Integrative Review of the Recent Literature on Human Resilience: From Concepts, Theories, and Discussions Towards a Complex Understanding

Effects of a 6-h Resiliency Training on Well-Being in Nurse Leaders: A Pilot Study

BACKGROUND

Nurse leaders are at a higher risk for burnout post-pandemic. Resilience skills training incorporating mind-body awareness and self-compassion practices significantly improved stress, self-compassion, and mindfulness in medical professionals by the end of the training.

AIMS

This study aimed to assess if a 6-h resiliency training delivered to nurse leaders would improve measures related to well-being, for example, stress, burnout, life satisfaction, self-compassion, resilience, and mindfulness by the end of the course, and if any improvements would be sustained over time.

METHODS

We prospectively examined the effects of a 6-h resiliency training on well-being outcomes in nurse leaders in a longitudinal study during Spring 2022 through Fall 2022. Experienced resiliency teachers trained 46 nurse leaders. Participants took pre-, post-, and 2-months-post online surveys measuring well-being-related variables. Only 48% (n = 22) completed the entire course and surveys at all three times.

RESULTS

Nurse leaders were mostly female (n = 38, 83%) and white (n = 27, 59%) with an average age of 44.72 [SD = 9.5] years. Median years of experience were 15.5 [3.5-47]. One-way repeated measures ANOVA demonstrated a significant effect across time on stress (p = 0.02), self-compassion (p = 0.02), mindfulness (p = 0.04), and the exhaustion subscale of burnout (p = 0.008) but the significant changes occurred by the 2-month follow-up. Resilience, life satisfaction, and disengagement scores did not significantly change.

LINKING EVIDENCE TO ACTION

Baseline stress and burnout scores were high in 43.5%-63% of the nurse leaders, indicating a need for continued support of nurse leaders to reduce stress and burnout. Post resiliency training, scores in perceived stress and exhaustion decreased significantly over time, demonstrating the efficacy of this 6-h program to improve key variables related to well-being in nurse leaders. While baseline self-compassion scores were already high in nurse leaders, statistically significant improvements in self-compassion and mindfulness, but not resilience, occurred 2 months after this resiliency training program. Significant changes in key variables related to well-being occurred 2 months post training, indicating the need for further exposure and time with practices taught in the course. Nurse leaders need support to break away from work tasks to participate in psychoeducational trainings and interventions to improve well-being. We need further applied research on how to improve well-being in clinicians from a systems and environmental perspective.

The Interplay of Personal and Collective Resilience and Mental Health During Prolonged Conflict: Insights From Young Adults in Israel

In this study we employed a repeated cross-sectional design to examine mental health among young adults in Israel using samples collected before and after the October 7th attacks and subsequent war, with a focus on resilience resources, coping strategies, and post-traumatic stress disorder (PTSD) symptoms. Additionally, we explored risk and protective factors associated with PTSD symptoms separately for each sample. Data were gathered from two online surveys conducted pre- and post-October 7th, encompassing 2131 young adults aged 18-24. Findings revealed a significantly higher rate of PTSD in the post-October 7th sample (43.3%) compared to the pre-October 7th sample (25.2%). In addition, the post-October 7th sample reported lower levels of resilience resources and social support, along with a greater reliance on emotional coping strategies. PTSD symptom severity was also significantly higher in the post-October 7th sample. Perceived threat emerged as a key risk factor, whereas social support and personal resilience acted as protective factors. Emotional coping strategies such as self-blame and avoidance were found to exacerbate PTSD symptoms. Post-attack predictors of PTSD symptoms included direct exposure to the injury or death of loved ones and internal displacement. These findings underscore the vital role of personal resilience and social support in mitigating the mental health effects of severe trauma. Furthermore, the study highlights the nuanced relationship between coping strategies and mental health, emphasising that commonly employed strategies may not always protect against severe stress. Identifying effective resources for recovery in the context of prolonged and intense threat is essential for informing intervention efforts.

Networking trait resilience: Unifying fragmented trait resilience systems from an ecological systems theory perspective

OBJECTIVE

This study reconceptualized trait resilience, defining it as a network of systems; utilizing direct resilience assessments-engineering, ecological, adaptive capacity, social cohesion-and proxy resilience assessments-personality, cognitive, emotional, eudaimonia, and health.

BACKGROUND

The background of the study addresses the fragmented conceptualization of trait resilience by proposing a unifying network model based on ecological systems theory, illustrating the dynamic interplay of resilience factors across varying levels of disturbance.

METHOD

In Study One, four USA or UK samples (total n = 2396) were used to depict the trait resilience network. Study Two (n = 1091) examined the relationship between the network and disturbance at two time-points, using mental health levels as a disturbance metric.

RESULTS

Study One found that adaptive capacity, and sometimes positive emotional processes, were central variables to the network. Study Two found that in lower disturbance groups, adaptive capacity remained important, while in higher disturbance groups, a broader set of variables became central to the network.

CONCLUSIONS

Study One suggests a Broaden-and-Build approach, where adaptive capacity is a foundational resilience capability, reciprocally associated with positive emotional mechanisms. Study Two suggests a new "Dynamic Resilience Spectrum Theory," proposing that increased disturbances necessitate the use of a more diverse set of resilience traits.

The ART of resilience: a theoretical bridge across resilience perspectives

The theoretical understanding of psychological resilience has evolved significantly over recent decades, leading to diverse conceptual frameworks that emphasize different aspects of resilient adaptation. Some frameworks focus on resilience as a personal trait, others view it as a dynamic process, while still others emphasize the role of environmental and systemic factors. This theoretical paper introduces the ART framework (Acknowledgment, Reframe, and Tailoring), which provides an integrative perspective that bridges these seemingly disparate approaches. The ART framework offers a comprehensive understanding of how various resilience mechanisms work together in real-world contexts by focusing on the dynamic interplay between resource identification, reframing threats as challenges, and adaptive tailoring between resources and challenges. The ART framework incorporates and extends existing theoretical perspectives while providing a practical structure for understanding resilience development and intervention.

Cognitive Correlates of Resilience in Adults Experiencing Homelessness

OBJECTIVE

In adults who have experienced homelessness, greater psychological resilience is related to better quality of life, community functioning, and social cognition. Domain-specific cognitive functioning is positively associated with resilience in housed populations; however, these relationships have yet to be explored among adults experiencing homelessness. The aim of this study is to examine the relationships between domain-specific cognitive function and psychological resilience among adults experiencing homelessness.

METHOD

One hundred and six adults who have experienced homelessness were recruited in Toronto, Canada, and 88 were included in analyses (51% female, mean age = 43 years). Study measures assessed psychological resilience as well as domain-specific cognition (vocabulary, oral reading, processing speed, episodic memory, and executive functioning) using the NIH Toolbox Cognition Battery. Additional covariates of interest included psychological distress, social network size, substance misuse, and major psychiatric disorders. Hierarchical regression modeling explored the contributions of each cognitive domain to resilience while accounting for established covariates.

RESULTS

Oral reading was positively associated with higher resilience, explaining 12.45% of the variance in resilience while controlling for age, education, gender, substance misuse, psychological distress, and social network size. Performance on measures of executive functioning, processing speed, and visual memory were not found to be related to self-reported resilience.

CONCLUSION

The results suggest that verbal vocabulary, shaped by the accumulation of experiences across one's lifetime, may be an important contributor to psychological resilience. Better crystallized abilities may reflect more enriched early life experiences that are critical to better coping skills and well-being of adults experiencing homelessness.

Development of a Web-Based Intervention for Middle Managers to Enhance Resilience at the Individual, Team, and Organizational Levels in Health Care Systems: Multiphase Study

BACKGROUND

Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams.

OBJECTIVE

This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience.

METHODS

An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador.

RESULTS

The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points.

CONCLUSIONS

The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings.

Current Challenges, Solutions, and Novel Directions in Research and Clinical Care: Proceedings From the 14th Annual International Workshop on HIV and Aging

Integrating antiretroviral therapy into HIV care dramatically extended the lifespan for people living with HIV. Improving the health span requires understanding aging, HIV, associated comorbid conditions, and concurrent treatments. The 14th annual International Workshop on HIV and Aging on October 26-27, 2023 included podium presentations on: Sarcopenia: Biology, Pathophysiology, Prevention and Treatment; Long-acting ART; Central Nervous System (CNS) complications; Asymptomatic Neurocognitive Impairment (ANI); Mental Health; Loneliness; and Resilience. Presentations highlighted persistent concerns for people living with HIV including sarcopenia and frailty, mental health, loneliness, and cognition. Presenters encouraged prioritizing mental health treatment, reducing social isolation, and research on resiliency.

Disrupting the Path from Depression to Loneliness: Multilevel Resilience among Older Sexual Minority Men with and without HIV

Existing studies examining resilience among sexual minority men (SMM) have been limited by only analyzing 1 level of resilience. We therefore investigated the impact of multiple levels of resilience on the bidirectional relationship between loneliness and depression symptoms among older SMM. Loneliness, depression symptoms, and multilevel resilience scores were collected across 3 time points (October 2016 to March 2017 [T1]; October 2017 to March 2018 [T2]; and October 2018 to March 2019 [T3]) among 1,264 SMM aged 40 years and older living with and without HIV. Longitudinal mediation models were used to test the mediating effect of the multilevel resilience factors at T2 on the bidirectional relationship between loneliness and depression symptoms, adjusting for sociodemographic covariates. The multilevel resilience factors were negatively associated with loneliness and depression symptoms at T1. The individual-level global resilience factor was associated with decreased odds of depression symptoms (odds ratio [OR] = 0.50; 95% CI, 0.32-0.78), while the interpersonal-level relationship confidence (OR = 0.43; 95% CI, 0.24-0.77) and reliability (OR = 0.36; 95% CI, 0.15-0.84) factors were associated with decreased odds of loneliness at T3. The total effect of loneliness at T1 on depressive symptoms at T3 was β = 0.20 (95% CI, 0.11-0.28) and was reduced to β = 0.08 (95% CI, -0.04 to 0.20) after the inclusion of the multilevel resilience factors. The total effect of depressive symptoms at T1 on loneliness at T3 was similar (β = 0.21; 95% CI, 0.13-0.28) with the direct effect of β = 0.01 (95% CI, -0.08 to 0.11) after the inclusion of the multilevel resilience factors. Regarding specific indirect effects, individual-level global resilience (depression symptoms at T3 only) as well as the interpersonal-level relationship reliability and confidence (loneliness at T3 model only) factors were statistically significant. Multilevel resilience factors mediated the bidirectional relationship between loneliness and depression symptoms. Mental health interventions should consider implementing resilience-informed strategies that mitigate depression symptoms and loneliness among older SMM.

Sense of danger, sense of country's mastery, and sense of personal mastery as concomitants of psychological distress and subjective well-being in a sample of Poles following Russia's invasion of Ukraine: Prospective analyses

This study investigated psychological toll of the ongoing war in neighboring Ukraine in a sample of adult Poles (N = 1245). Data were collected online in early February and August 2022. Prospective analyses that accounted for psychological health status assessed before the Russian invasion showed that higher levels of sense of danger due to the war predicted higher levels of psychological distress and lower levels of affect balance close to 6 months after Russia attacked Ukraine. Sense of country's mastery (i.e. beliefs that government, its major institutions, and citizens would effectively cope with various emergencies and crises) served as a protective factor. Likewise, Poles who had confidence in their personal mastery (e.g., beliefs in ability to exercise control over life challenges) exhibited less distress and more subjective well-being. These findings emerged after controlling for sociodemographic factors, the presence of stressful experiences associated with the COVID-19 pandemic, and other life events. Wars dramatically reverberate beyond the borders of the countries involved. People's own sense of mastery and their trust in the resilience of their governmental and public institutions are critical in times of coping with existential security threats and wars.

A full-scale Russian invasion of Ukraine in 2022: Resilience and coping within and beyond Ukraine

The study examined the resilience and coping of samples from Ukraine and five nearby countries during the war in Ukraine. The research focused on (1) the levels of community and societal resilience of the Ukrainian respondents compared with the populations of five nearby European countries and (2) commonalities and diversities concerning coping indicators (hope, well-being, perceived threats, distress symptoms, and sense of danger) across the examined countries. A cross-sectional study was conducted, based on data collection through Internet panel samples, representing the six countries' adult populations. Ukrainian respondents reported the highest levels of community and societal resilience, hope, and distress symptoms and the lowest level of well-being, compared to the population of the five nearby European countries. Hope was the best predictor of community and societal resilience in all countries. Positive coping variables, most notably hope, but also perceived well-being are instrumental in building resilience. While building resilience on a societal level is a complex, multifaceted task, various dimensions must be considered when planning actions to support these states. It is essential to monitor the levels of resilience, during and following the resolution of the crisis, both in Ukraine and in the neighboring countries.

A longitudinal study of societal resilience and its predictors during the Israel-Gaza war

This study assesses the resilience of Israeli society during the ongoing Israel-Gaza conflict and pinpoints factors that influence this resilience in prolonged national crises. A longitudinal study was carried out with two surveys, both using the same questionnaire to gage societal, community, and individual resilience levels, along with hope, morale, distress, perceived threats, and government support. The initial survey was administered 5 days after the war escalated and the second 1 month later. The study's results reveal a decline in societal resilience over time. The regression analysis identified four major associations at both resilience measurement points. The key variables are community resilience and hope, both contributing positively. Attitudes towards government support (specifically being a government supporter vs. an opponent) also played a role. Additionally, there was a negative association with levels of religiosity, particularly distinguishing between ultra-orthodox and secular individuals. In the temporal analysis predicting future resilience (from data at the first time point to predict resilience at the second time point), societal resilience at the first measurement was the strongest forecaster of its resilience at the second measurement. Additionally, the main continuous variable from the previous analysis, community resilience, continued to be an influential and positive forecaster in the time-based analysis. The research suggests that the initial unifying effect of the conflict, similar to a "Rally around the flag" phenomenon, may be short-lived. The study underlines the importance of community strength, hope, government support, and religious considerations in shaping societal resilience in the face of conflict.

Drogue, violence et résilience : consommateurs de drogue en cure et anciens délinquants violents à Dakar

In Senegal, violent delinquency and illicit drug use are on the increase. This study focuses on two distinct groups: drug users (DUs) undergoing rehabilitation and violent ex-offenders (VEs). The methodology adopted includes a quantitative survey of the general population (n=1009), followed by a qualitative survey of fifteen participants, including eight DUs undergoing treatment at the Centre de prise en charge intégrée des addictions de Dakar (CEPIAD) (Integrated Addictions Management Center of Dakar) and the Centre Jacques Chirac de Thiaroye, and seven former VEs from the Grand Yoff district. This neighborhood, known for its violence, is juxtaposed with the Grand Yoff social housing estate, a residential area also affected by outbreaks of violence. This study aims to establish the link(s) between drug use and criminal violence by analyzing the life stories of young adults who have managed to leave drug use and delinquency behind. It then looks to identify the determinants of resilience in certain young people. The study revealed delinquent violence among young people does not systematically result from drug use. Rather, drug use is a factor conducive to violence. The links between drugs and violence depend on individual predisposition, the type of drugs used, and the level of addiction. Resilience results from a web of individual, sociocultural, and environmental factors. It is not static, but rather the result of a series of successes, failures, and even relapses.

Are we really studying resilience in sport? A critical review of adopted methodologies

Psychological resilience has gained considerable attention in sport. Nevertheless, the construct often remains poorly understood and multiple conceptual and methodological issues pervade the literature. The purpose of the present article is to provide a critical review of the commonly adopted methodologies to study resilience in sport. This review is divided into four sections. The first section will briefly discuss opposing conceptualizations of resilience as a static trait or a dynamic process. The second section will then discuss key methodological implications relating to the conceptualization of resilience as a dynamic process. In the third section, common methodologies to study resilience in sport are presented and critically reviewed. These methodologies are broadly divided into: (i) self-report resilience measures, (ii) qualitative research, and (iii) direct assessment of functioning in relation to observed adversity. In the final section, some avenues for future research are offered.

Impact of the war in Ukraine on resilience, protective, and vulnerability factors

War or armed conflict is one of the most severe human-made adversities. The current study examines the resilience, protective, and vulnerability factors of a sample of Ukrainian civilians, during the current Russian-Ukrainian war. The level of resilience and coping indicators were compared with the responses of an Israeli sample following an armed conflict in May 2021. The data were collected by an internet panel company. A representative sample of Ukrainian residents (N = 1,001) responded to an online questionnaire. A stratified sampling method was employed regarding geographic distribution, gender, and age. The data concerning the Israeli population (N = 647) were also collected by an internet panel company during a recent armed conflict with Gaza (May 2021). Three notable results emerged in this study: (a) The Ukrainian sample reported significantly higher levels of the following: Distress symptoms, sense of danger, and perceived threats, compared with the Israeli sample. However, despite these harsh feelings, the Ukrainian respondents reported substantially higher levels of hope and societal resilience compared, to their Israeli counterparts, and somewhat higher individual and community resilience. (b) The protective factors of the respondents in Ukraine (level of hope, wellbeing, and morale), predicted the three types of resilience (individual, community, and social) better than the vulnerability factors (sense of danger, distress symptoms, and level of threats). (c) The best predictors of the three types of resilience were hope and wellbeing. (d) The demographic characteristics of the Ukrainian respondents hardly added to the prediction of the three types of resilience. It appears that a war that threatens the independence and sovereignty of a country may, under certain conditions, enhance the societal resilience and hope of the population under risk, despite a lower sense of wellbeing and higher levels of distress, sense of danger, and perceived threats.