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Association of Psychological Resilience With Healthy Lifestyle and Body Weight in Young Adulthood
Abstract
Purpose
Childhood adversity is associated with adverse health outcomes, in part owing to its effects on healthy lifestyle. We examined whether psychological resilience to adversity may promote healthier behaviors and body weight in young adulthood.
Methods
Data are from the Growing Up Today Study, a longitudinal cohort of young adults (n = 3,767) who are children of participants of the Nurses' Health Study II, a separate longitudinal cohort. After characterizing psychological resilience as per levels of adversity exposure before the age of 18 years and young adult psychological health (defined by a composite of low psychological distress and high positive affect), we derived a categorical measure by cross-classifying adversity (exposed vs. unexposed) and psychological health (high vs. lower). We considered five outcomes self-reported at baseline (2010) and five years later: healthy body weight and four healthy lifestyle components including being a nonsmoker, moderate alcohol consumption, regular physical activity, and healthy diet. Poisson regression models evaluated associations of each outcome with psychological resilience, comparing psychologically resilient individuals with those who were not resilient or who were unexposed to adversity, adjusting for relevant covariates.
Results
We did not identify differences between psychologically resilient individuals and those unexposed to adversity who were psychologically healthy with respect to meeting recommendations for most healthy lifestyle components and associations were largely stable over time. Across most outcomes, nonresilient individuals were less likely to be healthy relative to resilient individuals.
Conclusions
Psychological resilience may disrupt negative effects of childhood adversity on having a healthy lifestyle in young adulthood.
... 18 The existing body of research has consistently demonstrated a negative association between psychological resilience and stress, underscoring the capacity of individuals to return to a state of normal functioning following significant adversity. [19][20][21][22] Resilience to stressors explained why individuals could maintain a positive outlook in the aftermath of challenging experiences. 23 Interventions designed to bolster resilience in individuals who have encountered stress have the potential to enhance their ability for positive adaptation. ...
... Consequently, this may alleviate stressrelated eating behaviors and minimize fat deposition associated with stress responses, thereby promoting BMI normalization and fostering a positive cycle. 21,22 On the other hand, individuals with high psychological resilience generally enjoyed better living conditions. In the context of Chinese culinary culture, people tended to enjoy food more and worry less, as the Chinese saying goes "a broad heart leads to a plump body," which may also contribute to higher BMI. ...
Background and Objective
While earlier studies have focused on the relationship between stress and obesity, there was a gap in understanding the potential impact of positive psychological factors, such as resilience, on obesity. By investigating the role of psychological resilience with obesity, this study aimed to address this gap and tackle obesity through a positive psychological framework.
Methods
Participants consisted of 2445 community residents from Shenzhen, China, with a mean age of 41.09 ± 13.72 years, comprising 846 males and 1599 females. Psychological resilience was measured using the Brief Resilience Scale; gender, age, marital status, education level, smoking status, alcohol consumption, frequency of physical exercise, and perceived stress were considered potential confounding factors. The relationship between psychological resilience and body mass index (BMI) was examined through multiple linear regression and logistic regression analyses.
Results
The participants had an average psychological resilience score of 3.46 (standard deviation [SD] = 0.62) and an average BMI of 22.59 (SD = 3.35), with 104 individuals (4.3%) identified with obesity. In the fully adjusted multiple linear regression model, a higher psychological resilience score was associated with a higher BMI (β = 0.507, 95% CI:0.283, 0.731). In the logistic regression model, higher psychological resilience scores were linked to increased obesity risk, with a more significant association observed among males (odds ratio [OR] = 2.169, 95% CI:1.155, 4.073), while psychological resilience acted as a protective factor against underweight among females (OR = 0.528, 95% CI:0.376, 0.816).
Conclusion
The study demonstrated a significant link between higher psychological resilience and elevated BMI, emphasizing the complex relationship between psychological fortitude and weight management. Interventions targeting socioeconomic status, education, lifestyle habits, and physiological well‐being might offer a promising strategy for enhancing psychological resilience and promoting healthier weight. Emphasizing self‐efficacy and coping skills at the individual level could contribute to balanced weight and comprehensive health outcomes, addressing the global challenge of obesity.
... There are several previous studies that have similar topic with this research. Longitudinal research related to resilience and healthy lifestyle behavior conducted by Nishimi et al stated that resilience counteract and neutralize the negative effects caused by difficult conditions faced by individuals related to the application of healthy lifestyle behavior (Nishimi et al., 2021). Previous research on information exposure has also been carried out, namely quantitative research about the effect of information exposure on preventive health behavior related to Covid-19 (Krirkgulthorn et al., 2021). ...
... Challenges and difficulties arise in various aspects of adolescents' life during the pandemic and endemic period, namely health, personal, social, educational, environmental, and economic aspects. Resilience in adolescents has contribution in helping adolescents perform healthy lifestyle behavior, by neutralizing the negative effects of problems or difficulties related to the implementation of healthy lifestyle behavior, helping adolescents adopt positive health-related behaviors and attitudes, helping adolescents respond the problem in a balance and calm way, helping adolescents experience healthy and positive emotions and avoid negativity related to healthy lifestyle behavior, helping adolescents adapt to situations related to healthy lifestyle behavior, providing safe effect (comforting effect) on adolescents to bounce back to healthy lifestyle behavior, raising adolescents' awareness in turning difficulties or problems into challenges or opportunities when they perform healthy lifestyle behavior, and being a buffer or protector for adolescents when facing problems or difficulties in healthy lifestyle behavior implementation (Höltge et al., 2021;Taylor, 2018;Ungar, 2021;Wagnild & Collins, 2009) The results of this study are in line with study conducted by Nishimi et al (Nishimi et al., 2021). Their longitudinal research states that in general, resilient individuals tend to adopt healthy lifestyle behavior, have ideal body weight and have good health condition. ...
Background: Facing a disruptive era that full of changes and challenges during the pandemic, psychological strength is needed by adolescents to be able to rise and bounce back to the optimal health functions. Adolescents are one of the high-risk groups in pandemic situation, therefore they need to stay safe and healthy to continue their lives in the future, one of which is by doing healthy lifestyle behavior. In this context, resilience and exposure of adequate health-related information need to be considered by adolescents in performing healthy lifestyle behavior in their daily life.
Purpose: This research aimed to determine the influence of resilience and health-related information exposure on adolescents’ healthy lifestyle behavior in endemic era.
Methods: This research used a descriptive-analytic study with a cross-sectional design. The population were all adolescents in Kediri aged 15-19 years old. The sample was collected by cluster random sampling. The total sample of this research were 111 respondents. The independent variable was resilience and health-related information exposure. The dependent variable was adolescents’ healthy lifestyle behavior. Data were collected by using questionnaires and analyzed by using regression with dummy variable.
Results: Based on regression analysis, variables that affect the adolescents’ healthy lifestyle behavior are resilience and health-related information exposure (p=0,000). Adolescents’ healthy lifestyle behavior has significant correlation with resilience (p=0,024) and health-related information exposure (p=0,000).
Conclusion: Resilience and health-related information exposure are predictors of adolescents’ healthy lifestyle behavior in endemic era. According to the research result, adolescent in Kediri need to raise awareness and practice about resilience and to look for more access to health-related information to maintain or increase their healthy lifestyle behavior in this endemic era.
... By means of such a logic, the contextual and relational factors that shape food availability and affordability (such as poverty, cultural values or geographic access to food) are erased (Rail and Jette 2015). Importantly, people who can regulate their food choice and adopt 'healthy lifestyles' are not only viewed as being more responsible but also more resilient to the adversities that bring about unhealthy body weight in the first place (Nishimi et al. 2022). ...
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.
... Furthermore, studies have shown that excessive psychological stress can exacerbate weight gain and influence lifestyle choices, leading to the frequent adoption of unhealthy lifestyles. Therefore, assessing the psychological status of patients with MASLD using the ESS can also aid in interventions aimed at promoting healthy lifestyles (41). Through this series of questionnaires, we can also more intuitively observe that patients in the observation group have shown significant improvements in physical activity, diet, and emotional wellbeing. ...
Background
Obesity is the primary cause of metabolic associated steatotic liver disease (MASLD). Healthy lifestyle management has potential value in the treatment of MASLD.
Methods
A total of 150 patients with MASLD diagnosed at the Health Management Center of our hospital were enrolled and randomly divided into a traditional treatment (control group, n=75) and healthy lifestyle group (observation group, n=75). All patients underwent a three-month intervention. Data on general information, body composition, glucose metabolism, lipid metabolism, and inflammatory factors were analyzed.
Results
The difference in the change of fatty liver grade was statistically significant (P<0.05). There were statistically significant differences in treatment efficiency for physical conditions (P<0.05), including body fat mass (BF), body mass index (BMI), body weight (BW), waist circumference (WC), and waist-to-hip ratio (WHR). Additionally, there were statistically significant differences in treatment efficiency for scales such as the Diet Rating Scale (DRS), Emotional Stress Scale (ESS), and Global Physical Activity Questionnaire (GPAQ) (P<0.05). Differences in treatment efficiency for body fat parameters, including percentage of body fat (PBF), visceral fat area (VFA), aspartate aminotransferase (AST), and diastolic blood pressure (DBP), were also statistically significant (P<0.05). After treatment, statistically significant differences were observed in interferon-γ (IFN-γ), insulin, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and tumor necrosis factor-α (TNF-α) (P<0.05).
Conclusion
Our study indicates that a healthy lifestyle can effectively promote the reduction of fatty liver grade in patients with MASLD, demonstrating positive effects in improving lipid metabolism and inflammatory responses in these patients.
... Despite data suggesting a connection between resilience and health behaviors, few studies on this topic have been conducted in the context of population-level adversity, instead primarily focusing on individuallevel experiences like childhood trauma (Hughes et al., 2017;Nishimi et al., 2022). Furthermore, scant research in this area is conducted among vulnerable communities who already experience disproportionate social inequities that increase their risk for unhealthy behaviors and disease (OHCHR, United Nations, n.d.). ...
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.
... 8,9 One widely accepted and utilized definition suggested that a healthy lifestyle encompassed five key factors: healthy physical activity level, healthy diet, healthy body weight, non-smoking, and moderate alcohol intake. 10 Some studies also used exercise, nutrition, and stress management as important predictors of healthy lifestyles. 11 Maintaining such habits could yield numerous beneficial outcomes. ...
Objective
Adolescents face various health challenges due to academic pressures and sedentary lifestyles. Establishing healthy habits during this critical period is essential for long-term well-being. With the widespread use of fitness apps, understanding their impact on adolescent health behaviors and the underlying mechanisms is crucial. Guided by social support theory and social comparison theory, this study examined the influence of WeRun, a fitness app within WeChat, on adolescents’ adoption of healthy lifestyles. It investigated the correlation between WeRun usage and healthy behaviors, as well as the underlying mechanisms driving this relationship.
Methods
A cross-sectional survey was conducted across 31 provinces and metropolitans in China, utilizing a random cluster sampling approach targeting high school and freshman students aged 15–24 (N = 1312). A parallel mediation model was employed to test the hypotheses.
Results
The analysis showed that WeRun use positively predicted both social support and social comparison. Meanwhile, both social support and social comparison were positively associated with healthy lifestyles. Additionally, WeRun use could not directly predict healthy lifestyles. However, WeRun use indirectly predicted healthy lifestyles via social support and social comparison.
Conclusions
The study's findings revealed the pivotal roles of social support and social comparison as mediating variables in the relationship between adolescents’ WeRun usage and adoption of healthy lifestyles. The results contributed to the current comprehension of the mechanisms linking app utilization to health-promoting behaviors. Furthermore, it provided valuable insights for promoting adolescent health and informed improved design strategies for fitness apps.
... In other words, an increase in the scales or sub-dimensions will lead to an increase in other dimensions. As a result of the research conducted by Nishimi et al. (2022) ...
It was aimed to examine the effect of healthy lifestyle behavior on psychological resilience of associate degree students receiving health education after the earthquake. In line with the aim of the study, 428 people, who were determined by convenience sampling method among the students continuing their education and training at the university, constitute the sample of the study and the data were collected by applying an online questionnaire. In the study, "Personal Information Form", "Healthy Lifestyle Behavior Scale II" and "Brief Psychological Resilience Scale" were used. The data were analyzed with SPSS program. In addition, Pearson correlation and regression analyses were applied upon the determination that the data were normally distributed as an analysis method. As a result of the study, it was determined that there was a positive and significant relationship between healthy lifestyle behavior and its sub-dimensions and psychological resilience. In addition, it was determined that healthy lifestyle behavior has a positive and significant effect on psychological resilience. It is predicted that increasing the healthy lifestyle behavior of students after the earthquake will increase their psychological resilience against the disaster in a positive way.
... The topographic setting plays a significant role in determining the ideal site for any given land use. Because these findings are in line with those of national-scale research [33],it is clear that the influencing components chosen for this study are particularly trustworthy for improving land use on medium and small scales. Evidence from all over the world shows that land use changes have profound scale effects and regional variances. ...
... where they showed that non-resilient people were less healthy in terms of physical activity, body weight, and diet when compared to resilient individuals. 34 At 3-months post-operatively BRS was shown to impact PROMs. This finding is corroborated by DiSilvestro et al. who assessed the effect of resilience on outcomes 3-months postoperatively. ...
Background
Currently, it is incompletely understood how pre-operative resilience affects 1-year post-operative outcomes following lumbar spinal fusion.
Methods
Patients undergoing open lumbar spinal fusion at a single-center institution were identified between November 2019 to September 2022. Pre-operative resilience was assessed using the Brief Resilience Scale (BRS). Demographic data at baseline including age, gender, comorbidities, and BMI was extracted. Patient reported outcome measures including ODI, PROMIS Global Physical Health (GPH), PROMIS Global Mental Health (GMH), and EuroQol5 scores were collected before the surgery and at 3-months and 1-year post-operatively. Bivariate correlation was conducted between BRS scores and outcome measures at 3-months and 1-year post-operatively.
Results
93 patients had baseline and 1-year outcome data. Compared to patients with high resilience, patients in the low resilience group had a higher percentage of females (69.4% vs 43.9%, p=0.02), a higher BMI (32.7 vs 30.1, p=0.03), and lower preoperative GPH (35.8 vs 38.9, p=0.045), GMH (42.2 vs 49.2, p<0.001), and EuroQol scores (0.56 vs 0.61, p=0.01). At 3-months post-operatively, resilience was moderately correlated with GMH (r=0.39) and EuroQol (r=0.32). Similarly, at 1 year post-operatively, resilience was moderately correlated with GMH (r=0.33), and EuroQol (r=0.34). Comparable results were seen in multivariable regression analysis controlling for age, gender, number of levels fused, BMI, CCI, procedure, anxiety/depression, and complications.
Conclusion
Low pre-operative resilience can negatively affect patient reported outcomes 1-year after lumbar spinal fusion. Resiliency is a potentially modifiable risk factor, and surgeons should consider targeted interventions for at-risk patient groups.
... Although limited literature has focused on whether or how psychological resilience to trauma may influence subsequent physical health outcomes, emerging evidence suggests that it may have protective effects. First, some studies found that resilience was associated with reduced risk for adverse health conditions involving immune and inflammatory processes, such as cardiometabolic disease (19,20). Second, in observational studies, different resilience phenotypes have been found to be associated with healthier immune profiles, characterized by higher levels of anti-inflammatory cytokines and lower levels of proinflammatory cytokines. ...
Objective
Prior work suggests psychological resilience to trauma may protect not only mental but also physical health. This study examined the relationship of pre-pandemic psychological resilience to lifetime trauma with self-reported COVID-19 infection and symptoms during the early years of the COVID-19 pandemic.
Methods
Data are from 18,670 longitudinal cohort participants in the Nurses’ Health Study II. Based on prior evidence that trauma and subsequent distress can increase infection risk and severity, and that psychological assets may offset this risk, we hypothesized higher versus lower psychological resilience to prior trauma would be associated with lower risk for COVID-19 infection. Pre-pandemic resilience was assessed via self-report between 2017-2019 based on self-reported lifetime trauma exposure and psychological health. COVID-19 infection and symptoms were self-reported on 7 questionnaires administered between May 2020 – October 2021, from which we derived a composite outcome measure of probable COVID-19 infection, defined as having 3+ COVID-19 symptoms (out of 9) and/or a positive COVID-19 test result at any single assessment.
Results
Multivariable regression revealed significant associations between higher pre-pandemic resilience scores and lower risk for probable COVID-19 infection, adjusting for socio-demographic and COVID-19-related risk factors (RR = 0.90 [95% CI 0.87, 0.93]). Considering subcomponents of the composite COVID-19 infection measure separately, pre-pandemic resilience was significantly associated with lower risk of reported symptoms (RR = 0.83 [95% CI 0.79, 0.88]), but not with a positive test result alone (RR = 0.96 (95% CI 0.91, 1.01]).
Conclusion
Identifying protective factors for infection risk may help inform psychosocial interventions to improve health outcomes.
... Research indicates an association between psychological resilience and lower cortisol levels [53], with cortisol secretion strongly linked to diet quality [54]. Furthermore, psychological resilience correlates with sleep, body weight, and dietary patterns [55][56][57]. Although there is less research evidence on healthy lifestyles and psychological resilience, our findings provide evidence for the effect of healthy lifestyles on psychological resilience. ...
Objectives
This study aimed to validate the interrelationships and potential pathways of influence between healthy lifestyles, psychological resilience, and depressive symptoms in the Chinese elderly population.
Methods
We utilized data from the Chinese Elderly Health Influential Factors Tracking Survey 2018 and included 9448 samples for the study after screening according to the qualifying conditions. The interrelationships among healthy lifestyles, psychological resilience and depressive symptoms were analyzed using stepwise regression, and the robustness of mediation effects was assessed using Sobel and Bootstrap test.
Results
Among Chinese older adults, healthy lifestyles were negatively associated with depressive symptoms (β = -0.310, 95% CI: -0.405, -0.215), positively associated with psychological resilience (β = 0.137, 95% CI:0.071, 0.023), and psychological resilience was negatively associated with depressive symptoms (β = -1.014, 95% CI: -1.037, -0.990).
Conclusions
Psychological resilience partially mediated the association between healthy lifestyles and depressive symptoms, with the mediating effect accounting for 44.8% of the total effect. Our study contributes to the understanding of the relationship between healthy lifestyles and depressive symptoms in the elderly population and emphasizes the important role of psychological resilience. It is recommended that the government and policymakers improve depressive symptoms among older adults through comprehensive measures such as promoting healthy lifestyles and education, providing psychological support services, and creating a favorable environment.
... Although not directly studied, showing psychological resilience following trauma may lessen or inhibit these physiological impacts, thereby lowering disease risk. Behaviorally, showing psychological resilience may be associated with more healthy behavior patterns [9,50], as also seen in the current data, with resilience linked to non-smoking and higher physical activity at baseline. While resilience may promote healthier behaviors, which may in turn lower disease risk, accounting for time-updated behaviors in our analyses did not greatly impact associations, suggesting they were not prominent mediating factors. ...
Objective: Trauma exposure is associated with risk for cardiometabolic disease and mortality, in part through negative psychological sequelae. In contrast, psychological resilience, showing positive psychological health despite experiencing trauma, may offset some of this risk. We examined longitudinal associations of psychological resilience to lifetime trauma and cardiometabolic outcomes and mortality in a large sample of older adults. Methods: Using data from 6596 US Health and Retirement Study participants who had experienced lifetime trauma (mean age 64), we defined manifested psychological resilience based on trauma burden and psychological health (composite of low distress and high psychological well-being) through 2012. New onset car-diometabolic disease (heart problems, stroke, diabetes) and mortality were assessed across eight years of follow-up (through 2020). Repeated measures regressions determined associations between psychological resilience and outcomes over follow-up, adjusting for sociodemographic factors and prior disease. Results: Higher levels of manifested psychological resilience were associated with lower risk for developing any cardiometabolic outcomes (relative risk for one SD higher resilience score, RR = 0.91, 95%CI 0.88-0.94) and for all-cause mortality (RR = 0.73, 95%CI 0.63, 0.86), adjusting for sociodemographic confounders. When examining individual diseases, resilience was significantly associated with lower risk for certain heart problems (i.e., congestive heart failure) and diabetes. Associations generally held when additionally adjusting for adult psy-chosocial and biobehavioral factors that could be potential pathway variables. Conclusion: Psychological resilience to lifetime trauma may be linked to better cardiometabolic health even later in life. Promoting recovery and psychological resilience to trauma may be a target for more favorable health and longevity.
... This linkage is what led us to our conclusion. As a substitute for it, we depend on the coherence analysis to validate our findings (Nishimi et al. 2022). Since the growth of the production of clean energy depends on the sector's ability to attract new investments, it is essential to highlight the relative return and risk potential of the clean energy business compared to alternative choices. ...
Numerous economic and financial crises, particularly the present crisis in the healthcare sector, have pushed major shock spillover channels over stock marketplaces. This research studied how the shock spillover system is affected by three significant factors: Bitcoins, unpredictability, and the China stock market between 2014 and 2021. While much earlier empirical research has looked at risk dispersion in different financial markets, this article will zero in on green markets. This investigation seeks to accomplish something that has never been done before: determine whether or not green commodities, Bitcoin, and uncertainty impact the performance of the China stock market. The following are significant results based on a quantile vector autoregressive (VAR) connection. (i) A static spillover system indicates that information was widely shared across markets during intense market circumstances. (ii) The global green economy and clean energy marketplaces are the primary sources of knowledge spillover in adverse market conditions. This research elucidates the asymmetrical influence of green products, Bitcoin, and market volatility in China. This is vital due to the dynamic nature of international and regional connections. Recent studies have shown that shock spillovers are excellent for cryptocurrencies such as Bitcoin (BTC), uncertainty indices, and global carbon indexes, but bad for most eco-friendly products.
... Because of this, nations that are heavily reliant on the importation of fossil fuels will face an energy crisis, which will have the consequence of putting a damper on economic activity. Energy insecurity and political risk in countries that export fossil fuels give these countries an excellent opportunity to transition to alternative forms of energy, which may contribute to an increase in demand for renewable forms of energy (Nishimi et al. 2022). The protracted conflict between Russia and Ukraine may have the unintentional but desirable effect of increasing demand for renewable energy in the nations of Western Europe as a hedge against the political risk in Russia. ...
It is only possible to achieve the aims of reversing the impacts of the resource constraint and attaining sustainable growth if there is a rise in tourism organizational efficacy and tourism and a decrease in political instability. This is because these factors can influence the demand for energy by causing changes in the amount of power consumed. These factors may affect energy demand via changes in energy transitions. In light of this, the objective of this study is to investigate the impact that critical measures of institutional efficiency, tourism, and policy instability have on the utilization of renewable energy sources in a dataset consisting of 32 countries that are members of the Organization for Economic Co-operation and Development between the years 1997 and 2019. The article uses descriptive statistics and correlation models (cross-section dependency test and autoregressive distributed lag (ARDL) model) using panel data from 32 Organization for Economic Co-operation and Development (OECD) nations from 1997 to 2019. Insight into the matter aids in our selection of appropriate econometric methods. The following methods are briefly explained. Evidence shows that as a society’s average wealth and standard of life grow, so does its utilization of renewable energy sources. In addition, the economic globalization process and the danger it entails are adversely associated with a long-term reliance on renewable energy sources. Policymakers in countries that are members of the OECD should investigate the role that institutional effectiveness and policy instability play in the demand function for renewable energy to ensure a cleaner natural environment over the long term.
... It has also long been known that physical factors make an important contribution to resilience. Research has shown for example that more resilient people tend to exercise more [20] and have a healthier diet [70]. Moreover, a sufficient amount of quality sleep appears to be an important predictor of resilience. ...
Background
Resilience refers to the process through which individuals deal with the adversity they experience. Previous research has shown there are multiple factors that contribute to individuals’ resilience, leading to increasing interest in the development of multidimensional resilience models. Once such recently proposed model is The Resilience Shield, which clusters groups of protective factors into different shield layers. The stronger these layers, the better the protection against adversity (Pronk et al. in The Resilience Shield, Pan Macmillan Australia, 2021). While this model was based in part on existing literature, no empirical evaluation has occurred to date. The aim of this study was therefore to evaluate the model fit for each of the modifiable shield layers and the overall model, and to examine whether each of the constructs included contributes to observed resilience scores.
Methods
Participants completed a series of questionnaires via The Resilience Shield website assessing constructs relevant to each resilience shield layer. Data from 3337 participants was analysed using Structural Equation Modelling and regression analyses.
Results
The results showed acceptable fit of the measurement model for the Social, Mind, and Professional Layers, but poor fit for the Body Layer. There was also good fit for the overall model. In addition, all but one of the constructs included in The Resilience Shield survey explained independent variance in either dispositional resilience scores, or dispositional vulnerability scores.
Conclusion
These results broadly support the multidimensional structure proposed by The Resilience Shield model and suggest that (at least in the population in which it was tested) this may be an acceptable model to index individuals’ performance on a range of indicators that contribute to resilience.
... Indicators of healthy living behavior are the availability of clean water and healthy latrines, washing hands with clean water and soap, doing physical activity every day, and eating fruit and vegetables (Hartono et al., 2017;Sulaeman et al., 2022). Other studies also state that indicators of healthy living behavior are handwashing behavior, healthy snacks, and not littering (Cao et al., 2021;Nasiatin et al., 2021;Nishimi et al., 2022;Susanto et al., 2016). So, it will make a person able to reduce the risk of illness and optimize the immune system. ...
This research was conducted due to the lack of students’ awareness of the importance of health protocol behavior such as: no mask, no social distancing, no hand-washing, and no health awareness. Therefore, this study aims to analyze the impacts of the BATIK module (health integrated thematic learning material) on the conceptual understanding and behavior of clean and healthy living for elementary school students.The research design was quasi-experimental in form of a post-test control group design. The samples of the research were 58 students, consisting of 30 students for the experimental class and 28 students for the control class. Test and questionnaire methods were used for collecting the data. The test with 10 essay questions was used to examine the conceptual understanding. The questionnaire, consisting of 30 statements, was used to measure clean and healthy living behavior. The data analysis technique used was Manova. The results showed that there were significant differences in the understanding of the concept and behavior of clean and healthy living among the students who were taught by using the BATIK module and students who were not. So, it can be recommended that this module can be used as an alternative source of learning in elementary schools.
Introduction
The mental health of college students has garnered increasing attention currently, and psychological resilience is recognized as a crucial factor in coping with pressure and challenges. However, the influencing factors of psychological resilience require further exploration. This study aims to investigate the relationship between sports atmosphere and psychological resilience among college students, as well as the mediating role of a growth mindset.
Methods
A questionnaire survey was conducted with 315 college students using the Outdoor Sports Atmosphere Scale, Growth Mindset Scale, and Brief Resilience Scale.
Results
The findings revealed significant positive correlations between sports atmosphere, growth mindset, and psychological resilience. Regression analysis showed that a positive sports atmosphere significantly predicted both psychological resilience (β = 0.371, t = 8.648, p < 0.01) and growth mindset (β = 0.462, t = 10.227, p < 0.01). Structural equation modeling further confirmed that growth mindset played a significant mediating role in the relationship between sports atmosphere and psychological resilience [β = 0.182, 95% CI (0.036, 0.189), p < 0.05].
Discussion
These results highlight the importance of a supportive sports atmosphere in fostering psychological resilience among college students, with growth mindset acting as a key intermediary factor. By cultivating a growth mindset, students may better translate the benefits of an encouraging sports atmosphere into improved psychological resilience and adaptability. These insights provide actionable strategies for educators and policymakers to design interventions that promote psychological wellbeing.
Negative emotions effect to psychology and lead to eating disorders. Emotional eating occurs in response to negative emotional states. Hotel employees who have high workload and stress levels they are constantly exposed to food as part of their work processes. The research aims to measure the effect of hotel employees' psychological resilience on emotional eating behavior. The survey method was used in the study. The preliminary research was conducted with 200 participants and the final research with 410 participants. Participants were selected from individuals who working different departments of four-star and five-star hotels in Istanbul. Data were analyzed with regression analyses. As a result, it was found that self-perception, future perception, and social resources, which are the sub-dimensions of psychological resilience, had a statistically significant and negative effect on emotional eating. Also, no statistically significant effect of family cohesion and social competence, which are the other sub-dimensions of psychological resilience, on emotional eating was detected. The research is expected to contribute theoretically to the interdisciplinary literature in the fields of tourism, gastronomy, nutrition and psychology. In addition, practical contributions to hotel sector employees in terms of physiological and psychological aspects are aimed.
Purpose
The study aimed to explore the status of four common health problems (ie, smoking, internet addiction, physical inactivity, psychological disorder) among college students and analyze the relationship between psychological resilience, coping tendency and health problems.
Participants and Methods
The convenience sampling method was used to recruit 500 college students from four universities. The General Information Questionnaire, Adolescent Psychological Resilience Scale, Simplified Coping Style Questionnaire and Health Risk Behavior Questionnaire were used for survey.
Results
Among the students, there were 71 smokers (15.4%) and 61 internet addicts (13.2%). Over a third of the students reported physical inactivity (35.9%) and a minority had psychological disorder (6.3%). The psychological resilience score differed between students who smoked, had internet addiction, physical inactivity, psychological disorder and those without these health-risk behaviors. Logistic regression analysis showed that negative coping tendency was the common contributing factor of physical inactivity, internet addiction and psychological disorder. Coping tendency played a partial mediating effect in the relationship between psychological resilience and health problems, with a mediating effect of 37.93%.
Conclusion
Psychological resilience can not only affect health problems directly but also influence health problems indirectly through coping tendency. Educators and administrators in universities can apply effective measures to improve psychological resilience and positive coping to prevent or reduce health problems among undergraduates.
Stress plays a well-documented role in alcohol consumption and the risk for developing alcohol use disorder. The concept of resilience - coping with and successfully adapting to stressful life experiences – has received increasing attention in the field of addiction research in recent decades, and there has been an accumulation of evidence for resilience as a protective factor against problematic alcohol consumption, risk for alcohol use disorder, disorder severity, and relapse. The conceptual and methodological approaches used in the generation of this evidence vary considerably across investigations, however. In light of this, we carried out this review in order to provide a more thorough understanding of the meaning and scope of resilience, what factors contribute to resilience, how it is measured, and how it relates to alcohol-associated phenotypes. Implications for treatment through the use of resilience-building interventions are likewise discussed, as well as implications for future research on the role of resilience in the etiology and clinical outcomes of alcohol use disorder.
The modern conception of mental health encompasses not only mental illness but also mental wellbeing, including positive emotional states and other forms of positive experience. Accordingly, research on resilience — that is, recovery or adaptation following adversity – has recently expanded to consider the roles of positive affect in the resilience process. To review this research, we performed a keyword search of all peer-reviewed journals within the American Psychological Association’s PsycInfo database, retrieving all studies of positive affect in the context of resilience. These studies measured positive affect either as the outcome of the resilience process or as a resilience resource in its own right. With positive affect as the outcome, the literature suggests that various resilience resources can promote positive affect following a stressor, especially positive personality traits (eg, hope, optimism, self-compassion) and supportive interpersonal connections. With positive affect as a resilience resource, the literature suggests that higher levels of positive affect may protect individuals from the impact of stress on a number of outcomes, such as depression and trauma symptoms. In all, the reviewed research showcases a wide range of stressors, resources, and outcomes, and there are numerous openings for future discoveries in this promising area of inquiry.
Sustainable development is guided by three pillars: the economy, society and the environment. Social consequences on health are shaped by economic systems and social structures, which are integrated with the larger environment and affect the global allocation of energy resources. This is the first research of its kind to examine the social and economic effects of environmental degradation changes while considering cross‐sectional dependency. This article examines the effect of natural resource management policies and socioeconomic development on Asia's ecological footprint from 1995 to 2020, considering natural resources, population growth and industrial development. Our research shows that changes in the natural resources and ecological footprint have improved economic conditions and social outcomes, including human progress and income distribution. Two different outcomes of recent natural resource management are improved operational efficiency and decreased environmental degradation. Our findings hold up even considering other possible model specifications considering the interaction impacts of power sector changes. The findings reveal a favourable correlation between ecological footprint and natural net financial accounts, natural resources and GDP growth. Long‐term environmental sustainability is a byproduct of a flourishing society and economy.
The rapid development of intelligent technologies coupled with the stay-at-home trends in the Post-COVID-19 Era has significantly changed youth's health behavior as well as reshaped their lifestyles. Digital health technologies (DHTs) have been more and more used for health management among youngsters. However, little was known about the use of DHTs among youths and its consequences on their health, especially in developing countries like China. Inspired by behavior intervention technology (BIT) model, this study examined the underlying mechanisms of use and social interactions of DHTs on Chinese adolescents' and youngsters' healthy lifestyles and mental health, using a representatively national survey among high school and freshman students in China (N = 2,297). It found that use of DHTs had a significantly positive effect on Chinese youths' healthy lifestyles and mental health, with behavioral regulation as a mediator. However, social interactions of DHTs were negatively associated with their mental health. The findings contribute to a better guidance on health promotion, as well as the enhanced design of DHTs' products.
Objective:
Exposure to trauma increases risk for somatic symptoms, as well as acute and chronic physical diseases. However, many individuals display psychological resilience, showing positive psychological adaptation despite trauma exposure. Resilience to prior trauma may be a protective factor for physical health during subsequent stressors, including the COVID-19 pandemic.
Methods:
Using data from 528 US adults in a longitudinal cohort study, we examined psychological resilience to lifetime potentially traumatic events early in the pandemic and risk for COVID-19 infection and somatic symptoms across two years of follow-up. Resilience was defined as level of psychological functioning relative to lifetime trauma burden, assessed in August 2020. Outcomes included COVID-19 infection and symptom severity, long COVID, and somatic symptoms assessed every six months for 24 months. Using regression models, we examined associations between resilience and each outcome adjusting for covariates.
Results:
Higher psychological resilience to trauma was associated with lower likelihood of COVID-19 infection over time, with one standard deviation higher resilience score associated with 31% lower likelihood of COVID-19 infection, adjusting for socio-demographics and vaccination status. Furthermore, higher resilience was associated with lower levels of somatic symptoms during the pandemic, adjusting for COVID-19 infection and long COVID status. In contrast, resilience was not associated with COVID-19 disease severity or long COVID.
Conclusions:
Psychological resilience to prior trauma is associated with lower risk for COVID-19 infection and lower somatic symptoms during the pandemic. Promoting psychological resilience to trauma may benefit not only mental, but also physical, health.
Resilience and social support are important for emerging adults and especially those with chronic health conditions (CHC). We examined associations among resilience, social support, and health in those with and without a CHC. 132 emerging adults with a CHC and matched healthy participants completed questionnaires. Two-group, measuredvariable path analysis and mediational models were conducted. Those with a CHC had poorer resilience and health but equivalent social support. Resilience significantly predicted general health and emotional well-being. Resilience mediated the relationships between coping and health for healthy participants and between coping and emotional wellbeing in those with a CHC. Satisfaction with social support was significantly correlated with health, mediating the influence of network size on emotional well-being for those without a CHC and both physical functioning and emotional well-being for healthy participants. These results indicate the importance of resilience and social support for emerging adults, especially those with a CHC.
Background: Amidst the disruptive era that full of changes and challenges during Covid-19 pandemic, psychological strength is needed by adolescents to be able to focus on positivity and maintain the optimal health functions. Adolescents are one of the high-risk groups in this world recent situation. Therefore, adolescents need to stay safe and healthy to survive their future, one of which is by doing healthy lifestyle behavior. In this context, resilience, self-compassion, and hope need to be considered by adolescents in order to successfully perform healthy lifestyle behavior. Objective: The study objective was to analyze the relationship between resilience, self-compassion, and hope with healthy lifestyle behavior in adolescents. Methods: This research was descriptive-analytic study with cross-sectional design. Population were adolescents in Kediri, East Java aged 15-19 years old. Sample was collected by cluster random sampling. Total sample of this research were 342 respondents. Independent variable was resilience, self-compassion, and hope. Dependent variable was healthy lifestyle behavior. Data were collected by offline questionnaires filled by the respondent and analyzed using regression. Results: Based on regression analysis, variables that simultaneously and significantly related to healthy lifestyle behavior are resilience, self-compassion, and hope (p<0,001). There is significant relationship between each variables of resilience (p=0,001), self-compassion (p=0,002), and hope (p<0,001) with healthy lifestyle behavior. Conclusion: Resilience, self-compassion, and hope, both simultaneously and individually are predictor of healthy lifestyle behavior. According to the research result, adolescents need to raise awareness and practice about the psychological strengths to maintain their healthy lifestyle behavior in daily life.
Keyword: Adolescents; Healthy lifestyle behavior; Hope; Resilience; Self-compassion
Background
Psychological resilience – positive psychological adaptation in the context of adversity – is defined and measured in multiple ways across disciplines. However, little is known about whether definitions capture the same underlying construct and/or share similar correlates. This study examined the congruence of different resilience measures and associations with sociodemographic factors and body mass index (BMI), a key health indicator.
Methods
In a cross-sectional sample of 1429 African American adults exposed to child maltreatment, we derived four resilience measures: a self-report scale assessing resiliency (perceived trait resilience); a binary variable defining resilience as low depression and posttraumatic stress (absence of distress); a binary variable defining resilience as low distress and high positive affect (absence of distress plus positive functioning); and a continuous variable reflecting individuals' deviation from distress levels predicted by maltreatment severity (relative resilience). Associations between resilience measures, sociodemographic factors, and BMI were assessed using correlations and regressions.
ResultsResilience measures were weakly-to-moderately correlated (0.27–0.69), though similarly patterned across sociodemographic factors. Women showed higher relative resilience, but lower perceived trait resilience than men. Only measures incorporating positive affect or resiliency perceptions were associated with BMI: individuals classified as resilient by absence of distress plus positive functioning had lower BMI than non-resilient (β = −2.10, p = 0.026), as did those with higher perceived trait resilience (β = −0.63, p = 0.046).
Conclusion
Relatively low congruence between resilience measures suggests studies will yield divergent findings about predictors, prevalence, and consequences of resilience. Efforts to clearly define resilience are needed to better understand resilience and inform intervention and prevention efforts.
The majority of multi-wave studies examining resilience in adulthood have involved growth mixture modeling (GMM). We critically evaluate the central conclusion from this body of work that “resilience is commonplace”. Our emphasis is on two questionable methodological assumptions underlying this conclusion: (1) the variances are the same across trajectories (i.e., homogeneity of variance) and (2) the amount of change does not differ across individuals (i.e., slope variances are zero). Seventy-seven empirical studies were included that used GMM to examine resilience to diverse adversities in adulthood. Of these 77 relevant studies, 66 (86%) assumed homogeneity of variances across trajectories and 52 (68%) set slope variances to zero; in the minority of studies where these assumptions were not applied (particularly the homogeneity of variance assumption), the resilient trajectory was among the smallest. Furthermore, 63 (82%) of the 77 studies conferred labels of resilience based on a single outcome, which is problematic as resilience is never an “across-the-board” phenomenon. Based on our conclusions, we discuss three important directions for future research: (1) replication across samples and measures, (2) illumination of processes leading to resilience, and (3) incorporation of a multidimensional approach. We conclude by outlining a resilience framework for research, practice, and policy.
Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child's bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life.
Generalized Estimating Equation (GEE) is a marginal model popularly applied for longitudinal/clustered data analysis in clinical trials or biomedical studies. We provide a systematic review on GEE including basic concepts as well as several recent developments due to practical challenges in real applications. The topics including the selection of “working” correlation structure, sample size and power calculation, and the issue of informative cluster size are covered because these aspects play important roles in GEE utilization and its statistical inference. A brief summary and discussion of potential research interests regarding GEE are provided in the end.
The ability of personality traits to predict important life outcomes has traditionally been questioned because of the putative small effects of personality. In this article, we compare the predictive validity of personality traits with that of socioeconomic status (SES) and cognitive ability to test the relative contribution of personality traits to predictions of three critical outcomes: mortality, divorce, and occupational attainment. Only evidence from prospective longitudinal studies was considered. In addition, an attempt was made to limit the review to studies that controlled for important background factors. Results showed that the magnitude of the effects of personality traits on mortality, divorce, and occupational attainment was indistinguishable from the effects of SES and cognitive ability on these outcomes. These results demonstrate the influence of personality traits on important life outcomes, highlight the need to more routinely incorporate measures of personality into quality of life surveys, and encourage further research about the developmental origins of personality traits and the processes by which these traits influence diverse life outcomes.
© 2007 Association for Psychological Science.
Objective:
It is well established that child maltreatment reflects a context of risk for multiple negative outcomes. Identifying factors that protect against negative outcomes is important for the development of strengths-based approaches that emphasize resilience, particularly for youth transitioning out of the child welfare system. The current study examined the relationship between an internal resilience measure, the Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003), and several external measures of resilience and behavioral outcomes (tobacco use and dependence, alcohol use and problems, and depression symptoms). In addition, two models of resilience were examined in the context of child maltreatment: a compensatory model and a risk-protection model.
Methods:
Ninety-three emerging adults (ages 18-25) who were making the transition out of child welfare completed self-report measures of child maltreatment, internal resilience (CD-RISC), external resilience (academic achievement, religious and community involvement, monitoring by caregivers, and presence of an adult mentor), alcohol and tobacco use, and depression symptoms.
Results:
Internal resilience was significantly associated with involvement in religion and community, and monitoring by caregivers. In addition, internal resilience was negatively associated with past year smoking and nicotine dependence, and with symptoms of depression. Hierarchical regression analyses were conducted to examine the direct and interaction effects of resilience on depression symptoms in the context of child maltreatment. When internal resilience was added to the model, it made a significant contribution to depression scores over and above child maltreatment (physical, sexual, and emotional abuse; emotional neglect). In addition, there was a significant Sexual Abuse×Resilience interaction, wherein high resilience was associated with a reduction in depression scores at higher levels of sexual abuse.
Conclusions:
These findings support internal resilience as both a compensatory and protective factor for depression symptoms in the context of sexual abuse among emerging adults transitioning out of child welfare. Prevention and early intervention within child welfare should include strengthening internal resilience, with continued monitoring of competencies through the transition from adolescence to emerging adulthood.
Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.
A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.
This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors' Summary.
This review investigates the association between positive psychological well-being (PPWB) and cardiovascular disease (CVD). We also consider the mechanisms by which PPWB may be linked with CVD, focusing on the health behaviors (e.g., smoking, alcohol consumption, physical activity, sleep quality and quantity, and food consumption) and biological functions (e.g., cardiovascular, inflammatory, and metabolic processes) that are most relevant for cardiovascular health. Because PPWB is a broad concept, not all aspects of PPWB may be associated with cardiovascular health. Thus, we distinguish between eudaimonic well-being, hedonic well-being, optimism, and other measures of well-being when reviewing the literature. Findings suggest that PPWB protects consistently against CVD, independently of traditional risk factors and ill-being. Specifically, optimism is most robustly associated with a reduced risk of cardiovascular events. In general, PPWB is also positively associated with restorative health behaviors and biological function and inversely associated with deteriorative health behaviors and biological function. Cardiovascular health is more consistently associated with optimism and hedonic well-being than with eudaimonic well-being, although this could be due in part to more limited evidence being available concerning eudaimonic well-being. Some similarities were also evident across different measures of PPWB, which is likely due to measurement overlap. A theoretical context for this research is provided, and suggestions for future research are given, including the need for additional prospective investigations and research that includes multiple constructs of psychological well-being and ill-being.
Childhood gender nonconformity has been associated with poorer relationships with parents, but it is unknown if childhood gender nonconformity is associated with childhood abuse or risk of posttraumatic stress disorder (PTSD) in youth.
We examined whether gender nonconformity before age 11 years was associated with childhood sexual, physical, and psychological abuse and lifetime risk of probable PTSD by using self-report questionnaire data from the 2007 wave of the Growing Up Today Study (n = 9864, mean age = 22.7 years), a longitudinal cohort of US youth. We further examined whether higher exposure to childhood abuse mediated possible elevated prevalence of PTSD in nonconforming children. Finally, we examined whether association of childhood gender nonconformity with PTSD was independent of sexual orientation.
Exposure to childhood physical, psychological, and sexual abuse, and probable PTSD were elevated in youth in the top decile of childhood gender nonconformity compared with youth below median nonconformity. Abuse victimization disparities partly mediated PTSD disparities by gender nonconformity. Gender nonconformity predicted increased risk of lifetime probable PTSD in youth after adjustment for sexual orientation.
We identify gender nonconformity as an indicator of children at increased risk of abuse and probable PTSD. Pediatricians and school health providers should consider abuse screening for this vulnerable population. Further research to understand how gender nonconformity might increase risk of abuse and to develop family interventions to reduce abuse risk is needed.
The simplest approach to dealing with missing data is to restrict the analysis to complete cases, i.e. individuals with no missing values. This can induce bias, however. Inverse probability weighting (IPW) is a commonly used method to correct this bias. It is also used to adjust for unequal sampling fractions in sample surveys. This article is a review of the use of IPW in epidemiological research. We describe how the bias in the complete-case analysis arises and how IPW can remove it. IPW is compared with multiple imputation (MI) and we explain why, despite MI generally being more efficient, IPW may sometimes be preferred. We discuss the choice of missingness model and methods such as weight truncation, weight stabilisation and augmented IPW. The use of IPW is illustrated on data from the 1958 British Birth Cohort.
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.
Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults.
Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.
Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.
The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report - direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.
Describes the development of the Mental Health Inventory (MHI), a 38-item measure of psychological distress and well-being, developed for use in general populations. The MHI was fielded in 4 large samples (N = 5089) of Ss aged 13–69 yrs. One data set was used to explore the MHI's factor structure, and confirmatory factor analyses were used for cross validation. Results support a hierarchical factor model composed of a general underlying psychological distress vs well-being factor; a higher order structure defined by 2 correlated factors––Psychological Distress and Well-Being; and 5 correlated lower order factors––Anxiety, Depression, Emotional Ties, General Positive Affect, and Loss of Behavioral Emotional Control. Summated rating scales produced high internal consistency estimates and substantial stability over a 1-yr interval. Results provide strong psychometric support for a hierarchical model and scoring options ranging from 5 distinct constructs to reliance on 1 summary index. (36 ref)
To create a parent-to-child version of the Conflict Tactics Scales, the CTSPC.
Description of the conceptual and methodological approaches used and psychometric data for a nationally representative sample of 1,000 U.S. children.
(1) Improved Psychological Aggression and Physical Assault scales. (2) New Nonviolent Discipline scale, supplementary scale for Neglect, and supplemental questions on discipline methods and sexual abuse. (3) Reliability ranges from low to moderate. (4) Evidence of discriminant and construct validity.
The CTSPC is better suited to measuring child maltreatment than the original CTS. It is brief (6 to 8 minutes for the core scales) and therefore practical for epidemiological research on child maltreatment and for clinical screening. Methodological issues inherent in parent self-report measures of child maltreatment are discussed.
This paper presents a critical appraisal of resilience, a construct connoting the maintenance of positive adaptation by individuals despite experiences of significant adversity. As empirical research on resilience has burgeoned in recent years, criticisms have been levied at work in this area. These critiques have generally focused on ambiguities in definitions and central terminology; heterogeneity in risks experienced and competence achieved by individuals viewed as resilient; instability of the phenomenon of resilience; and concerns regarding the usefulness of resilience as a theoretical construct. We address each identified criticism in turn, proposing solutions for those we view as legitimate and clarifying misunderstandings surrounding those we believe to be less valid. We conclude that work on resilience possesses substantial potential for augmenting the understanding of processes affecting at-risk individuals. Realization of the potential embodied by this construct, however, will remain constrained without continued scientific attention to some of the serious conceptual and methodological pitfalls that have been noted by skeptics and proponents alike.
This paper introduces and applies an operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. Dimensions and scales of subjective well-being are reviewed and conceived of as mental health symptoms. A diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to data from the 1995 Midlife in the United States study of adults between the ages of 25 and 74 (n = 3,032). Findings revealed that 17.2 percent fit the criteria for flourishing, 56.6 percent were moderately mentally healthy, 12.1 percent of adults fit the criteria for languishing, and 14.1 percent fit the criteria for DSM-III-R major depressive episode (12-month), of which 9.4 percent were not languishing and 4.7 percent were also languishing. The risk of a major depressive episode was two times more likely among languishing than moderately mentally healthy adults, and nearly six times greater among languishing than flourishing adults. Multivariate analyses revealed that languishing and depression were associated with significant psychosocial impairment in terms of perceived emotional health, limitations of activities of daily living, and workdays lost or cutback. Flourishing and moderate mental health were associated with superior profiles of psychosocial functioning. The descriptive epidemiology revealed that males, older adults, more educated individuals, and married adults were more likely to be mentally healthy. Implications for the conception of mental health and the treatment and prevention of mental illness are discussed.
Patterns of continuity and change in competence and resilience over the transition to adulthood were examined in relation to adversity and psychosocial resources, with a focus on adaptive resources that may be particularly important for this transition. Variable-focused and person-focused analyses drew on data from the Project Competence longitudinal study of a school cohort followed over 20 years from childhood through emerging adulthood (EA) into the young adulthood (YA) years with excellent retention (90%). Success in age-salient and emerging developmental tasks from EA to YA was examined in a sample of 173 of the original participants with complete data on adversity, competence, and key resources. Regressions and extreme-group analyses indicated striking continuity in competence and resilience, yet also predictable change. Success in developmental tasks in EA and YA was related to core resources originating in childhood (IQ, parenting quality, socioeconomic status) and also to a set of EA adaptive resources that included planfulness/future motivation, autonomy, adult support, and coping skills. EA adaptive resources had unique predictive significance for successful transitions to adulthood, both overall and for the small group of individuals whose pattern of adaptation changed dramatically from maladaptive to resilient over the transition. Results are discussed in relation to the possibility that the transition to adulthood is a window of opportunity for changing the life course.
A multisystemic model of resilience suggests that the capacity of one system to cope with atypical stress improves the capacity of co-occurring systems. In this paper, we review research demonstrating this relationship, where the more resilient caregivers are, the more likely children are to experience the promotive and protective factors they require for optimal growth and development in both home and school settings. We examine research from the last two decades on school- or family-based resilience promoting interventions, and advocate for a new perspective which adopts a multisystemic view of resilience in order to redirect the focus of the international research agenda, which places emphasis on children rather than systems. The implications of this multisystemic approach to resilience are discussed in relation to the design of programs that promote the well-being of parents and teachers in ways that contribute to more supportive and stable home and school environments for children.
Background:
The Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale.
Methods:
The authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medline® Daily; Epub Ahead of Print, In-Process & Other Non-indexed citations; ERIC®; HAPI®; and SCOPUS®. Articles were selected by trained reviewers based on a priori inclusion criteria including: research, healthy sample, used the CDC-Kaiser ACE scale, and assessed some health outcome. Two reviewers used an abstraction form to independently collect data from each study. Unadjusted and adjusted odds ratio associated with ACE scale scores were aggregated and compared.
Results:
From 3167 unique titles, we identified 96 articles that assessed health outcomes associated with the ACEs in the CDC-Kaiser ACE scale. There were more studies focusing on psychosocial/behavioral outcomes than medical outcomes. The majority of the included studies were retrospective, observational, and relied on the same data set. Psychosocial/behavioral outcomes had higher odds ratio than medical outcomes with increasing ACE scale scores.
Conclusions:
Exposure to multiple ACEs is associated with a wide variety of outcomes. This data suggests a benefit of screening for ACEs using this scale and highlights the need to find interventions to ameliorate their effects.
Although exposure to adversity increases risk for poor mental health outcomes, many people exposed to adversity do not develop such outcomes. Psychological resilience, defined broadly as positive emotional and/or behavioral adaptation to adversity, may be influenced by genetic factors that have remained largely unexplored in the era of large-scale genome-wide studies. In this perspective, we provide an integrative framework for studying human genome-wide variation underlying resilience. We first outline three complementary working definitions of psychological resilience—as a capacity, process, and outcome. For each definition, we review emerging empirical evidence, including findings from positive psychology, to illustrate how a resilience-based framework can guide novel and fruitful directions for the field of psychiatric genomics, distinct from the ongoing study of psychiatric risk and related traits. Finally, we provide practical recommendations for future genomic research on resilience, highlighting a need to augment cross-sectional findings with prospective designs that include detailed measurement of adversities and outcomes. A research framework that explicitly addresses resilience could help us to probe biological mechanisms of stress adaptation, identify individuals who may benefit the most from prevention and early intervention, and ascertain modifiable protective factors that mitigate negative outcomes even for those at high genetic risk.
Background: The relationship between specific characteristics of physical activity (PA) (eg, intensity, type, frequency) with sex hormones is uncertain. The authors evaluated the association between characteristics of PA and circulating sex hormones. Methods: This was a cross-sectional analysis of the Women's Lifestyle Validation Study (n = 493). Total PA, light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA) were assessed by accelerometry (a) and self-report (sr). Self-report was used to assess PA type (ie, aerobic, weight training) and exercise frequency. Dehydroepiandrosterone sulfate, testosterone, and sex hormone-binding globulin (SHBG) were assayed among all women; estradiol was assayed in postmenopausal women not currently on hormone therapy. Results: Estradiol was inversely associated and SHBG positively associated with MVPA and LPA (estradiol: β = -0.15 per SD increase, P ≤ .01 for a-MVPA and a-LPA; SHBG: a-MVPA β = 0.20 per SD increase, P ≤ .01, a-LPA β = 0.15, P < .01). By type, aerobic activity and weight training were each independently associated with estradiol and SHBG. Controlling for body mass index attenuated all associations for estradiol, and to a lesser extent SHBG. PA was not associated with testosterone levels. Conclusions: Multiple aspects of PA were independently associated with sex hormones; associations varied some by activity intensity and type, and were attenuated after accounting for body mass index.
Research has long established the importance of individual health behaviors such as cigarette smoking for adult morbidity and mortality. However, we know little about how health behaviors cluster into health lifestyles among adolescents and young adults in the United States, or in turn, how such health lifestyles are associated with young adult health outcomes. This study establishes health lifestyles as distinct group phenomena at three developmental time points in a single cohort: late adolescence (ages 15-17), early adulthood (ages 20-24), and young adulthood (ages 26-31). We then identify the associations between these health lifestyles and young adult health outcomes. We use the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of U.S. adolescents followed into adulthood, and latent class analysis and regression models. We uncover diverse health lifestyles among adolescents, early adults, and young adults; however, few individuals engaged in a consistently salubrious lifestyle at any developmental stage. People with less healthy lifestyles also tended to exhibit poorer health in young adulthood. Our results showed that young adult health lifestyles were significantly associated with young adult cardiovascular risk. Moreover, health lifestyles in each of the three developmental stages were associated with young adult self-rated health, and accounting for lifestyles in later stages explained some of these associations. Overall, this study suggests a portrait of problematic health lifestyles among a nationally representative cohort of young Americans, with associated patterns of relatively poor physical health among those with poor health lifestyles.
U.S. trends in population health suggest alarming disparities among young adults, who are less healthy across most measureable domains than their counterparts in other high-income countries; these international comparisons are particularly troubling for women. To deepen our understanding of gender disparities in health and underlying behavioral contributions, we document gender-specific clusters of health behavior among U.S. young adults using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health. We find high levels of poor health behavior, but especially among men; 40 percent of men clustered into a group characterized by unhealthy behavior (e.g., poor diet, no exercise, substance use), compared to only 22 percent of women. Additionally, women tend to age out of unhealthy behaviors in young adulthood more than men. Further, we uncover gender differences in the extent to which sociodemographic position and adolescent contexts inform health behavior clustering. For example, college education was more protective for men, whereas marital status was equally protective across gender. Parental drinking mattered for health behavior clustering among men, whereas peer drinking mattered for clustering among women. We discuss these results in the context of declining female advantage in U.S. health and changing young adult social and health contexts.
Background:
Adverse childhood experiences (ACEs; e.g. abuse, neglect, and parental loss) have been associated with increased risk for later-life disease and dysfunction using adults' retrospective self-reports of ACEs. Research should test whether associations between ACEs and health outcomes are the same for prospective and retrospective ACE measures.
Methods:
We estimated agreement between ACEs prospectively recorded throughout childhood (by Study staff at Study member ages 3, 5, 7, 9, 11, 13, and 15) and retrospectively recalled in adulthood (by Study members when they reached age 38), in the population-representative Dunedin cohort (N = 1,037). We related both retrospective and prospective ACE measures to physical, mental, cognitive, and social health at midlife measured through both objective (e.g. biomarkers and neuropsychological tests) and subjective (e.g. self-reported) means.
Results:
Dunedin and U.S. Centers for Disease Control ACE distributions were similar. Retrospective and prospective measures of adversity showed moderate agreement (r = .47, p < .001; weighted Kappa = .31, 95% CI: .27-.35). Both associated with all midlife outcomes. As compared to prospective ACEs, retrospective ACEs showed stronger associations with life outcomes that were subjectively assessed, and weaker associations with life outcomes that were objectively assessed. Recalled ACEs and poor subjective outcomes were correlated regardless of whether prospectively recorded ACEs were evident. Individuals who recalled more ACEs than had been prospectively recorded were more neurotic than average, and individuals who recalled fewer ACEs than recorded were more agreeable.
Conclusions:
Prospective ACE records confirm associations between childhood adversity and negative life outcomes found previously using retrospective ACE reports. However, more agreeable and neurotic dispositions may, respectively, bias retrospective ACE measures toward underestimating the impact of adversity on objectively measured life outcomes and overestimating the impact of adversity on self-reported outcomes. Associations between personality factors and the propensity to recall adversity were extremely modest and warrant further investigation. Risk predictions based on retrospective ACE reports should utilize objective outcome measures. Where objective outcome measurements are difficult to obtain, correction factors may be warranted.
We have summarized the evolution of the Nurses’ Health Study (NHS), a prospective cohort study of 121 700 married registered nurses launched in 1976; NHS II, which began in 1989 and enrolled 116 430 nurses; and NHS3, which began in 2010 and has ongoing enrollment.
Over 40 years, these studies have generated long-term, multidimensional data, including lifestyle- and health-related information across the life course and an extensive repository of various biological specimens. We have described the questionnaire data collection, disease follow-up methods, biorepository resources, and data management and statistical procedures.
Through integrative analyses, these studies have sustained a high level of scientific productivity and substantially influenced public health recommendations. We have highlighted recent interdisciplinary research projects and discussed future directions for collaboration and innovation.
The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology. The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity.
Most research considers both psychological and physical health with a disease perspective by focusing on poor psychological functioning or disease outcomes. However, identifying attributes that support adaptive functioning may inform approaches to achieving health beyond what we learn from studying risk factors that accelerate deterioration. Recent evidence suggests that positive psychological functioning contributes to attaining optimal physical health. We evaluate the current state of knowledge on the relationship between positive psychological functioning and physical health, defining health beyond solely the absence of disease. We further consider when positive psychological functioning begins to exert effects on health, whether it has direct effects on biological processes or serves primarily to buffer the effects of stress, and whether it is associated with health outcomes and biological processes beyond those that reflect the absence of deterioration and disease. We propose some key directions for future research including the assessment of positive psychological functioning, positive biological functioning, and optimal health, the value of multi-system measures, and the potential of "omics" to provide novel insights into biological mechanisms underlying associations between positive psychological functioning and physical health.
This study constructed and tested models using the mediators of resilience and self-efficacy to help explain the relationship between social support and positive health practices (PHPs) in Black late adolescents. A cross-sectional, correlational design was used with a convenience sample of 179 Black college students, aged 18 to 23 years. Participants responded to four instruments; the five bivariate hypotheses were supported. Social support correlated positively with PHPs (r = .45, p < .001), resilience (r = .28, p < .001), and self-efficacy (r = .40, p < .001). Resilience (r = .31, p < .001) and self-efficacy (r = .38, p < .001) correlated positively with PHPs. Regression analyses indicated that resilience and self-efficacy were partial, not complete mediators of the relationship between social support and PHPs. This research has relevance for practice involving Black late adolescents, with social support playing a role in promoting PHPs.
© The Author(s) 2015.
How do children and adolescents “make it” when their development is threatened by poverty, neglect, maltreatment, war, violence, or exposure to oppression, racism, and discrimination? What protects them when their parents are disabled by substance abuse, mental illness, or serious physical illness? How do we explain the phenomenon of resilience—children succeeding in spite of serious challenges to their development—and put this knowledge to work for the benefit of children and society? The scientific study of resilience emerged around 1970 when a group of pioneering researchers began to notice the phenomenon of positive adaptation among subgroups of children who were considered “at risk” for developing later psychopathology (Masten, 2001, 2012).
Context.
—Gestational diabetes mellitus (GDM) affects 3% to 5% of pregnancies. Knowledge of risk factors for GDM is needed to identify possible preventive strategies.
Objective.
—To assess whether recognized determinants of non-insulindependent diabetes mellitus also may be markers for increased risk of GDM.
Design.
—Prospective cohort study.
Setting.
—The Nurses' Health Study II, which involves female US nurses aged 25 to 42 years at entry.
Participants.
—The analyses included 14613 women without previous GDM or other known diabetes who reported a singleton pregnancy between 1990 and 1994. Of these women, 722 (4.9%) reported a new diagnosis of GDM.
Main Outcome Measure:
Self-report of GDM, validated by medical record review in a subset.
Results.
—multivariate analyses including age, pregravid body mass index (BMI), and other GDM risk factors, the risk for GDM increased significantly with increasing maternal age (Pfor trend, <.01) and family history of diabetes mellitus (relative risk, 1.68; 95% confidence interval [CI], 1.39-2.04). Relative risks for GDM were 2.13 (95% CI, 1.65-2.74) for pregravid BMI of 25 to 29.9 kg/m2 and 2.90 (95% CI, 2.15-3.91) for BMI of 30 kg/m2 or more (vs BMI of <20 kg/m2) Risk for GDM increased with greater weight gain in early adulthood, and it also increased among nonwhite women. Pregravid current smokers had a relative risk for GDM of 1.43 (95% CI, 1.14-1.80), and pregravid vigorous exercise was associated with a nonsignificant reduction in GDM risk.
Conclusions.
—Advanced maternal age, family history of diabetes mellitus, nonwhite ethnicity, higher BMI, weight gain in early adulthood, and cigarette smoking predict increased GDM risk. These observations may facilitate the identification of women at particular risk for GDM and suggest potential strategies for reducing this risk even before a woman becomes pregnant, such as avoiding substantial weight gain and smoking.
Overall mortality rates from coronary heart disease (CHD) in the United States have declined in recent decades, but the rate has plateaued among younger women. The potential for further reductions in mortality rates among young women through changes in lifestyle is unknown.
The aim of this study was to estimate the proportion of CHD cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle.
A prospective analysis was conducted among 88,940 women ages 27 to 44 years at baseline in the Nurses' Health Study II who were followed from 1991 to 2011. Lifestyle factors were updated repeatedly by questionnaire. A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index-2010, and 0.1 to 14.9 g/day of alcohol. To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, and hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, we calculated the population-attributable risk percent.
During 20 years of follow-up, we documented 456 incident CHD cases. In multivariable-adjusted models, nonsmoking, a healthy body mass index, exercise, and a healthy diet were independently and significantly associated with lower CHD risk. Compared with women with no healthy lifestyle factors, the hazard ratio for CHD for women with 6 lifestyle factors was 0.08 (95% confidence interval: 0.03 to 0.22). Approximately 73% (95% confidence interval: 39% to 89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. Similarly, 46% (95% confidence interval: 43% to 49%) of clinical CVD risk factor cases were attributable to a poor lifestyle.
Primordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD.
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
The Revised Children's Manifest Anxiety Scale (RCMAS) was studied for its clinical usefulness in discriminating 44 children with DSM-III anxiety disorders from 95 children with other DSM-III psychiatric diagnoses. The Worry/ Oversensitivity factor of the RCMAS significantly distinguished the anxiety group from the group of other disorders with a higher mean T-score and a greater percentage of pathological T-score elevations. Within the anxiety group, this same factor showed the highest mean T-score and was most commonly the highest T-score in the RCMAS factor profile. A cutoff procedure using the Worry/Oversensitivity factor produced promising accuracy values, especially in the identification of children without anxiety disorders (specificity = 80%). Use of the RCMAS as one part of an empirical, multimethod assessment was recommended for the most accurate identification of children with anxiety disorders.
To determine the risk of mortality associated with cardiometabolic risk factors in a national sample of adolescents and young adults.
Prospective study of participants in the third NHANES (1988-1994), aged 12 to 39 years at the time of the survey (n = 9245). Risk factors included 3 measures of adiposity, glycated hemoglobin (HbA1c) level, cholesterol levels, blood pressure, self-reported smoking status, and cotinine level. Death before age 55 (n = 298) was determined by linkage to the National Death Index through 2006. Proportional hazards models, with age as the time scale, were used to determine the risk of death before age 55 years after adjusting for gender, race/ethnicity, and presence of comorbid conditions.
After adjusting for age, gender, and race/ethnicity, results of categorical analyses showed that current smokers were at 86% greater risk for early death than those classified as never smokers; that those with a waist-to-height ratio >0.65 were at 139% greater risk than those with a WHR <0.5; and that those with an HbA1c level >6.5% were at 281% greater risk than those with an HbA1c level <5.7%. Neither high-density lipoprotein nor non-high-density lipoprotein cholesterol measures were associated with risk for early death.
Our finding that risk for death before age 55 among US adolescents and young adults was associated with central obesity, smoking, and hyperglycemia supports reducing the prevalence of these risk factors among younger US residents.
Background:
Research on resilience in the aftermath of potentially traumatic life events (PTE) is still evolving. For decades, researchers have documented resilience in children exposed to corrosive early environments, such as poverty or chronic maltreatment. Relatively more recently, the study of resilience has migrated to the investigation of isolated PTE in adults.
Methods:
In this article, we first consider some of the key differences in the conceptualization of resilience following chronic adversity versus resilience following single-incident traumas, and then describe some of the misunderstandings that have developed about these constructs. To organize our discussion, we introduce the terms emergent resilience and minimal-impact resilience to represent trajectories of positive adjustment in these two domains, respectively.
Results:
We focused in particular on minimal-impact resilience, and reviewed recent advances in statistical modeling of latent trajectories that have informed the most recent research on minimal-impact resilience in both children and adults and the variables that predict it, including demographic variables, exposure, past and current stressors, resources, personality, positive emotion, coping and appraisal, and flexibility in coping and emotion regulation.
Conclusions:
The research on minimal-impact resilience is nascent. Further research is warranted with implications for a multiple levels of analysis approach to elucidate the processes that may mitigate or modify the impact of a PTE at different developmental stages.
The existence of depression in children and adolescents is well established, but debate remains about the phenomenology of the depressive syndrome in the young. In order to discover possible age differences in rates and etiology, the definition and measurement of depression must be comparable across the ages to be studied. A widely used self-report depression symptom scale, the Center for Epidemiologic Studies Depression (CES-D) Scale, was administered to convenient (and not necessarily representative) samples of high school and college students. The scores and patterns of responses to the 20 symptom items of the scale were compared with already existing data from junior high school students, from depressed patients, and from a representative community sample of adults and young adults. The results of the analyses suggest that the CES-D Scale is acceptable and reliable in all the groups studied. The scores of the junior high school group may be inflated by an excess of transient symptoms and should be interpreted with caution, but the scale seems to be very suitable for the high school and older groups.
To examine the links between three fundamental healthy lifestyle behaviors (not smoking, healthy diet, and adequate physical activity) and all-cause mortality in a national sample of adults in the United States.
We used data from 8375 U.S. participants aged ≥ 20 years of the National Health and Nutrition Examination Survey 1999-2002 who were followed through 2006.
During a mean follow-up of 5.7 years, 745 deaths occurred. Compared with their counterparts, the risk for all-cause mortality was reduced by 56% (95% confidence interval [CI]: 35%-70%) among adults who were nonsmokers, 47% (95% CI: 36%, 57%) among adults who were physically active, and 26% (95% CI: 4%, 42%) among adults who consumed a healthy diet. Compared with participants who had no healthy behaviors, the risk decreased progressively as the number of healthy behaviors increased. Adjusted hazard ratios and 95% confidence interval were 0.60 (0.38, 0.95), 0.45 (0.30, 0.67), and 0.18 (0.11, 0.29) for 1, 2, and 3 healthy behaviors, respectively.
Adults who do not smoke, consume a healthy diet, and engage in sufficient physical activity can substantially reduce their risk for early death.
This study examined trends in body mass index (BMI) during the transition from adolescence to young adulthood by gender and race, using national data from the United States spanning for >40 years from 1959 and 2002. Although past research has investigated BMI trends separately in childhood/adolescence and adulthood, this study uniquely focused on the transition to adulthood (12-26 years) to identify the emergence of the obesity epidemic during this critical life-stage.
Longitudinal and cross-sectional data were obtained from four nationally representative surveys: National Health and Nutrition Examination Survey, National Longitudinal Study of Adolescent Health, National Health Interview Survey, and National Longitudinal Surveys of Youth (NLSY79 and NLSY97). The analysis tracked age trends in BMI by time, which allowed for the examination of how BMI changed during the transition to adulthood and whether the patterns of change varied by period. Data best suited for trend analysis were identified. Age trends in BMI by gender and race were graphed and regression analysis was used to test for significant differences in the trends using the National Health and Nutrition Examination Survey and National Longitudinal Study of Adolescent Health.
BMI increased sharply in the adolescent ages, beginning in the 1990s and among young adults around 2000. This age pattern of BMI increase was more dramatic among females and blacks, particularly black females.
BMI increased during the transition to adulthood and these increases have grown larger over time. Obesity prevention efforts should focus on this high-risk transition period, particularly among minority populations.
Resilience has been conceptualized as a dynamic developmental process encompassing the attainment of positive adaptation within the context of significant threat, severe adversity, or trauma. Until the past decade, the empirical study of resilience predominantly focused on behavioral and psychosocial correlates of, and contributors to, the phenomenon and did not examine neurobiological or genetic correlates of and contributors to resilience. Technological advances in molecular genetics and neuroimaging, and in measuring other biological aspects of behavior, have made it more feasible to begin to conduct research on pathways to resilient functioning from a multilevel perspective. Child maltreatment constitutes a profound immersion in severe stress that challenges and frequently impairs development across diverse domains of biological and psychological functioning. Research on the determinants of resilience in maltreated children is presented as an illustration of empirical work that is moving from single-level to multilevel investigations of competent functioning in the face of adversity and trauma. These include studies of personality, neural, neuroendocrine, and molecular genetic contributors to resilient adaptation. Analogous to neural plasticity that takes place in response to brain injury, it is conjectured that it may be possible to conceptualize resilience as the ability of individuals to recover functioning after exposure to extreme stress. Multilevel randomized control prevention and intervention trials have substantial potential for facilitating the promotion of resilient functioning in diverse high-risk populations that have experienced significant adversity. Determining the multiple levels at which change is engendered through randomized control trials will provide insight into the mechanisms of change, the extent to which neural plasticity may be promoted, and the interrelations between biological and psychological processes in the development of maladaptation, psychopathology, and resilience.
This review presents a national health profile of adolescents and young adults (ages 10-24). The data presented include trends on demographics, mortality, health-related behaviors, and healthcare access and utilization, as well as the most significant gender and racial/ethnic disparities. Although the data show some improvement, many concerns remain. Encouraging trends-such as decreases in rates of homicide, suicide, and some measures of reproductive health-appear to be leveling off or, in some cases, reversing (e.g., birth and gonorrhea rates). Large disparities, particularly by race/ethnicity and gender, persist in many areas. Access to quality healthcare services remains a challenge, especially during young adulthood. Policy and research recommendations to improve health during these critical periods in the lifespan are outlined.
This report presents initial findings on the reliability and validity of a new retrospective measure of child abuse and neglect, the Childhood Trauma Questionnaire.
Two hundred eighty-six drug- or alcohol-dependent patients were given the Childhood Trauma Questionnaire as part of a larger test battery, and 40 of these patients were given the questionnaire again after an interval of 2 to 6 months. Sixty-eight of the patients were also given a structured interview for child abuse and neglect, the Childhood Trauma Interview, that was developed by the authors.
Principal-components analysis of responses on the Childhood Trauma Questionnaire yielded four rotated orthogonal factors: physical and emotional abuse, emotional neglect, sexual abuse, and physical neglect. Cronbach's alpha for the factors ranged from 0.79 to 0.94, indicating high internal consistency. The Childhood Trauma Questionnaire also demonstrated good test-retest reliability over a 2- to 6-month interval (intraclass correlation = 0.88), as well as convergence with the Childhood Trauma Interview, indicating that patients' reports of child abuse and neglect based on the Childhood Trauma Questionnaire were highly stable, both over time and across type of instruments.
These findings provide strong initial support for the reliability and validity of the Childhood Trauma Questionnaire.
Gestational diabetes mellitus (GDM) affects 3% to 5% of pregnancies. Knowledge of risk factors for GDM is needed to identify possible preventive strategies.
To assess whether recognized determinants of noninsulin-dependent diabetes mellitus also may be markers for increased risk of GDM.
Prospective cohort study.
The Nurses' Health Study II, which involves female US nurses aged 25 to 42 years at entry.
The analyses included 14613 women without previous GDM or other known diabetes who reported a singleton pregnancy between 1990 and 1994. Of these women, 722 (4.9%) reported a new diagnosis of GDM.
Self-report of GDM, validated by medical record review in a subset.
In multivariate analyses including age, pregravid body mass index (BMI), and other GDM risk factors, the risk for GDM increased significantly with increasing maternal age (P for trend, <.01) and family history of diabetes mellitus (relative risk, 1.68; 95% confidence interval [CI], 1.39-2.04). Relative risks for GDM were 2.13 (95% CI, 1.65-2.74) for pregravid BMI of 25 to 29.9 kg/m2 and 2.90 (95% CI, 2.15-3.91) for BMI of 30 kg/m2 or more (vs BMI of <20 kg/m2). Risk for GDM increased with greater weight gain in early adulthood, and it also increased among nonwhite women. Pregravid current smokers had a relative risk for GDM of 1.43 (95% CI, 1.14-1.80), and pregravid vigorous exercise was associated with a nonsignificant reduction in GDM risk.
Advanced maternal age, family history of diabetes mellitus, nonwhite ethnicity, higher BMI, weight gain in early adulthood, and cigarette smoking predict increased GDM risk. These observations may facilitate the identification of women at particular risk for GDM and suggest potential strategies for reducing this risk even before a woman becomes pregnant, such as avoiding substantial weight gain and smoking.
To examine correlates of high overall level of emotional functioning (emotional vitality) in disabled older women.
A community-based study: The Women's Health and Aging Study.
A total of 1002 moderately to severely disabled women aged 65 and older living in the community.
Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. Correlations with demographics, health status, and social context were examined.
Despite their physical disabilities, 35% of the 1002 disabled older women were emotionally vital. The percent of emotionally vital women declined with increasing severity of disability. After adjustment for disability status, a significantly increased likelihood for being emotionally vital was found for black race (OR=1.69) and for having higher income (OR=1.77), better cognition (OR=2.36), no vision problems (OR=1.61), adequate emotional support (OR=2.54), and many face-to-face contacts (OR=1.64). Having more than one negative life event reduced the likelihood of emotional vitality (OR=0.57).
A substantial proportion of even the most disabled older women can be described as emotionally vital. Findings also suggest that emotional vitality is not solely a function of stable, enduring individual characteristics but that health status, disability, and sociodemographic context also have an influence on emotional vitality.
The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology.
Relative risk is usually the parameter of interest in epidemiologic and medical studies. In this paper, the author proposes a modified Poisson regression approach (i.e., Poisson regression with a robust error variance) to estimate this effect measure directly. A simple 2-by-2 table is used to justify the validity of this approach. Results from a limited simulation study indicate that this approach is very reliable even with total sample sizes as small as 100. The method is illustrated with two data sets.
The aim of this article is to review recent epidemiological research on age-of-onset of mental disorders, focusing on the WHO World Mental Health surveys.
Median and inter-quartile range (IQR; 25th-75th percentiles) of age-of-onset is much earlier for phobias (7-14, IQR 4-20) and impulse-control disorders (7-15; IQR 4-35) than other anxiety disorders (25-53, IQR 15-75), mood disorders (25-45, IQR 17-65), and substance disorders (18-29, IQR 16-43). Although less data exist for nonaffective psychosis, available evidence suggests that median age-of-onset is in the range late teens through early 20s. Roughly half of all lifetime mental disorders in most studies start by the mid-teens and three quarters by the mid-20s. Later onsets are mostly secondary conditions. Severe disorders are typically preceded by less severe disorders that are seldom brought to clinical attention.
First onset of mental disorders usually occur in childhood or adolescence, although treatment typically does not occur until a number of years later. Although interventions with early incipient disorders might help reduce severity-persistence of primary disorders and prevent secondary disorders, additional research is needed on appropriate treatments for early incipient cases and on long-term evaluation of the effects of early intervention on secondary prevention.