Resilience is an Adverse Event: A Critical Discussion of Resilience Theory in Health Services Research and Public Health

The Problem With Resilience: Individualisation, Reductionism and Relationality in Health Discourses on Resilience

Narratives of resilience are proliferating in health policy and research where they are used to address problems threatening individuals and communities. Resilience approaches are often considered alternatives to other models of intervention because they signal a shift away from deficit assumptions to more empowering ways of promoting health. To date, however, there has been a lack of scrutiny of the nature, assumptions and effects of resilience discourse within the health field. This paper critically analyses the logics that underpin the use of such discourse, and the implications of their allure. Findings show that resilience discourse is largely understood and operationalised in neoliberal, individualistic and reductionist terms. Such logics create normative standards for what counts as 'proper resilience' and, by doing so, engender experiences of guilt and shame when individuals are not 'resilient enough'. Seen differently, through the logics of social relationality, for example, resilience can engender new forms of subjectivity and practice for individuals and communities as 'expert' and 'knowing'. Relational resilience is especially evident in First Nations scholarship, where it is conceptualised in terms of collective values, practices and identities rather than the attributes of individuals, offering opportunities to advance thinking about resilience and its use in health contexts.

Exploring the sequential mediation model of coping humor, self-esteem, resilience, and subjective well-being among Taiwanese university students

Amidst growing scholarly interest in the integrative effects of psychological traits on well-being, the roles of coping humor, self-esteem, and resilience as pathways to subjective happiness remain underexplored. This study examined a sequential mediation model among these variables in Taiwanese university students. The sample comprised 524 undergraduates (228 males, 296 females; M = 21.06) from 64 universities across Taiwan. Data were collected via an online survey in September 2023 using validated scales, including the Coping Humor Scale, Rosenberg's Self-Esteem Scale, the Brief Resilience Scale, and the Subjective Happiness Scale. Analyses were conducted using IBM SPSS 27.0 and SmartPLS 4.0, applying descriptive statistics, Pearson correlation, t-tests, ANOVA, and Partial Least Squares Structural Equation Modeling (PLS-SEM). Results confirmed that self-esteem and resilience significantly mediate the relationship between coping humor and subjective happiness, validating the proposed model. Additionally, adaptive humor styles, such as affiliative and self-enhancing humor, significantly predict self-esteem and well-being, mediating the link between self-esteem and happiness. Psychological well-being, subjective happiness, and positive humor styles were positively correlated, reinforcing humor's role in fostering happiness. These findings highlight the potential of enhancing coping humor, resilience, and self-esteem to promote well-being in educational settings. The study also provides theoretical and practical implications, as well as research limitations and future directions.

"'Corona' was bigger than AIDS": exploring how female sex workers with HIV navigated HIV care and treatment during the onset of COVID-19 in the Dominican Republic and Tanzania

Initial efforts to control COVID-19 included restricting human movement, which caused heightened economic insecurity and challenges to the management of chronic health conditions such as HIV. The aims of this study were to: (1) explore how female sex workers living with HIV in the Dominican Republic and Tanzania, two different cultural and epidemic contexts, reacted to the onset of the COVID-19 pandemic, and (2) assess how lockdown measures impacted HIV care and treatment experiences. We analysed data from interviews (20 in each country) conducted during the onset of the COVID-19 pandemic as part of a longitudinal study of the social determinants of HIV outcomes. Using narrative and thematic analytic techniques, we identified fear and financial insecurity as the two main impacts of the initial COVID-19 lockdown on female sex workers in both settings. While participants experienced challenges accessing HIV-related care and treatment and received limited to no state-level social protection, they adapted to these changes by drawing on individual resilience and family and community support to sustain adherence to medication and overall wellbeing. Findings highlight the need for systems-level social protection to reduce economic insecurity prior to shocks and bolster individual resilience, family, and community-level supports during crises such as COVID-19.

Individuals with minoritized and intersecting identities in the prevention of body image and eating disorder pathology: Grounding theoretical frameworks of resilience and risk

Individuals with intersecting marginalized identities experience body image and eating pathology at disproportionately high rates. To date, research in this area has been limited by an absence of overarching and guiding frameworks to support hypothesis-driven research and interpretation of the findings. This constitutes an important barrier to the development of theoretically grounded intervention strategies. In this article, we review theoretical frameworks relevant to the investigation of body image and eating pathology among marginalized individuals using an intersectional lens and considering how processes of both risk and resilience unfold at multiple levels. We describe factors at the macrosystem (e.g., structural racism, capitalism, patriarchy), exosystem (e.g., food environment, social media, mass media), and microsystem (e.g., family, peers) levels. At the macrosystem level, we review critical race theories and those illuminating the role of systems that maintain power, privilege, and oppression, which describe how systemic discriminatory practices have led to marginalized individuals being neglected in efforts to conceptualize, identify, prevent, and treat body image and eating pathology. At the exosystem level, marginalized individuals experience heightened socioeconomic stressors and associated lack of access to resources that may impact body image and eating pathology. Furthermore, sociocultural theories focus on how visible marginalized identities are discriminated against, while white appearance ideals are upheld. At the micosystem level, we review sociocultural and minority stress theories that account for how interpersonal agents may perpetuate oppressive discourses and how marginalized individuals may experience negative interpersonal experiences that impact body image and eating pathology. We provide a comprehensive theoretical framework to guide future research on the distribution and determinants of inequities in body image and eating pathology among marginalized populations.

Community-Engaged Health Communication Strategies During the COVID 19 Pandemic: Experiences From Southern Andean Peru

This study examines the work of a collective of community-based Indigenous health rights activists in southern Peru who, at the height of the pandemic, designed, recorded, and disseminated seven Quechua language and culturally tailored Public Service Announcements for radio broadcast to provide information about COVID-19 vaccines. The activists took initiative amid a dysfunctional vaccine roll-out, when vaccination rates in their region were among the lowest in the country, and when mortality rates from COVID-19 were very high. The experiences of the activist collective, including their participatory, community-based approach and their connections with health workers, demonstrate the importance of pre-existing, strong, respectful relationships between communities and health systems in times of public health crisis. This is not an easy task given that relationships between communities and Peru's government-run health system are complex and shaped by dynamics of power, including colonial legacies and contemporary injustices. This case critically reflects on the notion of resilience and provides insights into the enduring struggles by Indigenous activists to decolonize and strengthen the public health system by pushing for forms of community participation based on substantive partnerships with community-based actors that genuinely integrate their knowledge and expertise.

A capsule network-based public health prediction system for chronic diseases: clinical and community implications

Objective

To observe the role of a public health chronic disease prediction method based on capsule network and information system in clinical treatment and public health management.

Methods

Patients with hypertension, diabetes, and asthma admitted from May 2022 to October 2023 were incorporated into the research. They were grouped into hypertension group (n = 341), diabetes group (n = 341), and asthma group (n = 341). The established chronic disease prediction method was used to diagnose these types of public health chronic diseases. The key influencing factors obtained by the prediction method were compared with the regression analysis results. In addition, its diagnostic accuracy and specificity were analyzed, and the clinical diagnostic value of this method was explored. This method was applied to public health management and the management approach was improved based on the distribution and prevalence of chronic diseases. The effectiveness and residents' acceptance of public health management before and after improvement were compared, and the application value of this method in public health management was explored.

Results

The key factors affecting the three diseases obtained by the application of prediction methods were found to be significantly correlated with disease occurrence after regression analysis (p < 0.05). Compared with before application, the diagnostic accuracy, specificity and sensitivity values of the method were 88.6, 89 and 92%, respectively, which were higher than the empirical diagnostic methods of doctors (p < 0.05). Compared with other existing AI-based chronic disease prediction methods, the AUC value of the proposed method was significantly higher than theirs (p < 0.05). This indicates that the diagnostic method proposed in this study has higher accuracy. After applying this method to public health management, the wellbeing of individuals with chronic conditions in the community was notably improved, and the incidence rate was notably reduced (p < 0.05). The acceptance level of residents toward the management work of public health management departments was also notably raised (p < 0.05).

Conclusion

The public health chronic disease prediction method based on information systems and capsule network has high clinical value in diagnosis and can help physicians accurately diagnose patients' conditions. In addition, this method has high application value in public health management. Management departments can adjust management strategies in a timely manner through predictive analysis results and propose targeted management measures based on the characteristics of residents in the management community.

Chronic Pain, Mental Health, and Sense of Purpose in Life Among Women Living with HIV Compared to HIV-Negative Women in the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study

Chronic pain and mental health conditions are common among women living with HIV (WLWH) and can negatively impact the HIV care continuum, decrease quality of life, and negatively affect aging trajectories. A strong sense of purpose in life, while potentially being protective, can also be attenuated or accentuated by varying sociobehavioral-structural correlates. However, less is known about how these factors intersect. This cross-sectional analysis of the British Columbia CARMA-CHIWOS Collaboration Study examines the prevalence of self-reported mental health conditions, differences in purpose in life, as measured by the Oregon Brief Purpose Measure, and associated correlates in 176 WLWH and 273 HIV-negative controls (median age 48, 41% white). Depression (38%), anxiety (37%), post-traumatic stress disorder (24%), substance use disorder (13%) and attention deficit hyperactivity disorder (12%) were most prevalent, and the burden of mental health diagnoses was greatest among women with chronic pain, compared to those without, independent of HIV. Higher scores on measures of resilience, purpose in life, and social support were associated with upwards of 43% (95% CI 29-54%) fewer mental health diagnoses, whereas histories of childhood violence and higher perceived sexism scores were associated with upwards of 96% (95% CI 40-274%) more diagnoses. Purpose in life scores were altogether comparable across groups, with post-hoc comparisons showing no statistically significant difference in women with concurrent HIV and chronic pain relative to others. In adjusted regressions, resilience emerged as the strongest predictor of a greater sense of purpose in life (ß = 3.50, 95% CI 2.78-4.22), with employment (ß = 1.14, 95% CI 0.43-1.96) and caring for dependents (ß = 1.01, 95% CI 0.24-1.78) also contributing. Programs and activities that promote a greater sense of purpose in life may help women living with HIV and chronic pain.

"Created Anew": Notes on Black Queer Intersectional Joy

While a focus on intersectional oppression elucidates important structural influences on health, it also obfuscates elements of how oppressed communities view themselves and their experiences. Black queer intersectional joy is one such element, and exploring this concept provides different openings for researchers to build solidarity with and produce relevant research alongside communities facing class oppression, heterosexism, racism, and cissexism. This article provides examples of Black queer intersectional joy, as well as potential problems and opportunities for engaging this concept.

Programming the next generation of prenatal programming of stress research: A review and suggestions for the future of the field

In this article, I highlight core ideas, empirical findings, and advances in the study of how stress during pregnancy may prenatally program child neurodevelopmental, psychopathological, and health outcomes, emphasizing reviews, metanalyses, and recent contributions of conceptual and empirical work. The article offers a perspective on the history of this area of science, the underrecognized contributions of influential scholars from diverse fields of study, what we know from the evidence to date, the persistent challenges in sorting through what is left to learn, and suggestions for future research. I include sections focused on promoting resilience, pregnancy interventions that demonstrate positive effects across two generations, and the translational implications of the accruing data for practice and policy, highlighting opportunities for integrating across a range of fields and sectors. In the concluding sections, I discuss lessons learned from conducting this work and provide a closing summary of progress and future directions. The goal of this writing was to provide a viewpoint on some ways that emerging intergenerational transmission scholars might responsibly contribute to the future of the field of developmental psychopathology.

Horror and Solidarity: Collective Health During the COVID-19 Emergency in Guayaquil, Ecuador

In 2020, Ecuador was among the most affected places in the world in the context of the COVID-19 emergency. Serious problems of structural inequality and governance resulted in corpses lying in the streets of Guayaquil-Ecuador's largest city-while local communities resisted in different ways. We interviewed 18 participants who engaged in actions of solidarity during this context, critically analyzed their discourses, and generated relevant themes. There was a structural scheme of (pandemic) brutality that determined embodied experiences of horror, conditioned by a governance of abandonment and its related problems. To confront such horror, solidary community resistance focused on food, physical and mental health, management of corpses, community-led communication, online education, and political participation. We interpret that this was a process of social determination of collective health and discuss important theoretical, methodological, and ethical-political implications.

Resilience and strengths in the Black autism community in the United States: A scoping review

Gaps in research knowledge pertaining to resiliency factors and strengths among the Black autism community, inclusive of autistic persons and their support system exist. A scoping review was conducted to further explore quantitative, qualitative, and mixed methods studies that investigate resiliency factors and related strengths in the Black autism community in the United States. A total of 436 articles were identified, with 28 studies included in the final review. Results demonstrated that (1) strengths of Black autistic persons across the life course have been disregarded in research; (2) Black caregiver advocacy, while common, is also a developmental process that can be supported by community-based interventions; (3) informal supports including family and friends play an instrumental role in supporting the well-under investigated being of Black parents of autistic children; and (4) spirituality is often endorsed by Black caregivers of autistic children, such as playing a role in acceptance of the autism diagnosis and with coping with difficult life situations. Research and practice implications are discussed.

A longitudinal path model examining the transactional nature of parenting and child externalizing behaviors in a large, sociodemographically diverse sample

Children's externalizing behaviors are associated with impairments across the lifespan. Developmental psychopathology theories propose transactional (bidirectional) associations between child externalizing behaviors and parenting during childhood and adolescence. Yet, these foundational relations in early childhood are not well-studied. Utilizing a large, mixed-sex sample, we examined the reciprocal nature of parenting and child externalizing behaviors across early childhood using robust repeated-measures models. Repeated measures data were drawn from a socioeconomically diverse, longitudinal pregnancy cohort of 1287 (64% Black, 31% White) mother-child dyads at four time points (ages one to six). Three variables were included in cross-lagged panel models: observed parenting quality, child externalizing symptoms, and a maternal risk composite. In covariate-adjusted models, higher parenting quality at Wave 1 predicted lower child externalizing symptoms at Wave 2. Higher externalizing symptoms at Wave 1 and Wave 2 predicted lower parenting quality at Wave 2 and Wave 3, respectively. Maternal risk and parenting quality were not significantly associated. Findings showed both parent-driven and child-driven effects across early childhood that did not vary by child sex. The transactional nature of the parent-child relationship begins in infancy, underscoring the importance of early screening and provision of supports for families to minimize and prevent the development of serious psychopathology.

Re-politicizing the WHO's social determinants of health framework

Although the World Health Organization's (WHO's) framework on social and structural determinants of health and health inequities (SSDHHI) has done much to raise awareness of these determinants, it does not go far enough in considerations of politics and power. The framework has become more de-politicized since its publication, with the definition of social determinants shifting toward downstream and individualized factors. In the meantime, new research fields on legal, commercial and political determinants of health and health inequities have emerged; however, these have not become integrated adequately into broader SSDHHI frameworks. To address these challenges, we argue for a re-politicization and an expansion of the WHO's framework by including the agents who have power over shaping structural determinants and the ways they use power to shape these determinants. We also provide a more detailed conceptualization of structural determinants to facilitate research. We propose a guideline for evaluating studies according to the extent to which they point upstream versus downstream and incorporate agents and considerations of power. We then use this framework to encourage more research on associations among agents, mechanisms of power, and structural determinants; how changes in structural determinants affect power dynamics among agents; and a wider focus on structural determinants beyond laws and policies, such as broad economic and sociopolitical systems. We also urge researchers to consider societal and institutional forces shaping their research with respect to SSDHHI. Research based on this framework can be used to provide evidence for advocacy for structural changes and to build more just systems that respect the fundamental human right to a healthy life.

Psychological resilience, resilient coping, and health behaviors among adults in Puerto Rico after multiple adverse events

Objective: Residents of Puerto Rico have recently experienced multiple adverse events, including hurricanes, earthquakes, and political unrest. Such adversity is associated with worse mental and physical health. Psychological resilience and effective coping may mitigate these relations by fostering positive health behaviors, like consuming a high-quality diet and being physically active. However, empirical evidence for these relationships is limited. Methods: We assessed psychological resilience, resilient coping, and health behaviors among two groups of adults in Puerto Rico, before and during the pandemic, in 2019-2023 (total N = 1,342). Resilience and resilient coping were assessed using the Brief Resilience Scale and Brief Resilient Coping Scale. Diet quality was defined by the Alternate Healthy Eating Index from a food frequency questionnaire. We collected data on sleep, physical activity, alcohol intake, and tobacco use using validated questionnaires. Results: Adjusting for confounders, higher resilience z-scores were associated with being in the highest category of diet quality [OR: 1.25, 95 % CI: 1.04, 1.50]; getting 7-8 h of sleep per night [OR: 1.15, 95 % CI: 1.02,1.30]; and reporting moderate or heavy physical activity (vs. light or sedentary) [OR: 1.17, 95 % CI: 1.02,1.34]. The same patterns were observed for higher resilient coping z-scores, and for categorical measures of resilience and resilient coping. These relationships were stronger among participants interviewed during (vs. before) the COVID-19 pandemic, suggesting that resilience and resilient coping may be particularly relevant during an ongoing stressor. Conclusion: Identifying supportive strategies to cultivate resilience and effective coping mechanisms may contribute to healthier behaviors, particularly in a vulnerable population.

"Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black

Introduction

Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies.

Methods

We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models.

Results

Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts.

Discussion

These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review

BACKGROUND

Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts.

METHODS

We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field.

RESULTS

Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers.

CONCLUSIONS

We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.

Climate Events, Displacement, and Mental Health-Uprooted

This Viewpoint discusses the implications of climate event–related disasters and displacement as well as strategies for mitigating their mental health effects.

When resilience is not enough: Imagining novel approaches to supporting Black youth navigating racism

The narrative surrounding the impact racism has had on the well-being of Black youth has shifted across sociocultural and historical context. Early discourse around these topics were problem-saturated, focusing on deficits "within" Black youth. Over time, an important narrative shift occurred: greater attention was paid to the inherent assets of Black youth, their families, and communities, including how racial-ethnic protective factors such as racial socialization afforded them resilience. What resulted was decades of research seeking to understand the mechanisms that allow Black youth to bounce back in spite of racism-related adversity. Notwithstanding the viable practice and policy implications that have emerged from such inquiry, at what point does our focus on the resilience of Black youth - whether individual or multisystemic - fall short? It is with this question in mind that this paper challenges those committed to the optimal development of Black youth to consider yet another narrative shift: one that stands upon the legacy of cultural ecological frameworks and the seminal models underlying resilience research, and calls us toward not supporting Black youth's adaptation to racism, but toward collective efforts to transform our approach, pushing back against the perniciousness of racism.