, used in hundreds of published studies, and adopted for use in many practical settings. Empirically, the DSES predicts greater resilience, stress buffering, post-traumatic growth, and a sense of meaning in the face of illness, trauma, and daily stressors, as well as less substance abuse and burnout. Intervention studies using the DSES show that a variety of interventions can increase the frequency of these experiences. In this article, we will provide a brief overview of the scale and review its use in the empirical literature with respect to resilience and related outcomes. Findings suggest that the experiences measured by the DSES may serve as a resource for those experiencing distress of various kinds.

Childhood Abuse-Related Weight Gain: An Investigation of Potential Resilience Factors

INTRODUCTION

Childhood physical, sexual, and emotional abuse are linked to adult obesity, and little is known about what protective factors might mitigate this association.

METHODS

Data from female (n=4,247) and male (n=1,982) participants in the longitudinal Growing Up Today cohort study from 1996 to 2013 were used to examine whether factors found to promote mental health resilience after abuse also operate as buffers (modifiers) of the abuse-weight status association. At ages 20-25 years, participants were asked about their history of child abuse before age 18 years. Potential resilience factors (modifiers) included childhood family SES, neighborhood safety, supportive relationships with adult nonfamily members, quality of maternal relationship, family structure, religious service attendance, and prayer/meditation. Associations between child abuse and BMI at ages 25-32 years were modeled using linear regression, adjusted for sociodemographic variables and baseline BMI. Potential modifiers were tested with interaction terms. Analyses were run in 2019-2020.

RESULTS

Severe abuse was associated with 0.9 kg/m² (95% CI=0.5, 1.2) higher adult BMI than no abuse, corresponding to a 46% increased risk of obesity (95% CI=1.28, 1.67). Less severe abuse was not significantly associated with BMI (β=0.1, 95% CI= -0.2, 0.4). There were no significant interactions between modifiers and abuse.

CONCLUSIONS

Factors previously found to promote resilience to mental health sequelae after abuse did not modify the association of severe child abuse with higher weight status.

Suffering and Care of 0-12 Year-Old Children Exposed to Intimate Partner Violence: Making Clinical Forensic Data Talk

Children's exposure to intimate partner violence (IPV) is a widespread phenomenon that can have detrimental consequences on their health and well-being. This study examined how clinical forensic consultation data of adult victims of IPV might provide information on the potential suffering of children exposed to IPV, the duration of exposure and the knowledge of the situation by the professionals with whom those children were in contact. Data were collected from the consultation files of 112 adult victims of IPV who consulted the Violence Medical Unit at the Lausanne University Hospital (Switzerland) in 2014, and who were parents of children aged 0 through 12. Descriptive quantitative and qualitative analyses were performed. Symptoms of suffering, such as dysregulation of instinctual functions and developmental, behavioral or emotional difficulties, were reported for nearly one-third of the victims' children. Children's exposure to IPV often started around their birth and about four in 10 children had been exposed for three years or more. Health and childhood professionals were unaware of the exposure for the vast majority of the children. Clinical forensic data can be useful in providing information on the suffering and care of children exposed to IPV. Their suffering took the form of a non-specific posttraumatic symptomatology and therefore might be difficult to detect. It is necessary to make professionals and parents aware of the fact that IPV can have a harmful impact on children's health and well-being, and to encourage health professionals to consider the possibility of IPV when facing such symptoms.

The Road to Resilience: Strength and Coping Among Pregnant Women Exposed to Intimate Partner Violence

Pregnancy is a period of heightened risk for exposure to intimate partner violence (IPV), which is characterized by actual or threatened emotional, physical, or sexual violence committed by a past or current intimate partner. Pregnancy also represents a unique period in which women may be highly motivated to address IPV, to improve not only her health and well-being but also that of her child. Accordingly, the prenatal period affords an important opportunity for intervention among women experiencing IPV. Focus groups were conducted to evaluate coping strategies utilized by women exposed to IPV during pregnancy in addition to the strengths these women exhibit. Via thematic analysis, focus group data were evaluated from 10 women exposed to IPV proximal to their pregnancy and 46 service providers (e.g., medical personnel, family resource coordinators and case managers) who work directly with pregnant women experiencing IPV. When participants were queried about the personal strengths of IPV-exposed women, two domains emerged: (a) understanding and ending the cycle of IPV and (b) strengths achieved as a result of leaving the violent relationship (i.e., personal growth, enhanced self-esteem, improved attentiveness as a parent and resilience). With respect to coping, three central domains emerged: (a) the necessity of ensuring physical safety as a precondition for coping, (b) maladaptive coping strategies (e.g., substance use, avoidance), and (c) adaptive coping strategies (e.g., seeking support from others via both formal and informal relationships). These findings reinforce the importance of engaging with women before, during, and after they leave a violent relationship to provide support, affirmation and hope.

Personality Disorders, Risky Behaviors, and Adversity: The Moderating Role of Resilience

Individuals with personality disorders (PDs) comprise 30% to 40% of individuals receiving mental health treatment. Treatment of PDs is exceedingly difficult; therefore, research has focused on PD etiology and preventative factors. One known influence on PD etiology is adverse childhood experiences (ACEs). ACEs are associated with increased prevalence of several health risk behaviors (HRBs), including engagement in substance use, criminal, and risky sexual behavior. One protective factor, childhood resiliency, predicts lower prevalence of PDs and engagement in HRBs. We hypothesized that increased prevalence of ACEs would predict higher levels of PD symptoms and HRBs engagement. Furthermore, we predicted that childhood resiliency would moderate the relation between ACEs, PD symptoms, and HRBs. In the present study, students (N = 531) completed the Adverse Childhood Experiences survey, the Self-Administered - Standardized Assessment of Personality Abbreviated Scale, and the Childhood Youth and Resiliency Measure-28. They also responded to questions about substance use, criminal, and sexual behavior which were used to define a latent HRB variable. Structural equation modeling was conducted to examine study hypotheses. As hypothesized, we found positive relations between ACEs, PD symptoms, and our HRB latent variable. Childhood resiliency moderated both ACE and PD symptom paths. At lower levels of reported ACEs, individuals high in childhood resiliency reported fewer PD symptoms and HRBs than individuals low in childhood resiliency. At high levels of ACEs, childhood resiliency did not serve as a protective factor. Additionally, study findings suggest that childhood resiliency factors are integral for protecting against the development of these disorders.

Resilience Following Child Maltreatment: Definitional Considerations and Developmental Variations

Resilience following childhood maltreatment has received substantial empirical attention, with the number of studies on this construct growing exponentially in the past decade. While there is ample interest, inconsistencies remain about how to conceptualize and assess resilience. Further, there is a lack of consensus on how developmental stage influences resilience and how protective factors affect its expression. The current systematic review uses a developmental lens to synthesize findings on resilience following child maltreatment. Specifically, this article consolidates the body of empirical literature in a developmentally oriented review, with the intention of inclusively assessing three key areas-the conceptualization of resilience, assessment of resilience, and factors associated with resilience in maltreatment research. A total of 67 peer-reviewed, quantitative empirical articles that examined child maltreatment and resilience were included in this review. Results indicate that some inconsistencies in the literature may be addressed by utilizing a developmental lens and considering the individual's life stage when selecting a definition of resilience and associated measurement tool. The findings also support developmental variations in factors associated with resilience, with different individual, relational, and community protective factors emerging based on life stage. Implications for practice, policy, and research are incorporated throughout this review.

Are adverse childhood experiences associated with late-life cognitive performance across racial/ethnic groups: results from the Kaiser Healthy Aging and Diverse Life Experiences study baseline

OBJECTIVES

Evidence on adverse childhood experiences (ACEs) and late-life cognitive outcomes is inconsistent, with little research among diverse racial/ethnic groups. We investigated whether ACE exposures were associated with worse late-life cognition for all racial/ethnic groups and at different ages of exposure.

DESIGN

Covariate-adjusted mixed-effects linear regression models estimated associations of: (1) total number of ACEs experienced, (2) earliest age when ACE occurred and (3) type of ACE with overall cognition.

SETTING

Kaiser Permanente Northern California members aged 65 years and older, living in Northern California.

PARTICIPANTS

Kaiser Healthy Aging and Diverse Life Experiences study baseline participants, aged 65 years and older (n=1661; including 403 Asian-American, 338 Latino, 427 Black and 493 white participants).

RESULTS

Most respondents (69%) reported one or more ACE, most frequently family illness (36%), domestic violence (23%) and parental divorce (22%). ACE count was not adversely associated with cognition overall (β=0.01; 95% CI -0.01 to 0.03), in any racial/ethnic group or for any age category of exposure. Pooling across all race/ethnicities, parent's remarriage (β=-0.11; 95% CI -0.20 to -0.03), mother's death (β=-0.18; 95% CI -0.30 to -0.07) and father's death (β=-0.11; 95% CI -0.20 to -0.01) were associated with worse cognition.

CONCLUSION

Adverse childhood exposures overall were not associated with worse cognition in older adults in a diverse sample, although three ACEs were associated with worse cognitive outcomes.

Is there a relationship between spirituality/religiosity and resilience? A systematic review and meta-analysis of observational studies

Resilience is the ability to recover or cope with adverse situations. Spiritual and religious beliefs may be associated with important "resilience resources." To investigate whether there is a relationship between spirituality/religiosity (S/R) and resilience. This is a systematic review (observational studies) with meta-analysis following the PRISMA guidelines. From a total of 2468 articles, 34 observational studies were included. We identified a moderate positive correlation between S/R and resilience (r = 0.40 (95% CI, 0.32-0.48], p < 0.01). When only high-quality articles were included, the results were maintained. Conclusion: A moderate positive correlation was found between S/R and resilience.

Intervention Outcomes, Anxiety, Self-Esteem, and Self-Efficacy With DHH Students in Universities

This article reports the impact of an online spiritual counseling (OSC) program in mitigating anxiety and building self-esteem and academic self-efficacy among deaf and hard-of-hearing (DHH) students in universities. Compared to online relaxation sessions, the OSC was more effective. Male DHH students and those whose parents were highly qualified exhibited less anxiety and higher self-esteem and self-efficacy at pretest (T1). Post-test (T2) male students having better educated parents responded better to the OSC. T2 anxiety was lower and self-esteem and academic self-efficacy was higher for liberal arts students and having stay-at-home parents compared with science and commerce students and whose parents worked outside home. Self-esteem was also positively moderated by better economic class and presence of siblings. Intervention compliance in terms of regular attendance and self-practice mediated the relationship between sociodemographic predictors and outcomes. Results support the biopsychosocial model and encourage the implementation of the OSC with DHH university students.

Mediating Effect of Emotional and Social Competences on Interrelations Between Gender, Age and the Broad Autism Phenotype

The study aimed to identify the mediating role of emotional intelligence and social competences in the relationship between gender and broad autism phenotype (BAP) as well as between age and BAP. It comprised 85 parents of children with ASD. They completed the questionnaires of Autism-Spectrum Quotient, social competences, and emotional intelligence. The results revealed that emotional intelligence in general and its two dimensions: the ability to accept and express emotions and to empathize are important mediators of the relationship between gender and BAP. Also, social competences in general and two of their dimensions: the effectiveness of behavior in intimate situations and in social situations were significant mediators. The relationship between age and BAP could not be confirmed.

Features of Childhood Maltreatment and Resilience Capacity in Adulthood: Results from a Large Community-Based Sample

Childhood maltreatment is consistently associated with poor outcomes. However, few epidemiological studies have examined the association between childhood maltreatment and adult resilience capacity, defined as one's perceived ability to cope successfully with challenges. This study aimed to determine associations between adult resilience capacity and specific types and features of childhood maltreatment. Participants were African American adults recruited from a public urban hospital in Atlanta, GA (N = 1,962) between 2005 and 2013. Childhood maltreatment, including witnessing domestic violence or physical, emotional, and sexual abuse, was assessed retrospectively using the Traumatic Events Inventory. Perceived resilience capacity was assessed using the Connor-Davidson Resilience Scale. Linear regressions were performed assessing the association between resilience capacity and childhood maltreatment exposure in general, as well as specific dimensions of exposure, including type, co-occurrence, and developmental timing, adjusting for covariates. Participants exposed to any maltreatment reported lower resilience capacity than unexposed peers, B = -0.38, SE = 0.04, p < .001. All maltreatment types were negatively associated with resilience capacity, even after adjusting for other lifetime trauma exposure. Only emotional abuse remained significantly associated with resilience capacity after accounting for current psychological distress, B = -0.11, SE = 0.05, p = .022. Maltreatment co-occurrence followed an inverse dose-response relationship with resilience capacity: For each additional maltreatment type, scores decreased by 0.18 units (SD = 0.02), p < .001. Finally, the developmental timing of maltreatment did not reveal any differential influences on resilience capacity. The results suggest that childhood emotional abuse and co-occurrence of maltreatment types may be particularly deleterious to adult resilience capacity.

Validation of the Italian Version of the Brief Emotional Intelligence Scale (BEIS-10)

Based on Salovey and Mayer's conceptualization of emotional intelligence, Davies and colleagues developed the BEIS-10 scale, a 10-items self-report questionnaire that explores individual dispositions that people have about exploring one's own and others' emotions. To date, no studies assess the validity of the BEIS-10 scale in the Italian context. This article aims to fill this gap, exploring the validity, reliability, and construct validity of the Italian version of this scale. 244 Italian adults participated in the study and 67 respondents completed a second administration of the scale after two-weeks. The recommended statistical procedures were followed to validate the Italian version of the BEIS-10 scale and, after a back-translation process and a pilot testing, the five-factor structure of the scale was tested through a confirmatory factor analysis. Results highlighted that the five-factor model of emotional intelligence proposed by Davies and colleagues (2010) is confirmed in the Italian population. Data showed good reliability, good stability over time, and evidence of construct validity of the BEIS-10 scale. The BEIS-10 scale could be completed in a couple of minutes and it is particularly useful for collecting data in contexts in which time is an issue.

Psychological resilience and current stressful events as potential mediators between adverse childhood experiences and depression among college students in Eritrea

BACKGROUND

Adverse childhood experiences (ACEs) are well recognized remote risks for adulthood depression. However, proximal processes for this relationship is still an ongoing research endeavor, particularly among college students living in resource-limited settings. The mechanism of the impact of ACEs on depression may be attributed to mediators such as psychological resilience and current stressful events (CSEs).

METHODS

Data was obtained using a cross-sectional study from a national representative sample of college undergraduates in Eritrea (N = 507). To explain the mediated effect of ACEs on depression, a mediation analysis using structural equation modeling (SEM) was performed.

RESULTS

ACEs were found to have both direct (β = 0.102, p = 0.023) and indirect (β = 0.216, p < 0.001) effects on depression. The indirect effect was negatively mediated by psychological resilience and positively by CSEs. Respondents with higher levels of psychological resilience reported lower depressive symptoms and lower ACEs scores, while those with higher scores of either CSEs or ACEs reported more depressive symptoms.

CONCLUSIONS

The impact of ACEs on depression may be reduced by managing current stressors and building students' psychological resilience.

The Trauma and Suicide Potential Index-5: Psychometric Evaluation in College Samples

We provide a brief description of the development of the Trauma and Suicide Potential Index-5 (TSPI-5) and report on the psychometric properties of scores from the new instrument. The TSPI-5 is designed to assess an individual's desire to attempt suicide due to experiencing a trauma. We examined the structure of the instrument in two independent undergraduate samples. Study 1 (N = 415) examined the structure of the TSPI-5 using exploratory structural equation modeling. Study 2 (N = 538) reexamined the instrument structure using the same modeling strategy and also examined other validity estimates. Study 1 demonstrated an adequate fit to the sample data (χ² [1, N = 415] = 215.99, p < .001, comparative fit index (CFI ) = .969, Tucker-Lewis non-normed fit index (TLI) = .939, root mean squared error of approximation (RMSEA) = .319 [90% confidence interval (CI) = .283, .356], p < .001) and suggested evidence for unidimensionality. Study 2 confirmed the unidimensionality of the TSPI-5 as shown by acceptable fit estimates to the sample data, χ² (5, N = 538) = 80.45, p < .001, CFI = .996, TLI = .99, RMSEA = .17 (90% CI = .140, .200), p < .001. Scale reliability estimates for the TSPI-5 were good in Study 1 (omega = .94) and Study 2 (omega = .96). The TSPI-5 is a brief unidimensional instrument and its scores demonstrated good reliability and validity for assessing suicide-related behaviors due to experiencing a trauma in undergraduate samples.

Poly-victimization, Trauma, and Resilience: Exploring Strengths That Promote Thriving After Adversity

Although it is well known that victimization is associated with higher trauma symptoms, there is still limited information on the protective factors that can help people thrive after adversity. Using the Resilience Portfolio Model as a framework, this study explores a range of psychological and social strengths in a community sample of youth from the southern U.S.A sample of 440 youth aged 10 to 21 (average age 16.38, SD = 3.04) was recruited from youth-serving organizations. They completed a survey on trauma symptoms, victimization, other adversities, and 16 psychological and social strengths.Almost 9 in 10 (89.3%) youth reported one or more victimizations, with peer victimizations most common. Adult-perpetrated offenses were reported by almost half of youth (47.1%). Although several psychological and social strengths were inversely correlated with trauma symptoms at the bivariate level, hierarchical regressions indicated that a sense of purpose was the only strength that uniquely contributed to more resilient mental health in a model with all strengths and controlling for victimization, other adversities, poverty, age, and gender (total R² = .33). The variance explained by strengths (17%) was similar to the variance explained by adversities (15%).In this highly victimized sample of youth, many strengths were associated with lower trauma symptoms for youth, with a sense of purpose showing the most promise. Prevention and intervention programs may benefit from efforts to increase a sense of purpose or other meaning making activities, in addition to efforts that specifically target incidents of trauma.

Facets of dispositional mindfulness versus sources of social support predicting college students' psychological adjustment

Objective: This study examined the relative contribution of five dispositional mindfulness (DM) facets and two aspects of social support along with sex in predicting psychological adjustment. Participants: Three hundred fifty-three undergraduates (72% female; M = 18.82 years) participated with data collected from September 2014 through March 2016. Methods: Self-report measures of DM, social support, perceived stress, and emotional well-being were completed. Results: Sex and higher scores on specific mindfulness facets (ie, nonreactivity, nonjudging) predicted lower stress and greater emotional well-being. Higher family support predicted lower stress, whereas friend support predicted greater emotional well-being. The mindfulness facets were stronger predictors of adjustment than the social support domains. Females reported higher perceived stress and lower emotional well-being than males, and males scored significantly higher on total mindfulness, nonjudging, and nonreactivity. Conclusions: Results have implications for mindfulness-based interventions with college students such that focusing on the nonjudging and nonreactivity facets may enhance effectiveness.

Factor Structure, Reliability, and Validity of the Daily Self-Report Measure for Trauma-Related Sequelae (DSR-TRS)

The structure and psychometrics of daily self-report measures have only rarely been empirically tested. We developed the Daily Self-Report of Trauma-Related Sequelae (DSR-TRS), comprised of items assessing, in the past day: (1) posttraumatic stress disorder (PTSD) symptoms: (2) symptoms of affective-, behavioral-, relational-, somatic-, dissociative-, and self-dysregulation; and (3) stressors, mood, coping strategies, and drug and alcohol use. Psychometric analyses were conducted with data from 141 women who participated in a randomized clinical trial of two present-centered therapies for PTSD or a wait-list condition and completed at least one DSR-TRS during two 30-day periods at baseline and posttreatment/wait-list. Five DSR-TRS subscales were created based on a series of exploratory, confirmatory, and multilevel factor analyses: Positive Affect, Negative Affect, Self-Regulation, Dysregulation, and PTSD symptoms. DSR-TRS subscales had acceptable within-person and between-person reliability. Convergent and discriminant validity were supported at baseline and posttest in relation to questionnaire and interview assessment measures. Implications for research on daily self-report measures such as the DSR-TRS with trauma survivors are discussed.

Modelling resilience in adolescence and adversity: a novel framework to inform research and practice

Recent conceptualisations of resilience have advanced the notion that it is a dynamic and multifaceted construct. However, its adaptive components, especially those forged by adversity, have not been fully realised, and its neurobiological and psychosocial underpinnings are yet to be meaningfully integrated. In part, this is because a developmental perspective is often neglected in the formulation of resilience. In this review, we consider the findings of resilience research, with a specific emphasis on the developmental period of adolescence. To bridge the gaps in our current understanding, we propose a model of resilience that is predicated on experiencing adversity. Specifically, our model provides a sophisticated insight into the components of resilience, which, together with intrinsic features, involves facilitation of, and skill acquisition via strengthening processes we term tempering and fortification. The model also points to the potential trajectories of adversity-driven resilience and forms the basis of a framework that allows for individual variance in resilience, and the identification of both neurobiological and psychosocial targets for prevention and therapeutic interventions.

Resilient Adult Daughters of Abused Women: Turning Pain Into Purpose

Through the use of purposive sampling and the grounded theory method, this qualitative study delineates factors that promote adaptation and end family patterns of violence and dysfunction in the case of resilient adult daughters of abused women (N = 29). Coping processes included distancing from the family, seeking understanding and acceptance, and finding meaning and purpose. Motivating factors included learning what not to do from their families and breaking the cycle of violence and dysfunction from occurring in their adult lives. We learn how daughters of abused women may create a life informed, rather than directed, by their childhood adversity.

Ongoing Pediatric Health Care for the Child Who Has Been Maltreated

Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician's role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences.

Adverse Childhood Experiences Are Not Associated With Patient-reported Outcome Measures in Patients With Musculoskeletal Illness

BACKGROUND

Adverse childhood experiences (ACEs) affect adult mental health and tend to contribute to greater symptoms of depression and more frequent suicide attempts. Given the relationship between symptoms of depression and patient-reported outcomes (PROs), adversity in childhood might be associated with PROs in patients seeking care for musculoskeletal problems, but it is not clear whether in fact there is such an association among patients seeking care in an outpatient, upper extremity orthopaedic practice.

QUESTIONS/PURPOSES

(1) Are ACE scores independently associated with variation in physical limitations measured among patients seen by an orthopaedic surgeon? (2) Are ACE scores independently associated with variations in pain intensity? (3) What factors are associated with ACE scores when treated as a continuous variable or as a categorical variable?

METHODS

We prospectively enrolled 143 adult patients visiting one of seven participating orthopaedic surgeons at three private and one academic orthopaedic surgery offices in a large urban area. We recorded their demographics and measured ACEs (using a validated 10-item binary questionnaire that measured physical, emotional, and sexual abuse in the first 18 years of life), magnitude of physical limitations, pain intensity, symptoms of depression, catastrophic thinking, and health anxiety. There were 143 patients with a mean age of 51 years, 62 (43%) of whom were men. In addition, 112 (78%) presented with a specific diagnosis and most (n = 79 [55%]) had upper extremity symptoms. We created one logistic and three linear regression models to test whether age, gender, race, marital status, having children, level of education, work status, insurance type, comorbidities, body mass index, smoking, site of symptoms, type of diagnosis, symptoms of depression, catastrophic thinking, and health anxiety were independently associated with (1) the magnitude of limitations; (2) pain intensity; (3) ACE scores on the continuum; and (4) ACE scores categorized (< 3 or ≥ 3). We calculated a priori that to detect a medium effect size with 90% statistical power and α set at 0.05, a sample of 136 patients was needed for a regression with five predictors if ACEs would account for ≥ 5% of the variability in physical function, and our complete model would account for 15% of the overall variability. To account for 5% incomplete responses, we enrolled 143 patients.

RESULTS

We found no association between ACE scores and the magnitude of physical limitations measured by Patient-Reported Outcomes Measurement Information System Physical Function (p = 0.67; adjusted R = 0.55). ACE scores were not independently associated with pain intensity (Pearson correlation [r] = 0.11; p = 0.18). Greater ACE scores were independently associated with diagnosed mental comorbidities both when analyzed on the continuum (regression coefficient [β] = 1.1; 95% confidence interval [CI], 0.32-1.9; standard error [SE] 0.41; p = 0.006) and categorized (odds ratio [OR], 3.3; 95% CI, 1.2-9.2; SE 1.7; p = 0.024), but not with greater levels of health anxiety (OR, 1.1; 95% CI, 0.90-1.3; SE 0.096; p = 0.44, C statistic = 0.71), symptoms of depression (ACE < 3 mean ± SD = 0.73 ± 1.4; ACE ≥ 3 = 1.0 ± 1.4; p = 0.29) or catastrophic thinking (ACE < 3 = 3.6 ± 3.5; ACE ≥ 3 = 4.9 ± 5.1; p = 0.88).

CONCLUSIONS

ACEs may not contribute to greater pain intensity or magnitude of physical limitations unless they are accompanied by greater health anxiety or less effective coping strategies. Adverse events can contribute to anxiety and depression, but perhaps they sometimes lead to development of resilience and effective coping strategies. Future research might address whether ACEs affect symptoms and limitations in younger adult patients and patients with more severe musculoskeletal pathology such as major traumatic injuries.

LEVEL OF EVIDENCE

Level II, prognostic study.

The moderating effect of parental support: internalizing symptoms of emerging adults exposed to community violence

Evidence suggests parental support mitigates the association between community violence exposure and internalizing symptoms in adolescents. This study investigates this moderation of parental support for emerging adults and compares it with that for adolescents. Data were drawn from the Pathways to Desistence Study using community violence, parental support, and their interaction to predict internalizing symptoms in a series of regression models for adolescents and emerging adults. Results suggest that exposure to community violence during adolescence and emerging adulthood had a significant association with internalizing symptoms. Mother support during adolescence moderated this relationship. Emerging adulthood was marked by an increase in parental support; however, this support did not moderate the relationship between community violence and internalizing symptoms. Interventions, programs, and policies that leverage the parental support of emerging adults may be a useful strategy to mitigate the negative impacts of community violence.

Protective Factors associated with Resilience in Women Exposed to Intimate Partner Violence

OBJECTIVE

Research on adversity is often skewed toward assessing problematic functioning; yet many women display resilience following traumatic experiences. Examining individual, relational, community, and cultural variables can provide new knowledge about protective factors associated with resilience in women exposed to intimate partner violence (IPV). Controlling for demographics and circumstances of the violence, this study evaluated predictors of resilience, including spirituality, social support, community cohesion, and ethnic identity.

METHOD

The sample consisted of 112 women (M_age =32.12, SD=5.78) exposed to physical, psychological, and/or sexual intimate partner violence in the past 6 months. Approximately 70% of participants were Black. Hierarchical linear regression modeling was conducted to examine factors related to resilience. Model 1 included demographics (age, education, and socioeconomic status) and stressful life experiences. Model 2 added circumstances of the violence: IPV severity, IPV perpetration by participant, and number of violent partners. The third and final model added spirituality, social support, community cohesion, and ethnic identity.

RESULTS

The final model was significant, F(11, 97)=6.63; p<.001, adj. R² =36.5%; with greater social support (β=.24; p=.009), more spirituality (β=.28; p=.002), and fewer violent relationships (β= -.25; p=.003) predicting higher resilience among women exposed to IPV.

CONCLUSION

While risk factors associated with IPV are well-researched, little is known about factors related to resilient functioning, especially among minority populations. Knowledge gained from this study can advance the field of violence research by its identification of potentially mutable variables related to resilience. Such research could be applied to developing strength-based interventions for at-risk populations of violence-exposed women.

Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance

BACKGROUND

Adverse childhood experiences (ACEs) including maltreatment and exposure to household stressors can impact the health of children. Community factors that provide support, friendship and opportunities for development may build children's resilience and protect them against some harmful impacts of ACEs. We examine if a history of ACEs is associated with poor childhood health and school attendance and the extent to which such outcomes are counteracted by community resilience assets.

METHODS

A national (Wales) cross-sectional retrospective survey (n = 2452) using a stratified random probability sampling methodology and including a boost sample (n = 471) of Welsh speakers. Data collection used face-to-face interviews at participants' places of residence. Outcome measures were self-reported poor childhood health, specific conditions (asthma, allergies, headaches, digestive disorders) and school absenteeism.

RESULTS

Prevalence of each common childhood condition, poor childhood health and school absenteeism increased with number of ACEs reported. Childhood community resilience assets (being treated fairly, supportive childhood friends, being given opportunities to use your abilities, access to a trusted adult and having someone to look up to) were independently linked to better outcomes. In those with ≥4 ACEs the presence of all significant resilience assets (vs none) reduced adjusted prevalence of poor childhood health from 59.8 to 21.3%.

CONCLUSIONS

Better prevention of ACEs through the combined actions of public services may reduce levels of common childhood conditions, improve school attendance and help alleviate pressures on public services. Whilst the eradication of ACEs remains unlikely, actions to strengthen community resilience assets may partially offset their immediate harms.

Polyvictimization and Sexual Risk Behaviors in College-Aged Women

Current research suggests a link between childhood sexual abuse and risky sexual behaviors (RSBs) in emerging adults. However, previous studies neglect evaluating the influence of high levels of cumulative childhood victimization. The present study examined the relationships among polyvictimization, six aggregate categories of childhood victimization, and RSB in college women. This study first examined the relative contributions of polyvictimization and individual categories of childhood victimization in predicting RSB and then tested whether polyvictimization contributes any unique variance, beyond that accounted for by the combination of all six aggregate categories in a sample of 321 college women in a Southern state. Regression analyses reveal that (a) polyvictimization accounts for a significant proportion of variability in scores for RSB, beyond that accounted for by any of the six categories of childhood victimization alone; (b) the categories of childhood victimization contribute little to no variability beyond that accounted for by polyvictimization; and (c) polyvictimization accounts for a significant proportion of variability in RSB, beyond that already accounted for by the simultaneous entry of all six categories as predictor variables. Results suggest treatment providers working with college students should assess polyvictimization in relation to RSB and inform their prevention efforts given this link.