Understanding the pathways to resilience in university students in a UK-based higher education setting: a socio-ecological approach

Background: The mental health and well-being of university students has been deemed a global concern due to the rising prevalence of poor mental health and psychosocial functioning. The thesis's impetus was drawn from the increased advocacy for resilience promotion in university students by higher education-based policies. A review of resilience literature within the higher education context illuminated several discrepancies in the conceptual and operational enquiry of resilience for this specific population. Specifically, the study of resilience within the higher education setting has primarily been individual-focused which has discounted the risk or protective role of family and social factors. Additionally, a review of the resilience-based interventions for university students indicated the need for a systematic theoretical and empirical delineation of the complex construct. Objective: The thesis proposed and examined the prospective validity of a socio-ecological model of resilience. The influence of a within-individual (i.e., perceived stress), familial (i.e., dysfunctional parenting styles), and social (i.e., perceived social support) risk and protective factors on a multidimensional construct of resilience (i.e., psychological, social, and emotional resilience) were examined. The underlying mechanism of cognitive reappraisal and the potential variations in this mechanism due to the gender and ethnic identities of the university students were also examined. Methods: A two-phase study design with baseline and 5-month follow-up assessments were conducted. A sample of undergraduate students (79.72% female students, 81.44% While/White British students, mean age = 20.74 years) from all years of study completed a self-report survey at the start of their first term (baseline, n = 775) and again at the end of their second term (follow-up, n = 376). Confirmatory factor analyses were performed to establish longitudinal measurement invariance of the measures used in the self-report survey. Path analyses examined the direct associations, mediation effects, and moderated mediation effects on the data from a final matched sample (n = 362). Results: Longitudinal path models indicated that perceived stress was a significant predictor of psychological (i.e., mental well-being and psychological distress), social (campus connectedness), and emotional (i.e., positive and negative affect) resilience. Cognitive reappraisal partly conveyed the causal relationships between perceived stress and mental well-being, psychological distress, and positive affect across time. Perceived social support from friends was associated with mental well-being and campus connectedness, and these relationships were partly conveyed by cognitive reappraisal. Perceived social support from significant others was associated with mental well-being, psychological distress, and positive affect. Experiences of maternal dysfunctional parenting styles had direct relationships with mental well-being, psychological distress, campus connectedness, and negative affect. Perceived social support from family and paternal dysfunctional parenting styles were not associated with the outcomes of resilience. Gender and ethnicity did not moderate the underlying mechanism of cognitive reappraisal in the pathways of resilience in the longitudinal models. Discussion: This thesis's findings support the need to examine social and family-based factors as predictors of resilience. Specifically, the results suggest that early adverse experiences of poor family functioning can have a cascading effect on psychological, social, and emotional adaptation later in life. The partial support for cognitive reappraisal suggests that the ability to downregulate emotional responses in the face of stressors can be beneficial when perceived social support is low, and perceived stress is high. These findings have significant implications on the development of resilience-based interventions that provide opportunities for the formation of long-lasting social support networks and cultivating stress-management skills. Overall, the findings offer a useful socio-ecological framework for the conceptualisation and operationalisation of university students' resilience within the higher education context

Experiences and perceptions of nursing staff working with long-stay patients in a high secure psychiatric hospital setting

Background and Objective: Forensic psychiatric nursing is a demanding nursing specialty that deals with a highly complex group of patients who are detained in restrictive environments, often for lengthy periods. There is little information about the daily experiences of these nurses. This study sought to explore the roles and relationships of forensic psychiatric nurses with long-stay patients in a high secure hospital in England. Method and Analysis: The study obtained data via three focus groups, and thematic analysis was carried out using NVIVO 10 software. Results: Five prominent themes emerged: First, nurses elaborated on their roles with patients and the kinds of interactions they had with them. The next two themes explored the reasons why some patients are long-stay patients and the challenges nurses face while working with this group. The fourth theme was the impact of external support, such as the patient’s families, on length of stay. The final theme covered the changes that the nurses observed in these patients and in themselves over time. Conclusion: It was noticeable that those interviewed were committed professionals, eager to provide an optimistic and hopeful environment for the patients to help them progress through “the system”. The study presents a number of pertinent issues regarding long-stay patients that provide a basis for further research and to inform policy, educational reforms, and clinical practice

Understanding the pathways to resilience in university students in a UK-based higher education setting: a socio-ecological approach

Background: The mental health and well-being of university students has been deemed a global concern due to the rising prevalence of poor mental health and psychosocial functioning. The thesis's impetus was drawn from the increased advocacy for resilience promotion in university students by higher education-based policies. A review of resilience literature within the higher education context illuminated several discrepancies in the conceptual and operational enquiry of resilience for this specific population. Specifically, the study of resilience within the higher education setting has primarily been individual-focused which has discounted the risk or protective role of family and social factors. Additionally, a review of the resilience-based interventions for university students indicated the need for a systematic theoretical and empirical delineation of the complex construct. Objective: The thesis proposed and examined the prospective validity of a socio-ecological model of resilience. The influence of a within-individual (i.e., perceived stress), familial (i.e., dysfunctional parenting styles), and social (i.e., perceived social support) risk and protective factors on a multidimensional construct of resilience (i.e., psychological, social, and emotional resilience) were examined. The underlying mechanism of cognitive reappraisal and the potential variations in this mechanism due to the gender and ethnic identities of the university students were also examined. Methods: A two-phase study design with baseline and 5-month follow-up assessments were conducted. A sample of undergraduate students (79.72% female students, 81.44% While/White British students, mean age = 20.74 years) from all years of study completed a self-report survey at the start of their first term (baseline, n = 775) and again at the end of their second term (follow-up, n = 376). Confirmatory factor analyses were performed to establish longitudinal measurement invariance of the measures used in the self-report survey. Path analyses examined the direct associations, mediation effects, and moderated mediation effects on the data from a final matched sample (n = 362). Results: Longitudinal path models indicated that perceived stress was a significant predictor of psychological (i.e., mental well-being and psychological distress), social (campus connectedness), and emotional (i.e., positive and negative affect) resilience. Cognitive reappraisal partly conveyed the causal relationships between perceived stress and mental well-being, psychological distress, and positive affect across time. Perceived social support from friends was associated with mental well-being and campus connectedness, and these relationships were partly conveyed by cognitive reappraisal. Perceived social support from significant others was associated with mental well-being, psychological distress, and positive affect. Experiences of maternal dysfunctional parenting styles had direct relationships with mental well-being, psychological distress, campus connectedness, and negative affect. Perceived social support from family and paternal dysfunctional parenting styles were not associated with the outcomes of resilience. Gender and ethnicity did not moderate the underlying mechanism of cognitive reappraisal in the pathways of resilience in the longitudinal models. Discussion: This thesis's findings support the need to examine social and family-based factors as predictors of resilience. Specifically, the results suggest that early adverse experiences of poor family functioning can have a cascading effect on psychological, social, and emotional adaptation later in life. The partial support for cognitive reappraisal suggests that the ability to downregulate emotional responses in the face of stressors can be beneficial when perceived social support is low, and perceived stress is high. These findings have significant implications on the development of resilience-based interventions that provide opportunities for the formation of long-lasting social support networks and cultivating stress-management skills. Overall, the findings offer a useful socio-ecological framework for the conceptualisation and operationalisation of university students' resilience within the higher education context

Phenylbutyrate Counteracts Shigella Mediated Downregulation of Cathelicidin in Rabbit Lung and Intestinal Epithelia: A Potential Therapeutic Strategy

BACKGROUND: Cathelicidins and defensins are endogenous antimicrobial peptides (AMPs) that are downregulated in the mucosal epithelia of the large intestine in shigellosis. Oral treatment of Shigella infected rabbits with sodium butyrate (NaB) reduces clinical severity and counteracts the downregulation of cathelicidin (CAP-18) in the large intestinal epithelia. AIMS: To develop novel regimen for treating infectious diseases by inducing innate immunity, we selected sodium 4-phenylbutyrate (PB), a registered drug for a metabolic disorder as a potential therapeutic candidate in a rabbit model of shigellosis. Since acute respiratory infections often cause secondary complications during shigellosis, the systemic effect of PB and NaB on CAP-18 expression in respiratory epithelia was also evaluated. METHODS: The readouts were clinical outcomes, CAP-18 expression in mucosa of colon, rectum, lung and trachea (immunohistochemistry and real-time PCR) and release of the CAP-18 peptide/protein in stool (Western blot). PRINCIPAL FINDINGS: Significant downregulation of CAP-18 expression in the epithelia of rectum and colon, the site of Shigella infection was confirmed. Interestingly, reduced expression of CAP-18 was also noticed in the epithelia of lung and trachea, indicating a systemic effect of the infection. This suggests a causative link to acute respiratory infections during shigellosis. Oral treatment with PB resulted in reduced clinical illness and upregulation of CAP-18 in the epithelium of rectum. Both PB and NaB counteracted the downregulation of CAP-18 in lung epithelium. The drug effect is suggested to be systemic as intravenous administration of NaB could also upregulate CAP-18 in the epithelia of lung, rectum and colon. CONCLUSION: Our results suggest that PB has treatment potential in human shigellosis. Enhancement of CAP-18 in the mucosal epithelia of the respiratory tract by PB or NaB is a novel discovery. This could mediate protection from secondary respiratory infections that frequently are the lethal causes in dysentery

A case study exploring the experience of resilience-based clinical supervision and its influence on care towards self and others among student nurses

Background: Healthcare organisations are increasingly recognising their responsibility to support the wellbeing of nurses as a result of the accumulative demands of their role. Resilience-based clinical supervision is a newly developed intervention that encourages practitioners to pay attention and apply reasoning to behaviours and responses to emotive scenarios through a process of stress alleviation and prevention. Aims: To evaluate an intervention aimed at supporting pre-registration nursing students to develop resilience-based competencies that enable them to regulate their response to stress and monitor their own wellbeing using mindfulness, reflective discussion and positive reframing. Method: Case study methodology was used to explore how the characteristics associated with the expression and maintenance of resilience have been influenced by the intervention. Data were collected through focus groups at three timepoints with students and at the end of the intervention period with supervision facilitators, and then analysed by pattern matching to theoretical propositions. Findings: Participants expressed positive experiences of resilience-based clinical supervision. Their perception of the importance of self-care increased and their commitment to caring for others was maintained. They continued to demonstrate competencies of self-care six months after qualifying as nurses, despite the complexities of the workplace. As qualified nurses, participants recognised the implications of limited time and resources on the quality of care they were able to provide to patients, but they externalised this as organisational failings as opposed to personal inadequacy, and worked around such constraints where possible to maintain personal standards. Conclusion: Resilience-based clinical supervision has the potential to support healthcare practitioners in developing resilience-based competencies that allow them to recognise and attend to workplace stressors through appropriate and effective alleviation strategies. Implications for practice: There is potential to foster resilience where practitioners and healthcare organisations commit to a sustained investment in strategies that promote reflection and self-car

Effectiveness of Digital Interventions for Deficit-Oriented and Asset-Oriented Psychological Outcomes in the Workplace: A Systematic Review and Narrative Synthesis.

Peer reviewed: TrueBACKGROUND: Digital psychological interventions can target deficit-oriented and asset-oriented psychological outcomes in the workplace. This review examined: (a) the effectiveness of digital interventions for psychological well-being at work, (b) associations with workplace outcomes, and (c) associations between interventions' effectiveness and their theory-base. METHODS: six electronic databases were searched for randomised controlled trials (RCT) and quasi-experimental studies. The methodological quality of studies that used randomisation was conducted with the "Cochrane Collaboration's Risk of Bias" tool, while the "JBI Critical Appraisal Checklist" was used for non-randomised studies. Studies' theory-base was evaluated using an adaptation of the "theory coding scheme" (TSC). Due to heterogeneity, narrative synthesis was performed. RESULTS: 51 studies were included in a synthesis describing four clusters of digital interventions: (a) cognitive behavioural therapy, (b) stress-management interventions and workplace well-being promotion, (c) meditation training and mindfulness-based interventions, and (d) self-help interventions. Studies demonstrated a high risk of contamination effects and high attrition bias. Theory-informed interventions demonstrated greater effectiveness. Cognitive behavioural therapy demonstrated the most robust evidence for reducing depression symptoms among healthy employees. With the exception of the Headspace application, there was weak evidence for meditation training apps, while relaxation training was a key component of effective stress-management interventions

Near-infrared spectroscopy (NIRS) - electroencephalography (EEG) based brain-state dependent electrotherapy (BSDE): A computational approach based on excitation-inhibition balance hypothesis

Stroke is the leading cause of severe chronic disability and the second cause of death worldwide with 15 million new cases and 50 million stroke survivors. The post stroke chronic disability may be ameliorated with early neuro rehabilitation where non-invasive brain stimulation (NIBS) techniques can be used as an adjuvant treatment to hasten the effects. However, the heterogeneity in the lesioned brain will require individualized NIBS intervention where innovative neuroimaging technologies of portable electroencephalography (EEG) and functional-near-infrared spectroscopy (fNIRS) can be leveraged for Brain State Dependent Electrotherapy (BSDE). In this hypothesis and theory article, we propose a computational approach based on excitation-inhibition (E-I) balance hypothesis to objectively quantify the post stroke individual brain state using online fNIRS-EEG joint imaging. One of the key events that occurs following Stroke is the imbalance in local excitation-inhibition (that is the ratio of Glutamate/GABA) which may be targeted with NIBS using a computational pipeline that includes individual forward models to predict current flow patterns through the lesioned brain or brain target region. The current flow will polarize the neurons which can be captured with excitation-inhibition based brain models. Furthermore, E-I balance hypothesis can be used to find the consequences of cellular polarization on neuronal information processing which can then be implicated in changes in function. We first review evidence that shows how this local imbalance between excitation-inhibition leading to functional dysfunction can be restored in targeted sites with NIBS (Motor Cortex, Somatosensory Cortex) resulting in large scale plastic reorganization over the cortex, and probably facilitating recovery of functions. Secondly, we show evidence how BSDE based on inhibition–excitation balance hypothesis may target a specific brain site or network as an adjuvant treatment. Hence, computational neural mass model based integration of neuro stimulation with online neuroimaging systems may provide less ambiguous, robust optimization of NIBS, and its application in neurological conditions and disorders across individual patients