Lecture 10: Stress and resilience Flashcards
What has been found about the prevalence of mental disorders?
- major depression seen as second leading cause of disability worldwide while anxiety was ranked as ninth highest
- indicates negative consequences for society
- no decrease in numbers, despite success in understanding mechanisms and developing effective treatments
Why is there a failure to reduce disease prevalence?
- lack of improvement not due to increase in risk factors or greater public awareness of disorders
- instead, probably due to treatments not meeting minimal quality criteria-> quality gap
- no attempts to prevent disorders -> prevention gap
What is the resilience framework to promote mental health?
- based on the idea that many maintain mental health despite exposure to severe psychological or physical adversity
- aim is to understand why some people do not develop stress-related mental dysfunction
- linked to how to prevent the stress-related disorders than treating them at a later stage
- increase in popularity for resilience
What are some issues in resilience research?
- there is a great variety in the way that resilience is defined, operationalized and measured and how they are designed. some view it as a process of adapting well, for others is the ability to bounce back from emotional experiences, or collection of abilities and capacities
- the predictors of resilient outcomes are weak so only explain little variance in mental health populations, combining multiple predictors and the replicability needs to be assessed
- large gap between current resilience theory and how resilience research is conducted
What plays a large role in maintenance or recovery of mental health?
An active dynamic process of adaption to the given stressful circumstances, not passivity or insensitivity to stressors. Evidence includes: altered perspectives on life, new strengths or competences, immunization, epigenetic alterations, changes in neural systems affected by stressor exposure
What is the process nature of resilience?
- argues that it is not a trait or stable personality profile, genotype, so should not be characterised as such
- seen as an outcome of a dynamic process of adaptation to adversity-> ex post facto so following an adverse event
- can only be measured in response to stressful circumstances and not in the absence of adversity
- predispositions and stable traits can make resilient responding to a stressor more likely through activating coping mechanisms or promoting beneficial interactions from the environment
- can lead to an improvement or optimization of skills, capacities or behaviours which depend on personality and nature of the stressor and circumstance before and after the stressor
What are the consequences for study design?
- resilience studies consider resilience as a score on questionnaires which correlate-> implies resilience as stable characteristic or predisposition or that resilient outcomes can be predicted by questionnaires (no single baseline measure can predict this)
- prospective resilience studies should be focussed on, consisting of: baseline assessment of outcome dimension before stressor exposure, and endpoint assessment after stressor exposure
- resilience theory needs to measure mental health function at several time points before and after stressor exposure to identify stable mental health profiles with little disturbances (minimal impact resilience) to profiles of initial dysfunction followed by rapid recovery (emergent resilience)-> careful monitoring needed with little noise
- importance of comparisons between stressor exposure to not stressor exposed, or those with resilient outcomes to non-resilient outcomes to understand the interactions btw these variables
Why does stressor exposure need to be measured and quantified with lots of detail?
As deterioration in someone with massive stressor exposure is a more resilient outcome than moderate functional deterioration with moderate stressor exposure
How can it be critically evaluated that the current operationalization of resilience as a trait is invalid?
By looking at studies that do identify these, and seeing whether these factors do strongly predict mental health after adversity, so resilience could be measured in the absence of adversity
What was the inclusion criteria for the studies selected?
- mental health or psychological functioning was assessed in a quantitative way before the stressor exposure and once after (not pre-existing mental health problems or history of a previous stressor)
- amount or degree or stressor exposure between baseline and follow-up needs to be well-quantified
- stressor exposure had to show a positive relationship to the development of mental health problems
- only adolescents and adults
- group size of at least 30
- match a sample with stressor-related mental health impairments to a control sample without mental health issues
- only report the moderation effects instead of covariates
What was found about post-traumatic symptoms and social support?
Before being in a war zone, the social support (unit cohesion) negatively predicted post-traumatic symptoms, but it did not moderate the effects of stressor exposure on post-traumatic symptoms
What did the results find?
- the resilience predictors identified are very diverse and cannot be used as a marker for resilience-> no empirical support for the idea that resilience is a predisposition
- there can can be multiple separate predisposing factors which each have a small effect on outcomes
- potential resilience factors can be framed as a risk factor by changing their direction-> adds little to vulnerability research
Why is conducting more prospective resilience studies important?
- to better evaluate the predictive value of multiple baseline resilience factors
- to be able to address the processes of adaptation before and after stressor exposure
Limitations of the review
- lack of comprehensive searching and no formal quality assessment
- this approach is only a temporary pragmatic solution to advance research
- do not argue against the search for resilience predictors or markers as long as they do not coincide with resilience itself, and can be useful in clinical decision-making
- the approach they are suggesting is more expensive, time-consuming and life stressors are fairly limited, maladaptive outcomes are low and also with having a generalizable sample
