Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary

Abstract

Background: The term resilience is applied in numerous ways in the mental health field, leading to different perspectives of what constitutes a resilient response and disparate findings regarding its prevalence following trauma. Objective: illustrate the impact of various definitions on our understanding and prevalence of resilience, we compared various resilience definitions (absence of PTSD, absence of current mental health diagnosis, absence of generalized psychological distress, and an alternative trauma load–resilience discrepancy model of the difference between actual and predicted distress given lifetime trauma exposure) within a combat-exposed military personnel and veteran sample. Method: In this combat-trauma exposed sample (N = 849), of which approximately half were treatment seeking, rates of resilience were determined across all models, the kappa statistic was used to determine the concordance and strength of association across models, and t-tests examined the models in relation to a self-reported resilience measure. Results: Prevalence rates were 43.7%, 30.7%, 87.4%, and 50.1% in each of the four models. Concordance analyses identified 25.7% (n = 218) considered resilient by all four models (kappa = .40, p < .001). Correlations between models and self-reported resilience were strong, but did not fully overlap. Conclusions:The discussion highlights theoretical considerations regarding the impact of various definitions and methodologies on resilience classifications, links current findings to a systems-based perspective, and ends with suggestions for future research approaches on resilience.

Adverse childhood experiences and resilience among adult women: a population-based study

“…In line with previous literature (Nishimi, Choi, Cerutti, et al, 2020;Sheerin et al, 2018), we found that self-assessed coping ability and outcome-based psychiatric resilience were only moderately correlated with each other, indicating these may reflect different patterns of adaptive functioning following adversity. Collectively, our research adds to the growing literature on the nature of resilience as a construct.…”

“…Resilience is generally conceptualized as maintained mental health or positive adaptation despite trauma exposure (Choi, Stein, Dunn, Koenen, & Smoller, 2019;Kalisch et al, 2017;Luthar, Cicchetti, & Becker, 2000). The two most widely used approaches to operationalize the concept define resilience as perceived coping ability reflecting a stable tendency to cope effectively with stress and adversity (Campbell-Sills & Stein, 2007;Connor & Davidson, 2003), and as psychiatric resilience reflecting an empirically derived outcome, such as the absence of PTSD or other psychiatric disorders among individuals exposed to adversity (Nishimi, Choi, Cerutti, et al, 2020;Sheerin, Stratton, Amstadter, The VA Mid-Atlantic Mental Illness Research, Education, Clinical Center (MIRECC) Workgroup., & McDonald, 2018). The different resilience definitions are not mutually exclusive, but rather complementary and may capture different underlying dimensions of resilience (Choi et al, 2019;Fisher & Law, 2021;Sheerin et al, 2018) .…”

A decennial review of psychotraumatology: what did we learn and where are we going?

“…Biopsychosocial mechanisms and processes involved in the long-term adverse impact of childhood trauma over decades into mid-life and old age (Glück, Knefel, Tran, & Lueger-Schuster, 2016) and across generations (Kuffer, Thoma, & Maercker, 2016) have been preliminarily conceptualized but remain understudied. We do not know how, for whom, and under what circumstances trajectories of post-traumatic resilience emerge across the lifespan, although we are beginning to understand that resilience is a complex and multifaceted phenomenon that warrants much further study (Iacoviello & Charney, 2014;Nugent, Sumner, & Amstadter, 2014;Sheerin, Stratton, Amstadter, & McDonald, 2018;Southwick, Bonanno, Masten, Panter-Brick, & Yehuda, 2014), particularly in order to inform enhancements of trauma-focused therapies based on promoting resilience (Schnyder, 2014).…”

The association of resilience on psychiatric, substance use, and physical health outcomes in combat trauma-exposed military service members and veterans

“…This discrepancy-based psychiatric resilience measure, referred to hereafter as DBPR, has been examined in behavioural genetic (Amstadter, Moscati, Maes, Meyers, & Kendler, 2016), epidemiologic (Sheerin et al, 2018a), and combat-specific (Sheerin, Stratton, Amstadter, MIRECC workgroup, & McDonald, 2018b) samples, and has been previously demonstrated to protect against development of later internalizing disorders, even in the context of new-onset stressors (Sheerin et al, 2018a). DBPR has a modest correlation with the CD-RISC (Sheerin et al, 2018b), suggesting, as one would expect, these two measurements of resilience are meaningfully related yet are not tapping into a unitary construct. A remaining question is whether this index of resilience is useful when expanded to the examination of its association with other outcomes, above and beyond other known predictors.…”