Challenges and healthy Challenges and healthy ageing: the role of ageing: the role of

resilience across the life resilience across the life course course

30th September 2009

Bangor University

ResNet: Research QuestionsResNet: Research Questions

• To what extent is resilience determined by community, individual and biological characteristics?

• How can resilience best be defined and measured in order to inform research, policy and practice?

• How can resilience be developed, maintained and enhanced to reduce health and social inequalities and achieve healthy ageing across the life-course?

• How do life course experiences influence health and resilience?

ResNet: Work planResNet: Work plan Work Package 1 Months 1-4 Topic: Definitions and determinants

Output:

Scientific Meeting 1

Identification of other collaborators Identification of wider contacts for consultation on outputs Draft research, knowledge transfer and dissemination strategy.

Research development

Draft discussion paper- recommendations of definitions, critical review of determinants; identification of relevant policies

Draft universal summary and guidance for stakeholders/policy on definitions and determinants (derived from discussion paper).

Validation workshop 1 Synthesis of feedback - update discussion paper into academic publication, finalise universal summary and guidance for stakeholders/policy for publication.

Work Package 2 Months 5-8 Topic: Measurement and I nterventions

Output:

Scientific Meeting 2 Interventions to enhance resilience Measuring the determinants of resilience The potential of existing datasets

Research development Draft discussion paper- critical review of interventions, measurement and secondary data analyses

Draft universal summary and guidance for stakeholders/policy (derived from discussion paper).

Validation workshop 2 Synthesis of feedback- update discussion paper into academic publication, finalise universal summary and guidance for stakeholders/policy for publication.

Work package 3 Months 8-10 Topic: Research Development

Output:

Scientific Meeting 3 Final research, knowledge transfer and dissemination strategy Draft ideas for research proposal(s); based on papers

developed in WP1 and WP2 Research development Develop research proposal(s) Validation workshop 3 Synthesis of feedback into final research, knowledge transfer

and dissemination strategy; high quality research proposal(s).

Work Package 1Work Package 1UpdateUpdate

Literature Review – definitions, determinants, measurement, interventions

• A. (DE=resilien*) and((KW=biol*) or(KW=geog*) or(KW=community))

• B. (DE=resilien*) and((KW=Interven*) or(KW=promot*) or(KW=associat*) or(KW=determin*) or(KW=relat*) or(KW=predict*) or(KW=review) or (definition))

• Social Sciences CSA (ASSIA, Medline, PsycInfo)• Web of science (SSCI; SCI AHCI)• Greenfile• Cochrane database of systematic reviews

Methods (2)Methods (2)

• Inclusion/exclusion (to be applied when screening journal abstracts)

• Research papers where resilience is a key focus and/or is assessed (NOT papers that are just picking up the word in the discussion)

• The population of interest is human (not animal research)

• All age groups considered

• Peer reviewed journal articles, priority given to systematic reviews/meta analyses

• 1989 onwards

• English language only

• Exclude if only the title is available

• Google/websites

Results - summary by populationResults - summary by population

Definitions of Resilience – Key Points from Definitions of Resilience – Key Points from the Literature (1)the Literature (1)

• There is a consensus in the literature regarding the complexities of defining resilience

• There are variations in definitions of resilience, often according to the adversity under question, which in turn identify different risk or protective factors that impact on different outcomes.

• Definitions of resilience have been derived from observations in child & adolescent research which have shaped developmental theory – applied to adults and older age

Definitions of Resilience – Key Points from Definitions of Resilience – Key Points from the Literature (2)the Literature (2)

Three broad areas of resilience research (Masten 2007): • 1) Developing well in the context of high cumulative risk for developmental

problems (beating the odds, better than predicted development)

• 2) Functioning well under currently adverse conditions (stress-resistance/coping)

• 3) Recovery to normal functioning after catastrophic adversity or severe deprivation (bouncing back, normalization)

• Accounts mainly for observations derived primarily from children and adolescents, does this also account for some of the observations in adults and older adults? 

• In research on loss, trauma and human resilience in adults Bonnano (2004) defines resilience as an individual’s capacity to resist maladaptation in the face of risky experiences and maintain a stable equilibrirum - does 2 account for this? Is maintenance the same as functioning well?

• Bonnano does not agree that recovery is the same as resilience.•  

Resilience?Resilience?

Theoretical Framework – Bronfenbrenner’s Theoretical Framework – Bronfenbrenner’s Ecological Systems Theory of DevelopmentEcological Systems Theory of Development

Results – study design x population (1)Results – study design x population (1)

Results – design x population (2)Results – design x population (2)

• Adolescents and early adulthood – 3 papers (2 longitudinal studies, 1 qualitative)

• Families – 5 papers (1 literature review of intellectual disabilities, 4 cross sectional surveys

Results – design x population (3)Results – design x population (3)

Results – design x population Results – design x population (4)(4)

Results – Study Design x PopulationResults – Study Design x PopulationCommunity/Society – 7 papers, all literature reviews,

which discuss the threat of natural disasters or ‘national stressors’ at the society level such as social exclusion, economic disadvantage, social capital, violence.

Other – 25 papers which did not fit in the other categories 12 literature reviews, 5 relating to biological resilience in response to stress & childhood abuse

Specific populations and adversities e.g. cancer survivors, parents who were abused as children, burns

Results –Population x Adversity Results –Population x Adversity Children & AdolescentsChildren & Adolescents

Topic Number

Poor family background (e.g. poverty, abuse, poor parenting)

16

Not defined 14

Culture/racism 2

Risk of educational failure 3

In care 3

Adverse events/crisis(unplanned pregnancy, truancy)

8

Substance abuse 2

Learning disabilities 2

Violence 1

Homelessness 1

HIV/AIDS 1

War 1

Natural disasters 1

Refugees 1

Attempted suicide 1

Results – Population x AdversityResults – Population x AdversityAdolescents and early adults• 1 x risk of developing mental illness• 1 x socio-economic adversity• 1 x Families with substance abuse problems

Families• 1 x review of intellectual disabilities• 2 x stress & poverty• 1 x mental illness• 1 x maternal depression

Results – Population x AdversityResults – Population x AdversityYounger AdultsYounger Adults

Brain injury• Children with developmental disabilities• Violent trauma• Poverty• Bereavement • Progressive chronic disabilities• Unemployment• Immigration• Children with cancer/chronic conditions• Family crisis• HIV/AIDS• Work stress

Results – Population x AdversityResults – Population x AdversityOlder AdultsOlder Adults

• Bereavement• Rheumatoid Arthritis• PoW• Chronic illness and racism• Terminal illness• Depression• Stress• Stroke• Multiple adversities (limiting long term illness,

bereavement, stress, poor life circumstances)

Measurement – Key PointsMeasurement – Key Points

• Population differences in how data on resilience is obtained - adults v children

• Multiple vs single indicators

• Better results may be obtained if the adversity and the outcome are conceptually similar or theoretically linked

• The strength of resilience

• Direct, moderation, mediation

InterventionsInterventionsSo far, only one primary paper of an intervention has been identified. Be a star

community-based after-school program: Developing resiliency factors in high-risk preadolescent youth (Pierce et al, 1998). Designed to build resiliency to withstand pressure from peers and the community to abuse substances.

This reflects the results of an earlier review by (Newman & Blackburn, 2002) who state that  

• “The literature on resilience promotion, while empirically based, includes relatively few accounts of conscious and specific strategies used to promote resilience, and fewer still that have been subject to a robust evaluation using controlled trials”

• Others note that more investment has been made in identifying risk/protective factors, but less on designing and testing interventions that might change negative outcomes.

• Cochrane Data base of systematic reviews: Title: Psychosocial, community based interventions for promoting resilience in disadvantaged children aged 5-17 Stage: Registered Title : 10 June 2009 Last Updated: 01 July 2009 Author: Davidson, Gavin Country: UK Entity: Developmental, Psychosocial and Learning Problems Group

InterventionsInterventions• Luthar, S. S., & Brown, P. J. (2007).

• Outline a few interventions for children and their parents in the context of maltreatment, e.g. the Incredible Years, - training in parent skills, preparing children for school and parents coping with own problems. Many of these focus on attachment.

•  

• Characteristic to some of the resilience interventions is that they are implemented without the recipients having necessarily experiencing a significant adversity – they are preventative.

The UK Resilience Programme:

• Promoting emotional resilience in 11-13 year olds

• Promoting emotional resilience amongst older people

• Bernardo’s Arch Project

• Interventions need to consider culture and context when studying or theorizing resilience in at risk populations (Ungar 2005)

• Resilience or normal development?Luthar, S. S. & Brown, P. J. (2007). Maximizing resilience

through diverse levels of inquiry: Prevailing paradigms, possibilities, and priorities for the future. Development and

Psychopathology, 19(3), 931-955