Resilience and protective factors in the lives of adolescents

Children's vulnerabilities and pathways to conflict with the law: Insights from Swatantra Clinic, a specialised mental health service at a tertiary care centre in India

'Swatantra-Clinic' at NIMHANS, India, provides mental healthcare to vulnerable children. This study describes the clinical profile, vulnerability and protective factors of 77 adolescents in conflict with the law (CICL). 90.9 % (n=70) reported Adverse Childhood Experiences (ACEs), 58.4 % (n=45) had school-related difficulties, 68.9 % (n=53) reported child labour experiences, 64.9 % (n=50) had deviant peer associations, and 40 % (n=31) experimented with substance use. Despite vulnerabilities, 72.7 %(n=56) had a positive future orientation, 45.5 % (n=35) had supportive caregivers and exhibited prosocial skills. only 12 % (n=9) followed up on recommendations, highlighting the need for collaborative and transdisciplinary care to promote CICL rehabilitation and community integration.

Social Capital, Deprivation and Psychological Well-Being among Young Adolescents: A Multilevel Study from England and Wales

Examining the mechanisms influencing mental health and life satisfaction simultaneously allows for a better understanding of adolescents psychological well-being. Six indicators of neighbourhood social capital (NSC), neighbourhood socioeconomic deprivation (SecD) and their association with psychological well-being among young adolescents aged 10-15 from England and Wales were investigated. Using a random sample of 5201 adolescents (7253 observations) from the UK Household Longitudinal Study merged to aggregated local area census measures, we fitted a series of multilevel models. The findings showed that not being worried about crime and friendship networks mitigated the negative effects of deprivation on adolescent's psychological well-being. These findings suggest that some forms of NSC may have a buffering and protective function, with the strongest effects in deprived neighbourhoods. We further found that psychological well-being of adolescents is dependent on both individual vulnerabilities and neighbourhood context. However caution is required if, and when public health policies are formulated to address this issue, given significant variations (27-36%) in the inter- and intra-individual psychological well-being were found among this group over time. Thus, policies designed to improve psychological well-being among adolescents should take into account the role of social processes in transmitting deprivation's effects, as well as the various forms of social capital.

Family cohesion and family size moderating burnout and recovery connection

Background

It has been argued that family issues in individual cultures do not correlate with fulfilment. However, the universality of these findings is unknown as they are based on data from the Western world.

Aims

To examine the connection between job burnout and recovery and the moderating effects of perceived family cohesion and family size in this relationship.

Methods

Moderated hierarchical regression analyses were carried out on a sample of medical practitioners working in intensive care units from federal and state-owned hospitals in Southeastern Nigeria.

Results

There were 183 participants. Job burnout was negatively related to recovery and perceived family cohesion was positively related to recovery. However, contrary to our assumption, family size was positively related to recovery. Perceived family cohesion was vital in recovery regardless of the doctors' experience of high levels of burnout. In contrast to most previous findings, family size was found to have a moderating effect in the burnout-recovery connection.

Conclusions

The findings of this study suggested that family bond is important in collectivistic cultures. This was underscored by the moderating effects family issues had on the relation between burnout and recovery. These findings are different from those in Western societies in which previous studies have been conducted.

Process for developing a culturally informed brief motivational intervention

The present study culturally enhances a standard brief intervention for alcohol use. Through an iterative process engaging key stakeholders; including patients, and expert consultants, this research sought to enhance current evidence based interventions. Five culturally informed enhancements consistent with Motivational Interviewing were introduced into standard brief interventions. These culturally informed enhancements can be refined to address the cultural risk and protective factors of other priority populations. The distinctions and advantages of this approach over prior cultural adapted interventions is discussed. Importantly, the present study outlines a process for refining the culturally informed brief intervention to other target populations.

Protective Factors Among Transgender and Gender Variant Youth: A Systematic Review by Socioecological Level

Transgender and gender variant (GV) youth experience elevated risk for poor health and academic outcomes due mainly to social experiences of stigma and discrimination. To supplement the growing evidence on health risks encountered by transgender/GV youth, we identified factors theorized to be protective for these youth across all four levels of Bronfenbrenner's socioecological model (individual, relationship, community, societal). We conducted a systematic search of peer-reviewed research. The articles included in this review were published in peer-reviewed journals in English or Spanish between 1999 and 2014, analyzed data from a sample or subsample of transgender or GV participants with a mean age between 10 and 24 years, and examined the relationship of at least one theorized protective factor to a health or behavioral outcome. Twenty-one articles met inclusion criteria. Transgender/GV youth in included articles ranged from 11 to 26 years of age, were racially/ethnically diverse, and represented varied gender identities. Within these articles, 27 unique protective factors across four levels of the ecological model were identified as related to positive health and well-being. Self-esteem at the individual level, healthy relationships with parents and peers at the relationship-level, and gay-straight alliances at the community level emerged as protective factors across multiple studies. Our findings underscore the relative lack of research on transgender/GV youth and protective factors. Novel recruitment strategies for transgender/GV youth and better measurement of transgender identities are needed to confirm these protective relationships and identify others. Growth in these areas will contribute to building a body of evidence to inform interventions.

Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers

Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.

Social Support and Risky Sexual Behavior among Adolescents: The Protective Role of Parents and Best Friends

Parents and best friends provide social support to adolescents that can protect them from risky sexual behaviors. Although past research has examined various factors related to parents, the benefits of parental involvement in an adolescent's life as it relates to risky sexual activities have not been examined. Past studies have also examined peer influence on adolescent behaviors, but have largely ignored the effect of best friends. The National Longitudinal Study of Adolescent Health (1995) reports that higher levels of family involvement and best friend interaction were related to lowering the odds of engaging in risky sexual activities. Higher levels of family involvement and best friend interaction increased the likelihood of using contraception during intercourse and early sexual activity among adolescents. The effects varied by gender. Programs that are intended to reduce the chances of sexual risk can potentially encourage activities with parents and close friends. Also, programs might focus on best friends, not necessarily peers, as a possible deterrent to behavior among adolescents.

Cultural adaptation of a brief motivational intervention for heavy drinking among Hispanics in a medical setting

Background

Hispanics, particularly men of Mexican origin, are more likely to engage in heavy drinking and experience alcohol-related problems, but less likely to obtain treatment for alcohol problems than non-Hispanic men. Our previous research indicates that heavy-drinking Hispanics who received a brief motivational intervention (BMI) were significantly more likely than Hispanics receiving standard care to reduce subsequent alcohol use. Among Hispanics who drink heavily the BMI effectively reduced alcohol use but did not impact alcohol-related problems or treatment utilization. We hypothesized that an adapted BMI that integrates cultural values and addresses acculturative stress among Hispanics would be more effective.

Methods/Design

We describe here the protocol for the design and implementation of a randomized (approximately 300 patients per condition) controlled trial evaluating the comparative effectiveness of a culturally adapted (CA) BMI in contrast to a non-adapted BMI (NA-BMI) in a community hospital setting among men of Mexican origin. Study participants will include men who were hospitalized due to an alcohol related injury or screened positive for heavy drinking. By accounting for risk and protective factors of heavy drinking among Hispanics, we hypothesize that CA-BMI will significantly decrease alcohol use and alcohol problems, and increase help-seeking and treatment utilization.

Discussion

This is likely the first study to directly address alcohol related health disparities among non-treatment seeking men of Mexican origin by comparing the benefits of a CA-BMI to a NA-BMI. This study stands to not only inform interventions used in medical settings to reduce alcohol-related health disparities, but may also help reduce the public health burden of heavy alcohol use in the United States.

Trial registration

Trial registration clinicaltrials.gov identifier NCT02429401; Registration date: April 28, 2015.

Systematic review of universal school-based resilience interventions targeting adolescent tobacco, alcohol or illicit drug use: review protocol

INTRODUCTION

Tobacco, alcohol and illicit drug use contribute significantly to global rates of morbidity and mortality. Despite evidence suggesting interventions designed to increase adolescent resilience may represent a means of reducing adolescent substance use, and schools providing a key opportunity to implement such interventions, existing systematic reviews assessing the effectiveness of school-based interventions targeting adolescent substance use have not examined this potential.

METHODS AND ANALYSIS

The aim of the systematic review is to determine whether universal interventions focused on enhancing the resilience of adolescents are effective in reducing adolescent substance use. Eligible studies will: include participants 5-18 years of age; report tobacco use, alcohol consumption or illicit drug use as outcomes; and implement a school-based intervention designed to promote internal (eg, self-esteem) and external (eg, school connectedness) resilience factors. Eligible study designs include randomised controlled trials, cluster randomised controlled trials, staggered enrolment trials, stepped wedged trials, quasi-randomised trials, quasi-experimental trials, time series/interrupted time-series trials, preference trials, regression discontinuity trials and natural experiment studies with a parallel control group. A search strategy including criteria for participants, study design, outcome, setting and intervention will be implemented in various electronic databases and information sources. Two reviewers will independently screen studies to assess eligibility, as well as extract data from, and assess risk of bias of included studies. A third reviewer will resolve any discrepancies. Attempts will be made to quantify trial effects by meta-analysis. Binary outcomes will be pooled and effect size reported using ORs. For continuous data, effect size of trials will be reported using a mean difference where trial outcomes report the same outcome using a consistent measure, or standardised mean difference where trials report a comparable measure. Otherwise, trial outcomes will be described narratively.

DISSEMINATION

Review findings will be disseminated via peer-reviewed journals and conferences.

Fostering resilience among urban youth exposed to violence: a promising area for interdisciplinary research and practice

Most studies to date have examined negative effects of exposure to community violence, in line with the deficit-based perspective. However, given that most youth exposed to community violence demonstrate positive adaptation or resilience over time, we suggest a shift in perspective, practices, and policies across systems toward identifying and building individual, family, and community assets and strengths that may more effectively support youth who have been exposed to community violence and related risks into competent, caring, and thriving adults. In this article, we review how resilience has been conceptualized and operationalized within the context of community violence, highlight gaps in literature, and offer directions for future public health research and practice. We illustrate this review with practice-based examples from public health work in the San Francisco Bay Area. Future multidisciplinary longitudinal studies that identify protective processes and successful trajectories and rigorous evaluations of strength-based policies, programs, and protective processes are needed.

Perceptions of social support, empowerment and youth risk behaviors

This study examined the association of perceived social support and community empowerment among urban middle-school students living in Matamoros, Mexico and the risk behaviors of fighting, alcohol and tobacco use, and sexual activity. Middle school students (n = 1,181) from 32 public and private Mexican schools were surveyed. Weighted multiple logistic regression analyses were conducted. Among girls, lack of parent/teacher interactions regarding school increased odds for fighting, alcohol and tobacco use. Among boys, lack of empowerment increased odds of alcohol and tobacco use and lack of parent/teacher interactions regarding school increased odds for sexual activity. Community empowerment and perceived social support are uniquely associated with risk behaviors for girls and boys. Additionally, perceived social support from individuals most immediate to the youth are associated with protection against risk for some behaviors, while perceived social support from individuals more removed from youth have mixed association with risk behaviors.

Surveying adolescents: Focusing on positive development

Although risk behaviours can threaten healthy youth development, reducing risks alone is not sufficient to help youth successfully negotiate adolescence. Promoting protective factors that buffer risk, such as family and school connectedness, community engagement and positive peer support, are also important for helping youth to thrive. Since 1992, the Adolescent Health Surveys conducted by McCreary Centre Society (Vancouver, British Columbia) have monitored both risk behaviours and protective factors among high school students across British Columbia. They have shown that, contrary to media images and community perceptions, the majority of young people are not exposed to risk factors such as violence and abuse; most do not have unprotected sex, drink and drive, use illegal drugs or consider suicide. They have also documented key protective factors that are linked to lower rates of risk behaviours and more positive outcomes, even for youth who face unsafe environments, family problems and other stressors. The shift toward assessing and promoting protective factors is a major paradigm change in adolescent health care, and clinicians can be an important partner with families and schools to foster healthy youth development.

Adolescent propensity to engage in health risky behaviors: the role of individual resilience

In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs. Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience. Our analysis reveals that the overall-resilient were less likely to engage in risky behaviors. The self/family resilient were more likely to engage in risky behaviors, but consumed less. The self-resilient had reduced risk for smoking and drinking alcohol but elevated risk for using illegal drugs and being in an addictive stage of smoking and drinking, if participating.

Strong Souls: development and validation of a culturally appropriate tool for assessment of social and emotional well-being in Indigenous youth

OBJECTIVE

The aim of the present study was to develop and validate an appropriate tool to assess the social and emotional well-being (SEWB) of Indigenous adolescents participating in the longitudinal Aboriginal Birth Cohort (ABC) Study.

METHOD

A range of tools was assessed as to the suitability of each for use in the ABC Study. Two existing tools and a newly developed one called 'Strong Souls' were piloted in a representative group (n = 67). Strong Souls was selected as the most appropriate for use in the ABC Study, and was completed by 361 participants. Exploratory factor analysis was used to explore construct validity. Cronbach alpha was used to assess the reliability of the latent constructs and the tool overall.

RESULTS

Factor analysis produced a 25-item, four-factor model accounting for 34.5% of the variance. This model demonstrated sound construct validity and reliability. Factor structure was consistent with the epidemiological literature, identifying constructs of anxiety, resilience, depression and suicide risk. While these align with observations in mainstream populations, different relationships between distinct factors, and differences in symptomatology were found in this population. For example, two key findings were: feelings of sadness and low mood were linked with anxiety and not depression; and the expression of anger was verified as a unique symptom of depression for Indigenous people.

CONCLUSIONS

Strong Souls demonstrated validity, reliability and cultural appropriateness as a tool for screening for SEWB among Indigenous young people in the Northern Territory.

Posttraumatic stress disorder symptoms in adolescents: risk factors versus resilience moderation

BACKGROUND

Exposure to community violence and trauma, stress, and childhood abuse and neglect have been identified as risk factors for the development of posttraumatic stress disorder (PTSD) symptoms among adolescents. Although evidence suggests that resilience may moderate the relationship between some of these risk factors and PTSD symptoms, no studies to date have examined these risk factors collectively.

AIMS

Our first aim was to examine the relationship between exposure to community violence, childhood abuse and neglect, perceived stress, and PTSD symptoms. Our second aim was to examine the extent to which resilience moderated the relationship between risk factors and PTSD symptoms.

METHOD

A convenience sample of 787 participants was drawn from 5 public secondary schools in the Cape Town metropole of South Africa. The participants were invited to complete a battery of questionnaires on a single occasion.

RESULTS

Of the participants, 48.3% were Black, 58.6% were female, and 31.6% were in grade 8. After controlling for covariates, we found that exposure to community violence, perceived stress, and childhood abuse and neglect together accounted for 33.4% of the variance in PTSD symptoms (F(8,778) = 71.06, P < .001). Nevertheless, resilience moderated the relationship between childhood abuse and symptoms of PTSD (beta = .09, t(786) = 2.88, P < .001), where the independent effect of childhood abuse and neglect on PTSD symptoms was significantly reduced with increasing resilience. Resilience did not, however, interact with exposure to community violence or perceived levels of stress to influence PTSD symptoms.

CONCLUSION

High levels of exposure to community violence, perceived stress, and childhood abuse and neglect may contribute to the development of PTSD symptoms in South African adolescents. However, high levels of resilience may buffer the negative effects of childhood abuse and neglect.

Protective factors in the lives of bisexual adolescents in North America

OBJECTIVES

We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents.

METHODS

We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups.

RESULTS

Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners.

CONCLUSIONS

Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.

Normalising the abnormal: Palestinian youth and the contradictions of resilience in protracted conflict

This qualitative study explores the construct of resilience by Palestinian youth in the 10th to 12th grades at school living in and around Ramallah in the West Bank. We look at how adolescents themselves interpret and give meaning to the concept of resilience in dehumanising and abnormal conditions. The aim is to 'problematise' the construct to go beyond quantitative research and objective inquiry. Focus groups were conducted with 321 male and female Palestinian students in 15 schools in Ramallah and the surrounding villages. This study presents findings that are consistent with previous research on the value of supportive relationships such as families and friends. Political participation and education are vital to a sense of identity and political resistance. However, a key finding reveals the normalisation of everyday life in fostering resiliency within abnormal living conditions. Palestinian youth, nonetheless, paint a picture of resilience that reveals contradictions and tensions. This study underlines the fluid and dynamic nature of resilience. Despite the desire for order, Palestinian young people complain of emotional distress and boredom. Feelings of desperation are intermingled with optimism. We also argue that the concept of resilience developed in predominantly Western settings ignores a local idiom of communal care and support. International and local organisations providing psychosocial care rely on trauma programmes based on a Western style of counselling. An over-emphasis on individualised intervention overlooks the notion of collective resiliency and fails to build on existing social capital within communities. Policy-makers should do more than 'tweak' preconceived projects to fit the cultural context or to replicate them from one conflict area to another. We should also keep in mind that the search for psychological well-being and justice are not mutually exclusive.

A predictive and moderating model of psychosocial resilience in adolescents

PURPOSE

To identify point prevalence of psychosocial resilience (PR) and to test moderating and predictive relationships among optimism, chronological age, gender, perceived family and friend support, number of bad life events, and PR in rural adolescents.

DESIGN

A secondary analysis of a cross-sectional survey of 624 rural adolescents aged 14 to 18 in an eastern U.S. state.

METHOD

Descriptive statistics were used to identify point prevalence, and stepwise logistic regression was used to identify which variables alone or in combination had significant effects upon PR.

FINDINGS

The point prevalence of PR was 17% with the largest percentage of students reporting medium levels of resilience. Level of adolescent PR was partially predicted by cognitive factors (optimism, perceived family support), number of bad life events, age, and gender. Perceived support of friends and optimism modified the level of PR.

CONCLUSIONS

The predictive and moderating model was useful for building knowledge about the process of PR in rural adolescents.

Adolescents with a chronic condition: challenges living, challenges treating

In this review, we aim to focus attention on the interaction between adolescents with chronic conditions and the health systems that support them. At least 12% of adolescents live with a chronic condition. Some conditions are characterised by increasing incidence (eg, diabetes) or improving survival rates (eg, cystic fibrosis), while others are concerning because of differentially poorer outcomes in adolescents in comparison to both children and adults (eg cancer). Growing evidence suggests that young people with chronic conditions are doubly disadvantaged--engaging in risky behaviours to at least similar if not higher rates as healthy peers, while having the potential for greater adverse health outcomes from these behaviours. In addition to efforts at improving survival, in order to improve their life chances, we need to better understand how the social and emotional outcomes of young people with a chronic disease can be improved, and better support young people's emerging capacity for self-management.

Adolescent mothers: resilience, family health work and health-promoting practices

AIMS

This paper reports a study examining the relationships among mother's resilience, family health promotion (i.e. health work) and mother's health-promoting lifestyle practices in single-parent families led by adolescent mothers by testing hypotheses derived from the Developmental Model of Health and Nursing.

BACKGROUND

Research on families led by adolescent mothers has focussed primarily on negative maternal and child outcomes while ignoring the capacities of these families, including their efforts to promote the health and well-being of both mothers and children.

METHODS

This replication study was conducted with convenience sample of 41 adolescent mothers recruited using a variety of strategies. Mothers were asked to provide verbal responses to items on three study instruments: The Resilience Scale, a measure of mother's resilience, the Health Options Scale, a measure of family health work and the Health Promoting Lifestyle Profile a measure of mother's health promoting lifestyle practices, as well as a demographic questionnaire.

RESULTS

Consistent with the theory, moderate positive relationships were observed between mothers' resilience and both family health work (r = 0.34, P = 0.01) and mothers' health-promoting lifestyle practices (r = 0.42, P < 0.001). As predicted, moderate correlations were also observed between health work and mother's health promoting lifestyle practices (r = 0.62, P < 0.001). With the effects of employment status and professional support held constant, mother's resilience and health work explained 30.2% of the variance in mother's health-promoting lifestyle practices.

CONCLUSIONS

The study validates theoretical relationships among concepts in the developmental model of health and nursing and contributes to better understanding health promotion in families led by adolescent mothers.

Early Intervention for Adolescent Substance Abuse: Pretreatment to Posttreatment Outcomes of a Randomized Clinical Trial Comparing Multidimensional Family Therapy and Peer Group Treatment

This randomized clinical trial evaluated a family-based therapy and a peer group therapy with 80 urban, low-income, and ethnically diverse young adolescents (11 to 15 years) referred for substance abuse and behavioral problems. Both treatments were outpatient, relatively brief, manual-guided, equal in intervention dose, and delivered by community drug treatment therapists. Adolescents and their parents were assessed at intake to treatment, randomly assigned to either MDFT or group therapy, and reassessed at six weeks after intake and at discharge. Results indicated that the family-based treatment (MDFT, an intervention that targets teen and parent functioning within and across multiple systems on a variety of risk and protective factors) was significantly more effective than peer group therapy in reducing risk and promoting protective processes in the individual, family, peer, and school domains, as well as in reducing substance use over the course of treatment. These results, which add to the body of previous findings about the clinical and cost effectiveness of MDFT, support the clinical effectiveness and dissemination potential of this family-based, multisystem and developmentally-oriented intervention.

Resilience

Evolution of the construct of resilience from physiological and psychological research extends from the 1800s to the present. This review supports 3 observations: (1) the importance of a dynamic, interactive perspective for understanding resilience; (2) the complexity of the construct requires a holistic perspective; and (3) the importance of exposure to diverse experiences and educational perspectives for professional health care students.

Enhancing resilience in the adolescent

Of particular interest to educators, health care, and social service professionals working with young people are those factors upon which we can have an impact as we search for ways to influence and improve the lives of youth with whom we come into contact. In this article the author defines resilience and identifies some of the key theoretical issues related to this concept. Research findings on the characteristics of resilient youth are explored and potential interventions on the individual, program, and policy levels to enhance resilience are presented.

Promoting success for at-risk African-American youth: perceived barriers and resources in using community-based success criteria

A Delphi technique was used to assess service provider and community consensus on program elements essential for promoting the success of at-risk African American youth. The respondent group consisted of 54 subjects representing three broad groups: service agencies, community leaders and members, and school system participants. The study identified barriers to the use of community-derived success constructs, opportunities for collaboration between community members and service agencies in the development of programs, and the feasibility of incorporating success constructs into program development and delivery. Although consensus was achieved on key issues, individual variations between counties point to the necessity of targeting intervention programs to the unique problems and expectations found in each community.