Whatever does not kill us: Cumulative lifetime adversity, vulnerability, and resilience.

Exposure to adverse life events typically predicts subsequent negative effects on mental health and well-being, such that more adversity predicts worse outcomes. However, adverse experiences may also foster subsequent resilience, with resulting advantages for mental health and well-being. In a multiyear longitudinal study of a national sample, people with a history of some lifetime adversity reported better mental health and well-being outcomes than not only people with a high history of adversity but also than people with no history of adversity. Specifically, U-shaped quadratic relationships indicated that a history of some but nonzero lifetime adversity predicted relatively lower global distress, lower self-rated functional impairment, fewer posttraumatic stress symptoms, and higher life satisfaction over time. Furthermore, people with some prior lifetime adversity were the least affected by recent adverse events. These results suggest that, in moderation, whatever does not kill us may indeed make us stronger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Socioeconomic disadvantage, proximal environmental experiences, and socioemotional and academic adjustment in early adolescence: investigation of a mediated effects model

This study investigated interrelations among conditions of household socioeconomic disadvantage, proximal environmental experiences, and adaptational outcomes in a sample of 398 middle grade, early adolescents from a predominantly poor, rural area. Findings indicated that levels of disadvantage were related to both socioemotional and academic adjustment, with those from relatively disadvantaged backgrounds faring most poorly. Specifically, youth from homes in which adults were employed in low-income, unskilled occupations were found to have lower levels of school performance and achievement compared to those from homes in which adults were employed in higher paying semi-skilled or skilled/professional occupations. Further, youth from families in which neither parent had graduated from high school exhibited significantly worse socioemotional and academic adjustment than did those whose parents had higher educational levels. Youth who lived in relatively disadvantaged homes also reported more negative experiences of proximal environmental conditions relating to family and school contexts and greater exposure to stressful life events. Most notably, findings provided support for employing an ecological-mediational perspective to understand patterns of linkage between socioeconomic disadvantage and levels of adjustment. Support for this viewpoint included the finding that proximal environmental experiences were significant predictors of adolescent adjustment, independent of shared variance with conditions of household disadvantage, whereas conditions of disadvantage in several instances were no longer related significantly to indices of adjustment once their association with proximal environmental conditions was taken into account. The discussion considers implications for the targeting and scope of ecologically oriented approaches to preventive intervention.     

The Human Capacity for Growth Through Adversity.

Comments on George Bonanno's article entitled Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? (see record 2004-10043-003). The authors are encouraged by Bonanno's recognition of the human potential for resilience following adversity and his call for psychologists to pay greater attention to this capacity rather than simply focus on psychopathology. This approach parallels recent trends within psychology toward a more "positive psychology," as championed by former American Psychological Association President Martin Seligman. However, it fails to recognize research trends within the traumatic stress literature, which have increasingly pointed toward the capacity not just for resilience but also for people to use aversive events as a springboard for further growth and development. In this comment, the authors argue that the real paradigm shift needed in dealing with loss and trauma is not simply to include resilience (i.e., the absence of psychopathology). Rather, psychologists should seek to develop an understanding of reactions to adversity that explains the full range of reactions, from psychopathology, through resilience, to adversarial growth. Here they review the main points made by Bonanno (2004) within the context of the adversarial growth literature before presenting a brief overview of a new theory of adversarial growth that addresses these salient considerations, explaining the three possible outcomes of psychopathology, resilience, and adversarial growth following loss and trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth gambling behaviors: An examination of the role of resilience.

The study of resilient children has overturned many deficit-focused models concerning the ontogenesis of children raised in adversity. This study explored the relationship between risk and protective factors, resilience, and youth gambling behavior. More specifically, this study examined the relative contribution of various risk and protective domains in relation to problem gambling behavior and examined whether youth identified as resilient (high risk exposure- high internalized protection) were as likely as those identified as vulnerable (high risk exposure-low internalized protection) to engage in excessive gambling behavior. The sample consisted of 1,273 students ages 12 to 19. The findings demonstrated that risk and protective factors each provide a unique contribution to the prediction model of gambling problems. Resilient and vulnerable youth differed significantly in their self-reported gambling severity. As well, resilient youth were not statistically distinguishable from low-risk exposure groups in terms of their gambling severity. Findings are interpreted with respect to resilience and prevention research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conduct disorder with and without mania in a referred sample of ADHD children

OBJECTIVE: To test the hypothesis that dysphoric and non-dysphoric types of CD could be distinguished from one another in their patterns of familiality, adversity, and comorbidity. METHODS: We examined 140 ADHD and 120 normal controls at baseline and 4 years later using assessments from multiple domains. We compared ADHD subgroups with and without conduct (CD) and bipolar (BPD) disorders on psychiatric outcomes at a 4-year follow-up, familial psychopathology and psychosocial functioning. RESULTS: We found that ADHD children with both disorders had higher familial and personal risk for mood disorders than those with CD only, who had a higher personal risk for antisocial personality disorder. Among ADHD probands, having both CD and BPD was associated with poorer functioning and an increased risk for psychiatric hospitalization. DISCUSSION: Although preliminary, our findings suggest that the distinction between dysphoric and non-dysphoric CD may be clinically meaningful. If confirmed, our findings could have important diagnostic and therapeutic implications for the management of antisocial youth.     

Resilience to maternal depression in young adulthood.

Using a prospective longitudinal design, this study investigated factors associated with resilience in 20-year-old offspring of depressed mothers (n = 648). Resilient youth were operationally defined as those whose mothers were depressed but who themselves had no history of recurrent depression and currently evidenced adequate academic or work and romantic functioning, no Axis I psychopathology, and no clinically significant internalizing behavior problems. Low levels of perceived maternal psychological control (p = .02) and high child IQ (p p = .02), high maternal warmth (p p p p p = .03). Interventions focused on these 2 protective factors might yield the strongest benefits for offspring of depressed mothers as they transition to early adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ordinary magic: Resilience processes in development.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protective and exacerbating factors in children and adolescents with fibromyalgia.

Objective: To investigate protective and exacerbating factors in the adjustment of youth with juvenile primary fibromyalgia syndrome (JPFS), we examined the relationship of stress, coping strategies, social support, and self-efficacy to quality of life, pain, and depression. Method: Participants were 57 youths (ages 10 to 18 years) and their parents from rheumatology clinics at 2 children's hospitals. The youths self-reported daily hassles, coping strategies, social support, self-efficacy, quality of life, pain, and depression. Parents reported on the youths' major life events and quality of life. Results: In regression analyses, daily hassles, catastrophizing (a coping strategies scale), and self-efficacy predicted child-rated quality of life; self-efficacy predicted pain; and daily hassles predicted depression. Self-efficacy and familial social support moderated the relationship between daily hassles and depression. Conclusions: Daily hassles may be associated with health outcomes for youth with JPFS more than major life events are, and catastrophic thinking and self-efficacy beliefs could be appropriate intervention targets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways to adversity in young adulthood among early childbearers.

Women who give birth as teens differ from those who delay childbearing before and after a birth. These preexisting differences may account for the adverse outcomes faced by early childbearers in young adulthood. This study tested whether a history of conduct disorder, low IQ and educational attainment, and low childhood socioeconomic status accounted for poor psychosocial adjustment at age 26 among early childbearers. Study members were 482 women in a birth cohort, 26% of whom had given birth by age 26 in 1999. Findings supported the hypothesis that individual and family background factors partially accounted for the adverse socioeconomic, mental health, and interpersonal outcomes faced by young mothers. However, early childbearing exacerbated the difficulties associated with these risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Origins of health inequalities in a national population sample

BACKGROUND: Explanations for social inequalities in health are often explored but remain largely unresolved. To elucidate the origins of health inequalties, we investigated the extent to which adult-disease risk factors vary systematically according to social position over three decades of early life. METHODS: We used the 1958 birth cohort (all children born in England, Scotland, and Wales on March 3-9, 1958) with data up to age 33 years from parents, teachers, doctors, and cohort members (n = 11,407 for age 33 interview). FINDINGS: Social class of origin was associated with physical risk factors (birthweight, height, and adult body-mass index); economic circumstances, including household overcrowding, basic amenities, and low income; health behaviour of parents (breastfeeding and smoking) and of participants (smoking and diet); social and family functioning and structure, such as divorce or separation of participants or their parents, emotional adjustment in adolescence, social support in early adulthood; and educational achievement and working career, in particular no qualifications, unemployment, job strain, and insecurity. With few exceptions, there were strong significant trends of increasing risk from classes I and II to classes IV and V. Self-perceived health status and symptoms were worse in participants with lower class origins. INTERPRETATION: An individual's chance of encountering multiple adverse health risks throughout life is influenced powerfully by social position. Social trends in adult-disease risk factors do not emerge exclusively in mid-life, but accumulate over decades. Investment in educational and emotional development is needed in all social groups to strengthen prevention strategies relating to health behaviour, work-place environment, and income inequality.     

Psychosocial adjustment of adolescent children of a depressed, arthritic, or normal parent.

Examined the joint effects of having a parent with a psychological or physical disability and stressful life events on the mental health of 3 groups of adolescents: 16 adolescent children of a depressed parent, 16 adolescent children of a parent with rheumatoid arthritis, and 16 adolescent children of parents free from psychological or physical disability. Ss were asked to complete a battery of assessments, including the SCL-90, Rosenberg Self-Esteem Scale, Family Environment Scale, and scales assessing life events and satisfaction with school. It was found that, in contrast to the normal group, Ss with arthritic parents reported lower self-esteem, whereas Ss with depressed parents reported lower self-esteem and more symptomatology. However, the 2 risk groups did not differ in terms of mental health or family and school adjustment. Both negative and positive life events were strongly related to poorer adjustment, but only for Ss with depressed and arthritic parents. There was a significant interaction effect of parental disability (depressed vs normal) and negative life events on symptomatology, with the Ss with depressed parents who experienced few negative life events reporting symptom levels equivalent to that of the normal group. Within-group analyses revealed that a positive familial social climate was related to better adjustment among all 3 groups: satisfactory school involvements were related to better adjustment among the depressed-parent and normal groups. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and physical health at age 70 in the Lothian Birth Cohort 1936: Links with early life IQ, SES, and current cognitive function and neighborhood environment.

Objective: Researchers in many fields are interested in the robust observation that higher socioeconomic status (SES) is associated with better mental and physical health. Prominent explanations for the association involve effects of stress due to relative material and social adversity in lower socioeconomic environments, but early-life intelligence may also contribute directly to both later-life socioeconomic status and health. Here, we evaluated the effects of early-life IQ on mental and physical health outcomes at age 70, in the context of effects of SES. Design: The Lothian Birth Cohort of 1936 took part in the Scottish Mental Survey of 1947, providing a measure of IQ at age 11. They have been extensively surveyed at age 70. Main Outcome Measures: Body mass index, constraints on daily life activities, hospital anxiety and depression, number of diseases, level of physical activity, weekly units of alcohol consumption, and pack-years of smoking. Results and Conclusion: SES had apparently direct effects on most outcomes, but age 11 IQ was also involved in several, either directly or because it contributed to SES. Several interactions helped to integrate these associations. High age-11 IQ tended to buffer effects of adverse environments on physical and mental problems in old age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking histone acetylation to transcriptional regulation

A common result of many studies of children at risk for developmental disorder is the heterogeneity of individual reactions to adversity. One attempt to explain the differential outcome of children at risk lies in the assumption of protective factors. In a prospective study of 362 infants the significance of pre- and perinatal complications (early biological risks) and of adverse family living circumstances (early psychosocial risks) on child development at 4 1/2 years was examined. Additionally, to study the interplay between risk and protective factors a number of mother-child and family characteristics potentially favourable to early development were assessed. Results indicated that early risk factors made a significant contribution to child development at preschool age. Using multiple risk indices, between 10 and 20% of the variance of the developmental outcome at 4 1/2 years was explained. Significant predictors of later developmental disorders were neonatal seizures and very low birth weight among the biological risks and low educational level of the parents, early parenthood and unwanted pregnancy among the psychosocial risks. The contribution of early protective factors to developmental outcome, however, was only limited. The high overlap with risk factors, the low specific predictive power and the lack of a moderator effect question the theoretical usefulness of a global concept of protective factors. However, when interactions between specific risk and protective factors were studied, there was evidence of a buffer effect of a successful early mother child interaction.     

Psychosocial antecedents of tobacco chipping.

The authors examined adolescent antecedents and adult correlates of tobacco "chipping" compared with heavy smoking, experimental smoking, and nonsmoking in a representative community sample. As adolescents, future "chippers" had some smoking risk factors (attitudes, health beliefs, smoking intentions, and tolerance for deviance) and several protective factors (high values for academic success, internal locus of control, supportive relationships, and little smoking among peers and parents). As adults, risk factors included lessened belief in nicotine's addictiveness, lower conscientiousness, higher extraversion, and lower positive affect and life satisfaction; protective factors included high levels of educational attainment and employment and low levels of negative affect and stress (men only). Thus, chippers experience a complex mixture of risk and protective factors for smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of stressors on breast cancer incidence in the Women's Health Initiative.

Objective: To examine associations among life events stress, social support, and breast cancer incidence in a cohort of postmenopausal women. Design and main outcome measure: Women's Health Initiative observational study participants, breast cancer free at entry, who provided assessment of stressful life events, social support, and breast cancer risk factors, were prospectively followed for breast cancer incidence (n = 84,334). Results: During an average of 7.6 years of follow-up, 2,481 invasive breast cancers were diagnosed. In age-adjusted proportional hazards models, 1 stressful life event was associated with increased risk, but risk decreased with each additional stressful life event. After adjustment for confounders the decreasing risk was not significant. Stressful life events and social support appeared to interact in relation to breast cancer risk such that women who had greater number of stressful life events and low social support had a decreased risk of breast cancer. Conclusions: This study found no independent association between stressful life events and breast cancer risk. The results are compatible with a more complex model of psychosocial factors interacting in relation to breast cancer risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The differential effect of child age on the illness intrusiveness–parent distress relationship in juvenile rheumatic disease.

Objective: Examine age-related patterns of association between parent-reported illness intrusiveness and parent distress in parents of youth with juvenile rheumatic diseases (JRDs). Study Design: Cross-sectional multiple regression analysis tested child age as a moderator in the illness intrusiveness–distress relationship. Participants: Fifty-two parents of children ages 9–17 diagnosed with JRD. Main Outcome Measures: The Illness Intrusiveness Scale—Parent Version and the Brief Symptom Inventory. Results: Parent-reported illness intrusiveness demonstrated a significant main effect on distress for all parents in the sample. This was qualified by an Illness Intrusiveness × Child Age interaction. Illness intrusiveness was found to be significantly related to distress among parents of older youth, but was only marginally related to distress for parents of younger children. Conclusions: Results are consistent with family life cycle development models of adjustment to childhood chronic illness. The clinical implications of the findings are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antagonistic pleiotropy at the human IL6 promoter confers genetic resilience to the pro-inflammatory effects of adverse social conditions in adolescence.

The authors tested the evolutionary genetic hypothesis that the functional form of an asymmetrically risky Gene × Environment interaction will differ as a function of age-related antagonistic pleiotropy (i.e., show opposite effects in young vs. old individuals). Previous studies have identified a polymorphism in the human IL6 promoter (rs1800795; IL6 ?174 G/C) that interacts with adverse socioenvironmental conditions to promote chronic inflammation in older adults (elevated C-reactive protein). This study identifies a protective effect of the same polymorphism in 17- to 19-year-old adolescents confronting socioeconomic adversity. Over 60% of the environmental risk contribution to the IL6 × Socioeconomic Status interaction could be accounted for by interpersonal stress and adult role burden. Thus, the IL6 ?174G allele does not represent an undifferentiated risk factor but instead sensitizes inflammatory biology to socioenvironmental conditions, conferring either genetic vulnerability or resilience depending on the developmental “somatic environment” that interacts with social conditions to influence gene expression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predicting the 21/?-year outcome of dysthymic disorder: The roles of childhood adversity and family history of psychopathology.

Follow-up studies of dysthymic disorder (DD) indicate that demographic and clinical variables are not strong predictors of its outcome. The present study extended this literature by examining the relationship between the early home environment and family history of psychopathology and outcome in DD. Eighty-six outpatients with DD were followed up over a 30-month period using structured clinical interviews. A number of measures of childhood adversity and familial psychopathology assessed at baseline predicted outcome, even after controlling for baseline severity and clinical variables. The best predictors included a history of sexual abuse, quality of the patient's relationship with both parents, and higher familial loadings for drug abuse and Cluster A personality disorders. These findings indicated that childhood adversity and familial psychopathology have greater predictive utility for DD than for demographic and clinical variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Has Resilience to Severe Trauma Been Underestimated?

Comments on George Bonanno's article entitles Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? (see record 2004-10043-003). The author notes that Bonanno articulated a model of loss and trauma-related resilience cogently and evocatively. In the trauma field, there is a new focus on risk and resilience factors across the life span (e.g., King, Vogt, & King, 2004), and the article by Bonanno will serve as a herald for this new way of thinking about adjustment to trauma and loss. Because the author believes that the most important function of Bonanno's article should be to stimulate theory development and research in this burgeoning area, he raises three issues in service of that goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.