A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity

THIS IS A PRE-PRINT OF AN ARTICLE PUBLISHED IN “SCIENTIFIC REPORTS (8: 15774)”. THE FINAL AUTHENTICATED VERSION IS AVAILABLE ONLINE AT: https://doi.org/10.1038/s41598-018-34130-2Resilience factors (RFs) help prevent mental health problems after childhood adversity (CA). RFs are known to be related, but it is currently unknown how their interrelations facilitate mental health. Here, we used network analysis to examine the interrelations between ten RFs in 14-year-old adolescents exposed (‘CA’; n=638) and not exposed to CA (‘no-CA’; n=501). We found that the degree to which RFs are assumed to enhance each other is higher in the no-CA compared to the CA group. Upon correction for general distress levels, the global RF connectivity also differed between the two groups. More specifically, in the no-CA network almost all RFs were positively interrelated and thus may enhance each other, whereas in the CA network some RFs were negatively interrelated and thus may hamper each other. Moreover, the CA group showed more direct connections between the RFs and current distress. Therefore, CA seems to influence how RFs relate to each other and to current distress, potentially leading to a dysfunctional RF system. Translational research could explore whether intervening on negative RF interrelations so that they turn positive and RFs can enhance each other, may alter ‘RF-mental distress’ relations, resulting in a lower risk for subsequent mental health problems.

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An Empirical Examination of How Resilience Factors Mitigate the Effect of Childhood Adversity on Adolescent Mental Health

10.31219/osf.io/6z5h9 ◽

2020 ◽

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Ian Goodyer ◽

Anne-Laura Van Harmelen ◽

Paul O. Wilkinson

Keyword(s):

Mental Health ◽

Direct Effect ◽

Mental Distress ◽

Mental Health Problems ◽

Childhood Adversity ◽

Adolescent Mental Health ◽

Self Esteem ◽

Health Problems ◽

Resilience Factors ◽

The Relationship

Objective: More than one in three people worldwide are exposed to some form of childhood adversity (CA). CA is strongly associated with an increased risk for the development of mental health problems. Resilience factors (RFs), such as self-esteem, are known to reduce such vulnerability to mental health problems. Here we examine besides direct RF effects, whether RFs predominantly alter the relationship (i.e. moderation) or disrupt the developmental chain (i.e. mediation) between CA and mental health problems.Methods: We studied 1130 adolescents. CA exposure and 10 RFs (3 inter-individual e.g. friendships; 7 intra-individual e.g. self-esteem) were assessed at age 14. Mental health problems were assessed at age 14 and 17, and were combined into a mental distress index. We estimated direct-effect, moderation and mediation models.Results: When taking the effects of all 10 RFs into account, five of the 10 RFs had a significantly negative direct effect in the overall sample. However, of those five, only brooding revealed a significant effect in both the group of adolescents with and without CA. Of the 10 RFs, friendship support, family cohesion and distress tolerance had a significantly negative relationship with age-17 distress in the group of adolescents with CA, and no effect in the group of adolescents without CA. Yet, none of the three RFs revealed a significant moderation effect (p = 0.07-0.09). Positive self-esteem, negative self-esteem and aggression functioned as significant mediators for the relationship between CA and mental distress.Conclusions: In situations in which CA is not known, brooding seems to be the most beneficial RF, as it reduced subsequent mental distress in both adolescents with and without CA. Regarding RFs in the aftermath of CA, our findings provide predominant support for mediation rather than for moderation effects. More specifically, targeting negative self-esteem, positive self-esteem, and aggression seems most fruitful, when the aim is to disrupt the chain between CA and adolescent mental health problems.

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Unravelling the complex nature of resilience factors and their changes between early and later adolescence

BMC Medicine ◽

10.1186/s12916-019-1430-6 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 6

Author(s):

J. Fritz ◽

J. Stochl ◽

E. I. Fried ◽

I. M. Goodyer ◽

C. D. van Borkulo ◽

...

Keyword(s):

Mental Health ◽

Distress Tolerance ◽

Mental Health Problems ◽

Childhood Adversity ◽

Health Problems ◽

Complex Nature ◽

Early Age ◽

Empirically Supported ◽

Resilience Factors ◽

Shed Light

Abstract Background Childhood adversity (CA) is strongly associated with mental health problems. Resilience factors (RFs) reduce mental health problems following CA. Yet, knowledge on the nature of RFs is scarce. Therefore, we examined RF mean levels, RF interrelations, RF-distress pathways, and their changes between early (age 14) and later adolescence (age 17). Methods We studied 10 empirically supported RFs in adolescents with (CA+; n = 631) and without CA (CA−; n = 499), using network psychometrics. Results All inter-personal RFs (e.g. friendships) showed stable mean levels between age 14 and 17, and three of seven intra-personal RFs (e.g. distress tolerance) changed in a similar manner in the two groups. The CA+ group had lower RFs and higher distress at both ages. Thus, CA does not seem to inhibit RF changes, but to increase the risk of persistently lower RFs. At age 14, but not 17, the RF network of the CA+ group was less positively connected, suggesting that RFs are less likely to enhance each other than in the CA− group. Those findings underpin the notion that CA has a predominantly strong proximal effect. RF-distress pathways did not differ in strength between the CA+ and the CA− group, which suggests that RFs have a similarly protective strength in the two groups. Yet, as RFs are lower and distress is higher, RF-distress pathways may overall be less advantageous in the CA+ group. Most RF interrelations and RF-distress pathways were stable between age 14 and 17, which may help explain why exposure to CA is frequently found to have a lasting impact on mental health. Conclusions Our findings not only shed light on the nature and changes of RFs between early and later adolescence, but also offer some accounts for why exposure to CA has stronger proximal effects and is often found to have a lasting impact on mental health.

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Unravelling the Complex Nature of Resilience Factors and their Changes between Early and Later Adolescence

10.31219/osf.io/8xgkb ◽

2019 ◽

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Eiko I Fried ◽

Ian Goodyer ◽

Claudia D. van Borkulo ◽

...

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Childhood Adversity ◽

Health Problems ◽

Complex Nature ◽

Resilience Factors

THIS IS A PRE-PRINT OF AN ARTICLE PUBLISHED IN “BMC MEDICINE (17: 203)”. THE FINAL AUTHENTICATED VERSION IS AVAILABLE ONLINE AT: https://doi.org/10.1186/s12916-019-1430-6 Resilience factors (RFs) reduce mental health problems following childhood adversity (CA). We investigated 10 RFs in adolescents with (CA+; n=638) and without CA (CA-; n=501), using network-psychometrics. Specifically, we examined RF mean levels, RF-interrelations, RF-distress pathways, and their changes between age 14 and 17. Mean level changes were similar in both groups. CA+ had lower RFs and higher distress at both ages. Thus, CA does not inhibit RF changes but increases the risk of persistently lower RFs. At age 14, but not 17, the RFs of the CA+ group were less positively interrelated, suggesting that RFs enhance each other less than in the CA- group. The CA+ group had stronger negative RF-distress pathways, particularly at age 14, but those did not reduce distress to a similar mean level as in the CA- group. Most RF-interrelations and RF-distress pathways were stable, which may help explain why exposure to CA often has a lasting impact.

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The Relation between Childhood Adverse Experiences and Disability Due to Mental Health Problems in a Community Sample of Women

The Canadian Journal of Psychiatry ◽

10.1177/070674370505001207 ◽

2005 ◽

Vol 50 (12) ◽

pp. 778-783 ◽

Cited By ~ 17

Author(s):

Lil Tonmyr ◽

Ellen Jamieson ◽

Leslie S Mery ◽

Harriet L MacMillan

Keyword(s):

Mental Health ◽

Sexual Abuse ◽

Child Abuse ◽

Childhood Sexual Abuse ◽

Physical Abuse ◽

Mental Health Problems ◽

Community Sample ◽

Childhood Adversity ◽

Health Problems ◽

Adverse Experiences

Objective: The objective of this study was to examine the association between selected childhood adverse experiences and disability due to mental health problems in a community sample of women. Variables of interest included childhood physical and sexual abuse, parental psychiatric and substance abuse history, and sociodemographic factors. Method: Girls and women (aged 15 to 64 years) from a province-wide community sample ( n = 4239) were asked about disability and most childhood adverse experiences through interview; a self-administered questionnaire inquired about child abuse. Logistic regression (crude and adjusted odds ratios) was used to test the associations between childhood adversity and disability due to mental health problems. Results: Approximately 3% of the women had a disability due to mental health problems. Among women with a disability, about 50% had been abused while growing up. After controlling for income and age, we found that disability showed the strongest association with childhood sexual abuse, physical abuse, and parental psychiatric disorder. Conclusion: Disability due to mental health problems was experienced by women with and without exposure to abuse in childhood. However, childhood sexual abuse and physical abuse were important correlates of disability. Disability creates suffering and loss for the individual and society; this issue merits more research in relation to child abuse.

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Remarkable lives: Jen Waring in conversation with Jerome Carson

Mental Health and Social Inclusion ◽

10.1108/mhsi-05-2016-0016 ◽

2016 ◽

Vol 20 (3) ◽

pp. 153-159

Author(s):

Jen Waring ◽

Jerome Carson

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Distress ◽

Mental Health Problems ◽

Single Case ◽

Health Problems ◽

Content Type ◽

The Many ◽

Practical Implications

Purpose – The purpose of this paper is to provide a profile of Jen Waring. Design/methodology/approach – Jen provides a short biographical description of her life. She is then interviewed by Jerome. Findings – Jen talks about her long battle with mental health problems and what has sustained her over this time. She talks about the crucial importance of support from both loved ones and professionals, as well as medication. Research limitations/implications – Single case studies are of course just one person’s story. Given Jen is an academic biologist, she not only has a unique way of looking at mental illness, she can see the potential of developing approaches in the biological understanding for people experiencing mental distress. Practical implications – Jen’s account shows the need for long-term support for more severe mental health problems. There are no quick fixes! It also highlights the need for interventions at biological, psychological and social levels. Social implications – People need “somewhere to live, someone to love and something meaningful to do” (Rachel Perkins). Many sufferers do not have all three. Services may only be able to provide two of these. Originality/value – Accounts of mental illness recovery by academics can often provide the authors with amazing insights into the world of the mentally distressed. They can also serve as an inspiration to the many students who experience mental distress.

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Tracking Stress, Mental Health, and Resilience Factors in Medical Students Before, During, and After a Stress-Inducing Exam Period: Protocol and Proof-of-Principle Analyses for the RESIST Cohort Study (Preprint)

10.2196/preprints.20128 ◽

2020 ◽

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Rogier A Kievit ◽

Anne-Laura van Harmelen ◽

Paul O Wilkinson

Keyword(s):

Mental Health ◽

Cohort Study ◽

Medical Students ◽

Perceived Stress ◽

Mental Distress ◽

Mental Health Problems ◽

Growth Models ◽

Temporary Increase ◽

Exam Stress ◽

Resilience Factors

BACKGROUND Knowledge of mental distress and resilience factors over the time span from before to after a stressor is important to be able to leverage the most promising resilience factors and promote mental health at the right time. To shed light on this topic, we designed the RESIST (Resilience Study) study, in which we assessed medical students before, during, and after their yearly exam period. Exam time is generally a period of notable stress among medical students, and it has been suggested that exam time triggers mental distress. OBJECTIVE In this paper, we aim to describe the study protocol and to examine whether the exam period indeed induces higher perceived stress and mental distress. We also aim to explore whether perceived stress and mental distress coevolve in response to exams. METHODS RESIST is a cohort study in which exam stress functions as a within-subject natural stress manipulation. In this paper, we outline the sample (N=451), procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors, and adversity), and ethical considerations. Moreover, we conducted a series of latent growth models and bivariate latent change score models to analyze perceived stress and mental distress changes over the 3 time points. RESULTS We found that perceived stress and mental distress increased from the time before the exams to the exam period and decreased after the exams to a lower level than before the exams. Our findings further suggest that higher mental distress before exams increased the risk of developing more perceived stress during exams. Higher perceived stress during exams, in turn, increased the risk of experiencing a less successful (or quick) recovery of mental distress after exams. CONCLUSIONS As expected, the exam period caused a temporary increase in perceived stress and mental distress. Therefore, the RESIST study lends itself well to exploring resilience factors in response to naturally occurring exam stress. Such knowledge will eventually help researchers to find out which resilience factors lend themselves best as prevention targets and which lend themselves best as treatment targets for the mitigation of mental health problems that are triggered or accelerated by natural exam stress. The findings from the RESIST study may therefore inform student support services, mental health services, and resilience theory.

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Childhood abuse and its association with adults’ mental health problems: a cross-sectional study among men and women in the Yangon Region of Myanmar

BMJ Open ◽

10.1136/bmjopen-2020-045870 ◽

2021 ◽

Vol 11 (11) ◽

pp. e045870

Author(s):

Win Thuzar Aye ◽

Lars Lien ◽

Hein Stigum ◽

Espen Bjertness

Keyword(s):

Mental Health ◽

Childhood Abuse ◽

Mental Distress ◽

Mental Health Problems ◽

Cross Sectional Study ◽

Health Problems ◽

Ptsd Symptoms ◽

Cross Sectional ◽

Men And Women ◽

Adult Mental Health

ObjectivesTo estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms.DesignA community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale—Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively.SettingUrban and rural areas of the Yangon Region, Myanmar.ParticipantsA total of 2377 men and women aged 18–49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded.ResultsOverall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men.ConclusionsChildhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.

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Tracking Stress, Mental Health and Resilience Factors in Medical Students, Before, During and After a Stress-Inducing Exam Period: Protocol and Proof of Principle Analyses for the RESIST Cohort-Study

10.31219/osf.io/mt346 ◽

2020 ◽

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Rogier Kievit ◽

Anne-Laura Van Harmelen ◽

Paul Wilkinson

Keyword(s):

Mental Health ◽

Cohort Study ◽

Medical Students ◽

Perceived Stress ◽

Mental Distress ◽

Mental Health Problems ◽

Change Score ◽

Temporary Increase ◽

Stress Exposure ◽

Resilience Factors

Background: Resilience factors, such as self-esteem or social support, are known to reduce mental distress in the face of stress or adversity exposure. So far, knowledge on the promotive value of resilience factors over the time span from before to during and after the stress or adversity exposure is concerningly scarce. Such knowledge seems however important to eventually be able to leverage the most promising resilience factors at the right time. To shed light on this topic we designed the RESIST study, in which we assessed medical students (N=457) before, during and after their yearly exam period. Exam time is a period of notable stress in medical students and has been suggested to trigger mental health problems.Objectives: Here we describe the study protocol and examine whether the exam period did indeed induced higher (di)stress.Methods: RESIST is a cohort-study in which exam stress functions as within-subject natural stress manipulation. In this manuscript we outline the sample, procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors and adversity) and ethical considerations. Moreover, we conducted a series of latent growth and bivariate latent change score models to analyse perceived stress and mental distress changes over the three time points.Results: We found that perceived stress and mental distress increased during exams compared to before exams, but decreased below pre-exam levels afterwards. Our findings further suggest that higher perceived stress before the exams may result in less recovery in mental distress after exams. Moreover, higher mental distress before the exams increased the chance of higher perceived stress during exams, which in turn increased the risk for a less successful (or quick) recovery of mental distress after exams.Conclusion: As expected, the exam period caused a temporary increase in (di)stress. Therefore, the RESIST study lends itself well to explore whether the promotive value of resilience factors changes from before to during and/or after stress exposure. Such knowledge will eventually help to find out which resilience factors lend themselves best as prevention and which as intervention targets for the mitigation of mental health problems that are triggered or accelerated by the stress exposure. Findings from the RESIST study may therefore inform student support services, mental health services and resilience theory.

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Tracking Stress, Mental Health, and Resilience Factors in Medical Students Before, During, and After a Stress-Inducing Exam Period: Protocol and Proof-of-Principle Analyses for the RESIST Cohort Study

JMIR Formative Research ◽

10.2196/20128 ◽

2021 ◽

Vol 5 (6) ◽

pp. e20128

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Rogier A Kievit ◽

Anne-Laura van Harmelen ◽

Paul O Wilkinson

Keyword(s):

Mental Health ◽

Cohort Study ◽

Medical Students ◽

Perceived Stress ◽

Mental Distress ◽

Mental Health Problems ◽

Growth Models ◽

Temporary Increase ◽

Exam Stress ◽

Resilience Factors

Background Knowledge of mental distress and resilience factors over the time span from before to after a stressor is important to be able to leverage the most promising resilience factors and promote mental health at the right time. To shed light on this topic, we designed the RESIST (Resilience Study) study, in which we assessed medical students before, during, and after their yearly exam period. Exam time is generally a period of notable stress among medical students, and it has been suggested that exam time triggers mental distress. Objective In this paper, we aim to describe the study protocol and to examine whether the exam period indeed induces higher perceived stress and mental distress. We also aim to explore whether perceived stress and mental distress coevolve in response to exams. Methods RESIST is a cohort study in which exam stress functions as a within-subject natural stress manipulation. In this paper, we outline the sample (N=451), procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors, and adversity), and ethical considerations. Moreover, we conducted a series of latent growth models and bivariate latent change score models to analyze perceived stress and mental distress changes over the 3 time points. Results We found that perceived stress and mental distress increased from the time before the exams to the exam period and decreased after the exams to a lower level than before the exams. Our findings further suggest that higher mental distress before exams increased the risk of developing more perceived stress during exams. Higher perceived stress during exams, in turn, increased the risk of experiencing a less successful (or quick) recovery of mental distress after exams. Conclusions As expected, the exam period caused a temporary increase in perceived stress and mental distress. Therefore, the RESIST study lends itself well to exploring resilience factors in response to naturally occurring exam stress. Such knowledge will eventually help researchers to find out which resilience factors lend themselves best as prevention targets and which lend themselves best as treatment targets for the mitigation of mental health problems that are triggered or accelerated by natural exam stress. The findings from the RESIST study may therefore inform student support services, mental health services, and resilience theory.

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Mood and neural responses to social rejection do not seem to be altered in resilient adolescents with a history of adversity

Development and Psychopathology ◽

10.1017/s0954579419000178 ◽

2019 ◽

Vol 32 (2) ◽

pp. 411-423

Author(s):

Jessica Fritz ◽

Jason Stretton ◽

Adrian Dahl Askelund ◽

Susanne Schweizer ◽

Nicholas D. Walsh ◽

...

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Childhood Adversity ◽

Health Problems ◽

Social Rejection ◽

Anterior Cingulate ◽

Neural Responses ◽

Social Feedback ◽

Dorsal Anterior Cingulate Cortex ◽

History Of

AbstractChildhood adversity (CA) increases the risk of subsequent mental health problems. Adolescent social support (from family and/or friends) reduces the risk of mental health problems after CA. However, the mechanisms of this effect remain unclear, and we speculate that they are manifested on neurodevelopmental levels. Therefore, we investigated whether family and/or friendship support at ages 14 and 17 function as intermediate variables for the relationship between CA before age 11 and affective or neural responses to social rejection feedback at age 18. We studied 55 adolescents with normative mental health at age 18 (26 with CA and therefore considered “resilient”), from a longitudinal cohort. Participants underwent a Social Feedback Task in the magnetic resonance imaging scanner. Social rejection feedback activated the dorsal anterior cingulate cortex and the left anterior insula. CA did not predict affective or neural responses to social rejection at age 18. Yet, CA predicted better friendships at age 14 and age 18, when adolescents with and without CA had comparable mood levels. Thus, adolescents with CA and normative mood levels have more adolescent friendship support and seem to have normal mood and neural responses to social rejection.

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