A Qualitative Study of How Adolescents' Use of Coping Strategies and Support Varies in Line With Their Experiences of Adversity

Background

Adolescence is associated with a rise in the incidence of mental health issues. Thus, the factors, processes, and contexts that protect and promote positive mental health in adolescence are of key interest to policymakers.

Objective

Our aim was twofold: First, to explore the coping strategies and sources of support that adolescents identify as protective (or not) in the face of difficulty over a three-year period; second, to examine how and why this may vary in line with the levels of adversity that they report experiencing in life.

Methods

Participants were attending schools in England implementing a mental health prevention programme called HeadStart. 93 semi-structured interviews were conducted with 31 adolescents (age 11-12 at the outset of the study; 58% female) once per year over three years. The interviews were analysed using thematic analysis.

Results

Six coping strategy themes (e.g., 'Disengaging from problems') and five support themes (e.g., 'Parents as a source of comfort and advice') were derived from the interviews. The types, quality, and consistency of reported coping strategies and support varied in line with whether adolescents were experiencing higher or lower levels of adversity in life over time, and according to the resources that they had available within their physical and social contexts.

Conclusions

Our findings underscore the importance for mental health prevention programmes of bolstering both individual-level coping strategies and the resources available within adolescents' environments to help them to manage adversity.

Indigenous Youth and Resilience in Canada and the USA: a Scoping Review

Relative to non-Indigenous youth, Indigenous youth have been under-represented when studying pathways to mental wellness. Yet, a broad range of adversity is acknowledged, from intergenerational and ongoing trauma arising from colonial policies. This scoping review explores resilience definitions, measures, key stressors, and what Indigenous youth identify as pathways to their wellness, based on quantitative and qualitative peer-reviewed literature in Canada and the Continental United States. Eight databases (EBSCO, PsycINFO, Science Direct, Social Science Citation Index, Web of Science, PsycARTICLES, and EMBASE) and hand searches of 7 relevant journals were conducted to ensure literature coverage. Two independent reviewers screened each article, with one Indigenous screener per article. The final scoping review analysis included 44 articles. In articles, no Indigenous term for resilience was found, but related concepts were identified (“walking a good path,” “good mind,” Grandfathers’ teachings on 7 values, decision-making for 7 generations into the future, etc.). Few Indigenous-specific measures of resilience exist, with studies relying on Western measures of psychological resilience. Qualitative approaches supporting youth-led resilience definitions yielded important insights. Youth stressors included the following: substance use, family instability, and loss of cultural identity. Youth resilience strategies included the following: having a future orientation, cultural pride, learning from the natural world, and interacting with community members (e.g., relationship with Elders, being in community and on the land). Indigenous traditional knowledge and cultural continuity serve as prominent pathways to Indigenous youth resilience. More research is needed to yield a holistic, youth-centered measure of resilience that includes traditional practices.

The role of individual-, family-, and school-level resilience in the subjective well-being of children exposed to violence in Namibia

BACKGROUND

Children exposed to violence are at risk of a range of adverse outcomes. Given the unique cultural and social context, understanding what fosters children's resilience in resource-limited areas such as sub-Saharan Africa, is vital.

OBJECTIVES

Using data from the International Survey of Children's Well-Being (ISCWeB), this paper explores individual-, family-, and school-level factors associated with positive outcomes for children who have experienced some form of violence in Khomas region, Namibia.

METHOD AND PARTICIPANTS

Using a cross-sectional survey design, the ISCWeB questionnaire, assessing cognitive, affective, and psychological dimensions of well-being, child protection factors and violence exposure was administered to 2124 Grade four and six children.

RESULTS

Our sample had a mean age of 11.2 years. Overall, 56.8 % of children reported at least one incident of violence from an adult caregiver at home and 86.0 % of children reported some form of peer violence at school. Materially deprived children experienced higher incidence of both family and peer violence. The quality of children's relationships at home (β = 0.17, p < 0.001), and school (β = 0.07, p < 0.001) emerged as important protective factors for children's well-being for both types of violence, suggesting that supportive family and school relationships may be more important to the subjective well-being of children who experienced violence than material wellbeing, violence severity, and individual child factors.

CONCLUSIONS

Providing positive social interaction and emotional security in contextually and culturally appropriate ways within children's proximal systems should be prioritized while challenging norms that support violence in Namibian families and schools.

Are we walking the talk of participatory Indigenous health research? A scoping review of the literature in Atlantic Canada

INTRODUCTION

Participatory research involving community engagement is considered the gold standard in Indigenous health research. However, it is sometimes unclear whether and how Indigenous communities are engaged in research that impacts them, and whether and how engagement is reported. Indigenous health research varies in its degree of community engagement from minimal involvement to being community-directed and led. Research led and directed by Indigenous communities can support reconciliation and reclamation in Canada and globally, however clearer reporting and understandings of community-led research is needed. This scoping review assesses (a) how and to what extent researchers are reporting community engagement in Indigenous health research in Atlantic Canada, and (b) what recommendations exist in the literature regarding participatory and community-led research.

METHODS

Eleven databases were searched using keywords for Indigeneity, geographic regions, health, and Indigenous communities in Atlantic Canada between 2001-June 2020. Records were independently screened by two reviewers and were included if they were: peer-reviewed; written in English; health-related; and focused on Atlantic Canada. Data were extracted using a piloted data charting form, and a descriptive and thematic analysis was performed. 211 articles were retained for inclusion.

RESULTS

Few empirical articles reported community engagement in all aspects of the research process. Most described incorporating community engagement at the project's onset and/or during data collection; only a few articles explicitly identified as entirely community-directed or led. Results revealed a gap in reported capacity-building for both Indigenous communities and researchers, necessary for holistic community engagement. Also revealed was the need for funding bodies, ethics boards, and peer review processes to better facilitate participatory and community-led Indigenous health research.

CONCLUSION

As Indigenous communities continue reclaiming sovereignty over identities and territories, participatory research must involve substantive, agreed-upon involvement of Indigenous communities, with community-directed and led research as the ultimate goal.

Indigenous Resilience in Australia: A Scoping Review Using a Reflective Decolonizing Collective Dialogue

Contemporary definitions and understandings of resilience refer to an individual's positive adaptation to the experience of adversity. One of the challenges of this extant body of work is that the central concept of resilience is rarely questioned. Current understandings of these concepts, largely framed in Western understandings, are unquestioningly accepted, reframed for, yet not by, Indigenous peoples, and then are unchallenged when imposed on Indigenous peoples. A scoping review was conducted and reported in line with the PRISMA-ScR guidelines. The review involved the participation of local Aboriginal Research Cultural Advisory Groups who participated and approved the analysis of the findings and collaborated on the design and writing of the paper. Eight publications drew on Aboriginal constructs of resilience in examining the effectiveness of programs, processes, and practices to promote individual and/or collective resilience and well-being. Most studies emphasized the need for strategies to strengthen individual or community connection to culture to foster resilience. Six studies used culturally validated strength-based tools to measure resilience, while two relied on Western constructs. This review reveals both the distinctive colonial characteristics of adversity experienced by Aboriginal people and the range of coping strategies and protective resources that support the development of resilience within different Aboriginal communities in diverse research sites across Australia. Importantly, many studies confirm adversity is linked to the enduring legacies of colonization, continuous and cumulative transgenerational grief and loss, structural inequities, racism, and discrimination. These external factors of adversity are unique to Aboriginal populations, as are the protective factors that entail strengthening connection to culture (including language reclamation), community, ancestry and land (including management and economic development) which contribute to individual and collective resilience. These findings suggest that Aboriginal community resilience is strengthened through the collective experience of adversity, such as transgenerational grief and loss, and the resulting support structures and shared resources that are developed and maintained through cultural practices to strengthen the bonds and mutual reciprocity to participate in transformative strategies to address adversity. This review highlights that strategies such as building on community strengths, capacities, and resources is critical when strengthening resilience within Indigenous communities across Australia.

Instrumento WHOQOL-100 e políticas públicas: avaliação da qualidade de vida de população alvo de política habitacional

Resumo O ambiente é um dos determinantes sociais da saúde. No Brasil, as habitações sociais, financiadas por políticas públicas, tendem a ser erguidas em espaços desprovidos de infraestrutura urbana e a posse da casa se acompanha de incertezas na condução da vida cotidiana. Este trabalho visa investigar o uso do questionário de qualidade de vida WHOQOL - 100 como instrumento de análise da qualidade de vida de uma população atendida por política habitacional, integrando os campos da saúde coletiva e do planejamento urbano. O questionário foi respondido por 101 moradores de um conjunto habitacional de São José dos Campos, um município paulista de grande porte. Encontraram-se baixos escores de autoavaliação de qualidade de vida, ambiente e subjetividade comparados aos dados disponíveis em publicações acadêmicas que avaliam, no geral, populações adoecidas. Os resultados permitiram avaliar de modo objetivo a relação entre ambiente e qualidade de vida, subsidiando a formulação e implantação de políticas sociais integradas às habitacionais para garantia dos direitos sociais de populações carentes.

The resilience of Peruvian immigrants through participation in community-based organizations in urban Chile

This study explores the situational elements related to the resilience of Peruvian immigrants in Santiago, Chile. Through extensive fieldwork with Santiago community-based organizations, in-depth semistructured interviews (N = 18) completed with Peruvian leaders, and an innovative grounded theory situational analysis, a critical psychopolitical framework of community participation of Peruvian immigrants was generated. More specifically, three main themes emerged from data analysis and describe resilience processes, including, negotiating historical narratives and multiple identities; navigating to resources; and resisting racism and dehumanization. Results describe how community participation plays a role in promoting resilience by transforming immigrants' conditions and contexts while increasing their sense of mattering, and their access to resources and human rights.

Land and nature as sources of health and resilience among Indigenous youth in an urban Canadian context: a photovoice exploration

BACKGROUND

Population and environmental health research illustrate a positive relationship between access to greenspace or natural environments and peoples' perceived health, mental health, resilience, and overall well-being. This relationship is also particularly strong among Canadian Indigenous populations and social determinants of health research where notions of land, health, and nature can involve broader spiritual and cultural meanings. Among Indigenous youth health and resilience scholarship, however, research tends to conceptualize land and nature as rural phenomena without any serious consideration on their impacts within urban cityscapes. This study contributes to current literature by exploring Indigenous youths' meaning-making processes and engagements with land and nature in an urban Canadian context.

METHODS

Through photovoice and modified Grounded Theory methodology, this study explored urban Indigenous youth perspectives about health and resilience within an inner-city Canadian context. Over the course of one year, thirty-eight in-depth interviews were conducted with Indigenous (Plains Cree First Nations and Métis) youth along with photovoice arts-based and talking circle methodologies that occurred once per season. The research approach was also informed by Etuaptmumk or a "two-eyed seeing" framework where Indigenous and Western "ways of knowing" (worldviews) can work alongside one another.

RESULTS

Our strength-based analyses illustrated that engagement with and a connection to nature, either by way of being present in nature and viewing nature in their local urban context, was a central aspect of the young peoples' photos and their stories about those photos. This article focuses on three of the main themes that emerged from the youth photos and follow-up interviews: (1) nature as a calming place; (2) building metaphors of resilience; and (3) providing a sense of hope. These local processes were shown to help youth cope with stress, anger, fear, and other general difficult situations they may encounter and navigate on a day-to-day basis.

CONCLUSIONS

This study contributes to the literature exploring Indigenous youths' meaning-making process and engagements with land and nature in an urban context, and highlights the need for public health and municipal agencies to consider developing more culturally safe and meaningful natural environments that can support the health, resilience, and well-being of Indigenous youth within inner-city contexts.

Integrating Healthcare Services for Indigenous Australian Students at Boarding Schools: A Mixed-Methods Sequential Explanatory Study

INTRODUCTION

Many Aboriginal and Torres Strait Islander Australian adolescents from remote communities attend boarding schools, requiring integrated healthcare between home and schools. This study explored students' health status, healthcare service use and satisfaction.

METHODOLOGY

A two-phased mixed-methods explanatory design was implemented. 32 Indigenous primary and 188 secondary boarding school students were asked their health status, psychological distress, use of healthcare services in community and boarding school, and service satisfaction. Results were fed back to students, parents and community members, and education and healthcare staff to elicit further explanation and interpretation.

RESULTS

In the previous year, 75% of primary and 81% of secondary boarding school students had visited a doctor. More than 90% were satisfied with healthcare services used. Despite 27.1% reporting high psychological distress, students did not perceive distress as reducing their overall health, nor was distress associated with mental healthcare service use.

DISCUSSION

Despite high levels of service use and satisfaction, this study highlighted the need for improved healthcare integration for Indigenous adolescents between school-based and remote community services. Further research is needed to identify students' expectations and models for healthcare integration.

CONCLUSION

With resourcing, schools could play a greater role in facilitating access to healthcare.

Neuroimaging Markers of Risk, Disease Expression, and Resilience to Bipolar Disorder

PURPOSE OF REVIEW

Familial predisposition to bipolar disorder is associated with increased risk of affective morbidity in the first-degree relatives of patients. Nevertheless, a substantial proportion of relatives remain free of psychopathology throughout their lifetime. A series of studies reviewed here were designed to test whether resilience in these high-risk individuals is associated with adaptive brain plasticity.

RECENT FINDINGS

The findings presented here derive from structural and functional magnetic resonance imaging data obtained from patients, their resilient first-degree relatives, and healthy individuals. Patients and relatives showed similar abnormalities in activation and connectivity while performing tasks of interference control and facial affect recognition and in the resting-state connectivity of sensory and motor regions. Resilient relatives manifested unique neuroimaging features that differentiated them from patients and healthy individuals. Specifically, they had larger cerebellar vermis volume, enhanced prefrontal connectivity during task performance, and enhanced functional integration of the default mode network in task-free conditions. Resilience to bipolar disorder is not the reverse of risk but is associated with adaptive brain changes indicative of increased neural reserve. This line of research may open new avenues in preventing and treating bipolar disorder.

The Treasure in Leisure Activities: Fostering Resilience in Young People who are Blind

Because leisure activities are often viewed as optional, their value to people with disabilities may not be recognized. This study explored the benefits of leisure activities for eight young people who are blind. These activities provided them with supportive relationships, a desirable identity, experiences of power and control, and experiences of social justice. They enabled the young people we studied to thrive despite adversity.

A concurrent examination of protective factors associated with resilience and posttraumatic growth following childhood victimization

The present study concurrently examined protective factors associated with the adaptive outcomes of resilience and posttraumatic growth (PTG; defined as positive psychological change resulting from a life crisis or trauma), after accounting for relevant demographic factors and the impact of circumstances surrounding childhood victimization (i.e., age of first trauma, frequency of victimization, and perception of trauma severity). The protective factors examined in the present study included social support from friends and family, optimism, positive religious coping (i.e., looking to God for support and guidance; forgiveness), and negative religious coping (i.e., feeling abandoned by God; anger towards God). Participants included 161 college students from the US MidSouth, aged 18-24 (M_age = 19.97, SD = 1.86). All participants reported experiencing physical violence and/or sexual abuse during their childhood. Hierarchical multiple regression analyses indicated that after accounting for demographics and circumstances surrounding the childhood victimization, higher resilience was associated with greater family support, optimism, and positive religious coping, while higher posttraumatic growth was associated with greater optimism and positive religious coping. These findings underscore the protective role of optimism with respect to both resilience and posttraumatic growth. Additionally, results highlight the importance of examining cognitions related to religious coping rather than simply assessing broadband religiosity, as only positive religious coping was associated with adaptive outcomes. Findings suggest the importance of early intervention to bolster protective factors (i.e., family support, positive thinking, gratitude, and positive religious coping skills) among youth exposed to childhood physical and sexual victimization.

Paving Pathways Through the Pain: A Grounded Theory of Resilience Among Lesbian, Gay, Bisexual, Trans, and Queer Youth

This grounded theory study utilized interviews with 16 service providers and 19 lesbian, gay, bisexual, trans, and queer (LGBTQ) youth to develop a substantive theory of resilience processes among LGBTQ youth. The core category, paving pathways through the pain, suggests that LGBTQ youth build on emotional pain inflicted by external adversities to carve out pathways to resilience. Youth employed the following resilience processes: (1) navigating safety across contexts, (2) asserting personal agency, (3) seeking and cultivating meaningful relationships, (4) un-silencing marginalized identities, and (5) engaging in collective healing and action. Youth focused on particularly painful adversities and engaged intentionally in one or more of the resilience processes related to the origins of their pain.

The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health

BACKGROUND

Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health.

METHODS

We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health.

RESULTS

The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens.

CONCLUSIONS

While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.

Meaning, Resilience, and Traumatic Stress After the Deepwater Horizon Oil Spill: A Study of Mississippi Coastal Residents Seeking Mental Health Services

The present study examines the relationship between resilience, perceived meaning in life, and traumatic stress symptoms among coastal residents of Mississippi directly affected by the Deepwater Horizon oil spill (also known as the Gulf oil spill). The study was conducted as part of a larger project that assessed the spill's effect on the mental health of individuals seeking therapeutic services. Multiple regression analyses were conducted to determine if resilience and perceived meaning are significant predictors of scores from a measure of posttraumatic stress. Descriptive data, reliability coefficients, and correlations were also calculated. Higher levels of resilience and meaning together were predictive of fewer posttraumatic stress symptoms after controlling for the effect of the spill. Resilience and meaning appeared to be similar predictors of lower posttraumatic stress scores, and meaning appears to be an important facet of what makes a person resilient.

Telling stories and adding scores: Measuring resilience in young children affected by maternal HIV and AIDS

"Telling stories and adding scores: Measuring resilience in young children affected by maternal HIV and AIDS", demonstrates how a concurrent mixed method design assisted cross-cultural comparison and ecological descriptions of resilience in young South African children, as well as validated alternative ways to measure resilience in young children. In a longitudinal randomised control trial, which investigated psychological resilience in mothers and children affected by HIV/AIDS, we combined a qualitative projective story-telling technique (Düss Fable) with quantitative data (Child Behaviour Checklist). The children mostly displayed adaptive resilience-related behaviours, although maladaptive behaviours were present. Participating children use internal (resolve/agency, positive future expectations, emotional intelligence) and external protective resources (material resources, positive institutions) to mediate adaptation. Children's maladaptive behaviours were exacerbated by internal (limited problem-solving skills, negative emotions) and external risk factors (chronic and cumulative adversity).

Reorienting risk to resilience: street-involved youth perspectives on preventing the transition to injection drug use

BACKGROUND

The Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth (youth who had spent at least 3 consecutive nights without a fixed address or without their parents/caregivers in the previous six months) aged 16-24 years in Metro Vancouver, British Columbia.

METHODS

Ten focus groups were conducted by youth collaborators (peer-researchers) with street-involved youth (n = 47) from November 2009-April 2010. Audio recordings and focus group observational notes were transcribed verbatim and emergent themes identified by open coding and categorizing.

RESULTS

Through ongoing data analysis we identified that youth produced risk and deficiency rather than resiliency-based answers. This enabled the questioning guide to be reframed into a strengths-based guide in a timely manner. Factors youth identified that prevented them from IDU initiation were grouped into three domains loosely derived from the risk environment framework: Individual (fear and self-worth), Social Environment (stigma and group norms - including street-entrenched adults who actively discouraged youth from IDU, support/inclusion, family/friend drug use and responsibilities), and Physical/Economic Environment (safe/engaging spaces). Engaging youth collaborators in the research ensured relevance and validity of the study.

CONCLUSION

Participants emphasized having personal goals and ties to social networks, supportive family and role models, and the need for safe and stable housing as key to resiliency. Gaining the perspectives of street-involved youth on factors that prevent IDU provides a complementary perspective to risk-based studies and encourages strength-based approaches for coaching and care of at-risk youth and upon which prevention programs should be built.

The support needs of South African educators affected by HIV and AIDS

In a qualitative study of 77 South African educators, participants were asked to explain how they are affected by HIV and AIDS and how they would best like to be supported in response to this. The term 'affected' refers to educators who have colleagues, learners or loved ones who are HIV-positive or who have died from HIV-related illnesses, or those who teach children orphaned by AIDS or learners who are vulnerable because of a parent's or caregiver's HIV status. Their responses endorse current theory regarding support for educators in the context of the epidemic, but their needs for support also include forms of 'ecosystemic compassion': that is, a longing for the school management, learners' parents, learners, and colleagues to have compassion for their HIV-related predicaments. Because the latter need was pronounced among those educators caring for an ill HIV-positive loved one, this study introduces the importance of researchers' and stakeholders' sensitivity to the possibility of differentiated support, according to how educators are affected by HIV. Many of the participants' calls for support were at odds with policyfacilitated demands on educators to function as pillars of support to vulnerable learners and communities in the age of HIV and AIDS. The findings provide a caveat with regard to educators who require support-notwithstanding the expectation that they function as ecosystemic agents of support. Finally, the educators' calls for support should be tempered by resilience theory, which suggests that while it is important to support HIV-affected educators, the choice of supports should not stymie educators' agency or discourage educators' active participation in the support process.

Abrindo caminho para o futuro: redes de apoio social e resiliência em autobiografias de jovens socioeconomicamente vulneráveis

Este trabalho discute processos de resiliência e redes de apoio social a partir de entrevistas narrativas realizadas com jovens socioeconomicamente desfavorecidos de escolas públicas de Fortaleza. O objetivo do estudo foi analisar como contavam suas histórias de vida, especialmente como enfrentavam adversidades em busca de recursos promotores de saúde e bem-estar. Os relatos foram analisados temática e narrativamente a fim de compreender como os jovens recrutam recursos pessoais, familiares, comunitários e culturais disponíveis e como esses recursos e as formas de manejo atuam de modo protetivo. Considerando que a resiliência também implica a disponibilidade dos recursos buscados pelo jovem, atenção especial foi dada à capacidade de suas comunidades em fornecê-los apropriadamente. Um resultado significativo é sua percepção do poder público como ineficaz ou ausente. Frente ao declínio da esfera pública, o jovem tende a refugiar-se na família e em seus próprios recursos pessoais para enfrentar o futuro.