Perspectives on Self-Reported Resilience - Cross-Sectional, Longitudinal and Meta-Analytical Considerations

Resilience may describe a personality trait, an outcome - meaning the absence of psychopathological symptoms - or an active process of adaption. The current thesis comprises five studies concerning trait-resilience and other resilience-related, health-benefitting factors including sense of coherence (SOC), the key component of the salutogenesis framework. Study 1 investigated the relationship between SOC and posttraumatic stress symptoms using meta-analytical methods. Findings based on predominantly cross-sectional studies demonstrated a robust relationship between SOC and psychopathological symptoms, M(r) = -.41, indicating that a stronger SOC is related to less severe symptoms. Two field studies (Studies 2 and 3) assessed this relationship in occupations at risk for trauma and investigated the potential overlap between different health-benefitting concepts. Both studies identified SOC as the most important correlate of psychopathological symptoms, whereas other concepts (i.e., trait-resilience and locus of control) were less important. Study 4 used a longitudinal design and found that higher pre-treatment SOC levels were predictive of better treatment outcomes. A comprehensive meta-analytical project (Study 5) investigated the bivariate relationships between different health-benefitting factors and posttraumatic stress symptoms. SOC was identified as the most important correlate, while other health-benefitting factors (i.e., trait-resilience/hardiness, locus of control/sense of mastery, self-efficacy, dispositional optimism, and openness to experience) did not show incremental validity beyond SOC using meta-analytical regression models. Thus, the results of the current thesis underline the importance of SOC as a correlate of psychopathological symptoms as well as the strong need for longitudinal research allowing for an empirical test of the salutogenesis model.Resilienz kann sowohl als Persönlichkeitsmerkmal, als Ergebnis – im Sinne der Abwesenheit von Symptomen – als auch als aktiver Prozess verstanden werden. Die vorliegende Dissertation umfasst fünf Studien, die sich mit Resilienz als Persönlichkeitsmerkmal und konkurrierenden Konstrukten befassen, wie etwa Kohärenzerleben (sense of coherence, SOC) als Kernelement des Salutogenese-Ansatzes. Studie 1 untersuchte den Zusammenhang zwischen SOC und Symptomen posttraumatischer Belastung metaanalytisch. Die Ergebnisse zeigen, dass SOC in den überwiegend querschnittlichen Studien ein robustes Korrelat der Symptombelastung darstellt, M(r) = -.41. Ein höheres SOC ist mit einer geringeren Symptombelastung verbunden. Zwei Feldstudien (Studien 2 und 3) untersuchten diesen Zusammenhang in Risiko-Berufsgruppen sowie Schnittmengen mit konkurrierenden Konstrukten. Beide Studien identifizierten SOC als zentrales Korrelat psychopathologischer Belastung, konkurrierende Konstrukte haben nur eine untergeordnete Bedeutung. Studie 4 nutzte einen längsschnittlichen Ansatz und konnte zeigen, dass Patienten mit höherem SOC zu Beginn der Behandlung stärker von einer fünf- bis sechswöchigen stationären Rehabilitationsmaßnahme profitieren. Eine umfassende Metaanalyse (Studie 5) untersuchte schließlich den Zusammenhang verschiedener Resilienz-assoziierter Konstrukte mit posttraumatischer Belastung. Erneut erwies sich SOC als zentrales Belastungskorrelat. Alle übrigen Resilienz-assoziierten Konstrukte (Resilienz als Persönlichkeitsmerkmal/Hardiness, Kontroll-überzeugungen/Sense of Mastery, Selbstwirksamkeit, dispositionaler Optimismus und Offenheit für Erfahrungen) wiesen signifikant geringere Zusammenhänge auf und hatten in einem metaanalytischen Regressionsmodell keine inkrementelle Validität gegenüber SOC. Diese Ergebnisse unterstreichen die Bedeutung von SOC, jedoch auch die Relevanz von Längsschnittstudien, die das Salutogenese-Modell als solches einer empirischen Prüfung zugänglich machen

The Relationship between Dog Ownership, Psychopathological Symptoms and Health-Benefitting Factors in Occupations at Risk for Traumatization

Individuals working in high-risk occupations (e.g., emergency staff) are exposed to high levels of occupational stress including traumatic events. Correspondingly, several studies report high rates of mental health problems among these occupations. Pet ownership has been associated with better mental health. However, to date a study on the association between pet ownership and indicators of mental health in these occupations is missing. The present cross-sectional survey (N = 580) investigated pet ownership, attachment to pets, health-benefitting factors (i.e., sense of coherence, trait-resilience, locus of control) and psychopathological symptoms (i.e., general mental health problems, posttraumatic stress, burnout) in medical staff, police officers, and firefighters. Dog owners and non-dog owners showed comparable levels of psychopathological distress and health-benefitting factors. Compared to cat owners, dog owners demonstrated stronger emotional attachment to their pet. Moreover, a stronger attachment was also linked to higher levels of psychopathological symptoms and lower levels of health-benefitting factors. However, the relationship between attachment to pets and health-benefitting factors could be explained by their overlap with psychopathological symptom levels. Overall, our findings are not in line with the notion that pet ownership generally has a health-benefitting effect. Future studies need to investigate circumstances that modulate positive effects of pet ownership

The relationship between attachment to pets and mental health : the shared link via attachment to humans

Background: Several studies have investigated the relationship between emotional attachment to pets and mental health with the majority of studies fnding a negative relationship between emotional attachment to pets and mental health. Interestingly, attachment to pets difers from attachment to humans with studies showing that humans with an insecure attachment style form a particularly strong emotional attachment to their companion animals. Human attachment style is also related to mental health with secure attachment being associated with superior mental health. Building on those fndings, the current study aimed at exploring the role of attachment to humans in the relationship between emotional attachment to pets and mental health. Methods: In this cross-sectional online survey (N=610) we assessed the strength of emotional attachment to pets and attachment to humans. We further collected pet specifc data as well as mental health burden in a sample of German dog owners (Mage=33.12; 92.79% women). We used a mediation model estimating the indirect link between emotional attachment to pets and mental health burden via human attachment and the direct link between emo‑ tional attachment to pets and mental health burden simultaneously. Results: We found that attachment to humans fully mediated the positive association between emotional attach‑ ment to pets and mental health burden. A stronger emotional attachment to one’s dog was associated with lower comfort with depending on or trusting in others, whereby lower comfort with depending on or trusting in others was related to higher mental health burden. Moreover, a stronger attachment to one’s dog was also related to a greater fear of being rejected and unloved (Anxiety), which was, in turn, associated with a higher mental health burden. Conclusion: Our fndings suggest that the positive link between emotional attachment to pets and mental health burden is fully accounted for by its shared variance with insecure attachment to humans in a sample mostly compris‑ ing self-identifed women. Future studies need to examine whether strong emotional bonds with pets may evolve as a compensatory strategy to bufer difcult childhood bonding experiences

The relationship between childhood gender nonconformity, aversive childhood experiences, and mental health in heterosexual and non-heterosexual cisgender men: The buffering effect of sense of coherence

Childhood gender nonconformity (CGNC) seems to be associated with more mental health problems in adulthood. Previous research has suggested that this link might be mediated via the increased risk for aversive childhood experiences (ACEs) as a negative social reaction to CGNC. However, no study yet examined the role of resilience factors in this relationship. The present study aims to address this gap by examining the potential buffering effect of sense of coherence (SOC). In a German sample of 371 cisgender men, we used mediation models to investigate the relationship between CGNC, ACEs, and mental health problems in adulthood, that is, depressive symptoms, loneliness, and suicidal behavior. We then employed moderated mediation models to examine the buffering effect of SOC on the association ACEs and mental health problems. The results showed that higher levels of CGNC were associated with more severe adult mental health problems, with this link being partially mediated by higher levels of ACEs. For depressive symptoms and suicidal behavior in the last 12 months, we found evidence of a buffering effect of SOC. Higher levels of SOC were associated with a weaker association between ACEs and mental health problems. In contrast, this effect was absent for loneliness and lifetime suicidal behavior. Our study provides evidence that ACEs partly account for the relationship between CGNC and mental health in adulthood. Moreover, we found support for SOC having a buffering effect on this link. Future studies need to examine whether SOC might be an important target for resilience training in those experiencing CGNC. However, sustainable interventions may rather address the negative social reactions to CGNC

Correlates of mental health in occupations at risk for traumatization : a cross-sectional study

Background Hospitals, police stations, and fire departments are highly demanding workplaces. Staff members are regularly exposed to various stressors including traumatic events. Correspondingly, several studies report high rates of mental health issues among these occupations. Nevertheless, despite these challenging circumstances, some staff members manage to sustain their mental health. The current study is the first to investigate three health-promoting factors simultaneously among three different, highly demanding occupations. Methods The present cross-sectional survey investigated health-promoting factors (sense of coherence – SOC, trait-resilience, locus of control – LOC) and mental health outcomes (general psychopathological symptom burden, posttraumatic stress, burnout) in medical staff (n = 223), police officers (n = 257), and firefighters (n = 100). Results Among all occupations, SOC, trait-resilience, and an internal LOC were negatively associated with general psychopathological symptoms, posttraumatic stress, and burnout symptoms. By contrast, all these outcome measures were positively correlated with an external LOC. Multiple regression models including all health-promoting factors explained 56% of the variance in general psychopathological symptoms and 27% in posttraumatic stress symptoms. Among all occupations, SOC was the strongest predictor of both general psychopathological symptom burden and posttraumatic stress symptoms. Multigroup path analyses revealed minor differences across occupations, mainly driven by a stronger influence of LOC in police officers. Conclusion Across all occupations, SOC was identified as the most important health-promoting factor. Future longitudinal studies should further examine the causal link between health-promoting factors and mental distress in different workplaces. Such studies will also allow for further development and evaluation of resilience promoting programs

Pre-rehabilitation sense of coherence as a predictor of symptom change after rehabilitation

Sense of coherence (SOC) constitutes the key component of salutogenesis theory. It reflects individuals' confidence that their environment is comprehensible and manageable and that their lives are meaningful. Research demonstrates a strong cross-sectional relationship between SOC and mental health. However, little is known about SOC's temporal stability and its potential to predict changes in psychopathological symptom severity in different settings. The goal of the current study was to address this gap. The sample of the two-wave longitudinal study consists of 294 patients receiving inpatient psychotherapeutic (and psychopharmacological) treatment for various psychological disorders at a German psychosomatic rehabilitation clinic. SOC (Antonovsky, Social Science & Medicine, 1993, 36, 725-733) and outcome measures (i.e., general mental health problems, depression and anxiety symptoms) were assessed within two days of arrival and at the end of rehabilitation (week 5/6). SOC was significantly enhanced after treatment whereas psychopathological symptoms were significantly reduced. Regression analyses revealed that pre-treatment SOC was a significant negative predictor of post-treatment symptom severity for all outcome measures even after controlling for pre-treatment symptoms. The current findings provide first evidence that SOC is a significant unique predictor of symptom change. Future studies need to further investigate longitudinal associations between SOC and mental health outcomes in different settings

Design and validation of a German version of the GSRS-IBS - an analysis of its psychometric quality and factorial structure

Background: Currently, a suitable questionnaire in German language is not available to monitor the progression and evaluate the severity of irritable bowel syndrome (IBS). Therefore, this study aimed to translate the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) into German and to evaluate its psychometric qualities and factorial structure. Methods: This study is based on a total sample of 372 participants [62.6% female, mean age = 41 years (SD = 17 years)]. 17.5% of the participants had a diagnosis of IBS, 19.9% were receiving treatment for chronic inflammatory bowel disease, 12.1% of the participants were recruited from a psychosomatic clinic, and 50.5% belonged to a control group. All participants completed the German version of GSRS-IBS (called Reizdarm-Fragebogen, RDF), as well as the Gießen Subjective Complaints List (GBB-24) and the Hospital Anxiety and Depression Scale - German version (HADS-D). Results: The internal consistency of the RDF total scale was at least satisfactory in all subsamples (Cronbach’s Alpha between .77 and .92), and for all subscales (Cronbach’s Alpha between .79 and .91). The item difficulties (between .25 and .73) and the item-total correlations (between .48 and .83) were equally satisfactory. Principal axis analysis revealed a four-factorial structure of the RDF items, which mainly resembled the structure of the English original. Convergent validity was established based on substantial and significant correlations with the stomach-complaint scale of the GBB-24 (r = .71; p < .01) and the anxiety (r = .42; p < .01) and depression scales (r = .43; p < .01) of the HADS-D. Conclusion: The German version of the GSRS-IBS RDF proves to be an effective, reliable, and valid questionnaire for the assessment of symptom severity in IBS, which can be used in clinical practice as well as in clinical studies

Identification of an ADAMTS2 frameshift variant in a cat family with Ehlers-Danlos syndrome.

We investigated four European domestic shorthair kittens with skin lesions consistent with the dermatosparaxis type of the Ehlers-Danlos syndrome (EDS), a connective tissue disorder. The kittens were sired by the same tomcat, but were born by three different mothers. The kittens had easily torn skin resulting in non-healing skin wounds. Both clinically and histologically, the skin showed thin epidermis in addition to inflammatory changes. Changes in collagen fibers were visible in electron micrographs. The complete genome of an affected kitten was sequenced. A one base pair duplication leading to a frameshift in the candidate gene ADAMTS2 was identified, p.(Ser235fs*3). All four affected cats carried the frameshift duplication in a homozygous state. Genotypes at this variant showed perfect co-segregation with the autosomal recessive EDS phenotype in the available family. The mutant allele did not occur in 48 unrelated control cats. ADAMTS2 loss-of-function variants cause autosomal recessive forms of EDS in humans, mice, dogs, cattle and sheep. The available evidence from our investigation together with the functional knowledge on ADAMTS2 in other species allow to classify the identified ADAMTS2 variant as pathogenic and most likely causative variant for the observed EDS

Interrelations of resilience factors and their incremental impact for mental health: insights from network modeling using a prospective study across seven timepoints

Resilience can be viewed as trajectory of stable good mental health or the quick recovery of mental health during or after stressor exposure. Resilience factors (RFs) are psychological resources that buffer the potentially negative effects of stress on mental health. A problem of resilience research is the large number of conceptually overlapping RFs complicating their understanding. The current study sheds light on the interrelations of RFs in the face of the COVID-19 pandemic as a use case for major disruptions. The non-preregistered prospective study assessed a sample of 1275 German-speaking people from February 2020 to March 2021 at seven timepoints. We measured coping, hardiness, control beliefs, optimism, self-efficacy, sense of coherence (SOC), sense of mastery, social support and dispositional resilience as RFs in February 2020, and mental health (i.e., psychopathological symptoms, COVID-19-related rumination, stress-related growth) at all timepoints. Analyses used partial correlation network models and latent growth mixture modeling (LGMM). Pre-pandemic RFs were strongly interrelated, with SOC being the most central node. The strongest associations emerged between coping using emotional support and social support, SOC and sense of mastery, and dispositional resilience and self-efficacy. SOC and active coping were negatively linked. When we examined RFs as predictors of mental health trajectories, SOC was the strongest predictor of psychopathological symptoms and rumination, while trajectories of stress-related growth were predicted by optimism. Subsequent network analyses, including individual intercepts and slopes from LGMM, showed that RFs had small to moderate associations with intercepts but were unrelated to slopes. Our findings provide evidence for SOC playing an important role in mental distress and suggest further examining SOC’s incremental validity. However, our results also propose that RFs might be more important for stable levels of mental health than for adaptation processes over time. The differential associations for negative and positive outcomes support the use of multidimensional outcomes in resilience research

Therapy Dogs as a Crisis Intervention After Traumatic Events? – An Experimental Study

Animal-assisted therapy has been proposed as a treatment adjunct for traumatized patients. In animal-assisted crisis response, dogs are used directly after a traumatic event to reduce stress and anxiety. However, to date there are few controlled studies investigating the effects of therapy dogs on PTSD symptoms and to our knowledge there is no study investigating the effects of a therapy dog intervention directly after a traumatic event. In this study, 60 healthy female participants were randomly assigned to one of three groups: after exposure to a “traumatic” film clip (trauma-film paradigm), one group of participants interacted with a friendly dog for 15 min, another group of participants watched a film clip showing a person interacting with a friendly dog and the last group was instructed to relax. Participants who had interacted with the dog after the film reported lower anxiety levels, less negative affect, and more positive affect after the intervention as compared to the other two groups. However, the participants who interacted with the dog showed a smaller decrease in physiological arousal after the traumatic film clip compared to both other groups. There were no differences in intrusion symptoms between the three groups. Our results show that dogs are able to lessen subjectively experienced stress and anxiety after a “traumatic” stress situation