Toward Understanding Resilient Outcomes

Can J Psychiatry. 2011;56(5):256-257. Resilience, or the ability to maintain or regain mental health despite exposure to significant adversity, has captured the attention of researchers, clinicians, and policymakers in the last decade. Although systematic research on resilience began in the 1970s,1 its conceptualization has evolved from attention solely to personal psychological attributes, to an understanding that environment, in its broadest sense, interacts with genetic endowment and psychological factors to contribute to resilience.2 Consequently, the roles of family, schools, communities, social and health systems, and policies have assumed greater importance in resilience research and interventions. has evolved so rapidly that Norwegian researchers3 commented in 2007 that 85% of publications on this topic had appeared in the last decade. They attributed the growing interest in resilience to be largely motivated by the potential of identifying protective factors and mechanisms essential to prevent the development of psychiatric disorders despite exposure to significant life Stressors. The term resilience was made a Medical Subject Heading term in 2009, greatly facilitating literature searches so that a search of PsycINFO in August 2010 using the search term psychological resilience yielded 3931 papers. The first review article, What Is Resilience? by Professor Helen Herman (from Australia) and colleagues,4 discusses the evolution of definitions of resilience, the various psychological, biological, and environmental factors that contribute to it and recent attempts to measure resilience. The authors delineate some of the gaps in the resilience field that need to be addressed, including a lack of a standardized definition, a generally accepted theory, and some methodological issues. They outline exciting new biological research, including epigenetic (Gene ? Environment) investigations that are beginning to partly explain some of the mechanisms involved when some people exposed to adversity do not develop psychiatric disorders and how a few very fortunate people may even thrive following extreme hardship. They note the emerging view of resilience as resulting from multiple interacting personal and social circumstances and experiences. Finally, they consider the clinical and public health implications. As the factors determining mental health and resilience operate at 2 broad levels: each person's life and development and the socioculturel context; therefore, 2 different types of actions are needed to influence change in both of these. and mental health are promoted, as in all fields of health, through population-based public health measures alongside improved access to evidence-based treatment and prevention in primary and mental health care systems. The second review paper, Resilience Following Child Maltreatment: A Review of Protective Factors by Dr Tracie O Afifi and Professor Harriet L MacMillan,5 is a welcome contribution to the resilience field. The authors selected the 27 highest quality studies published on protective factors following child maltreatment and found that a stable family environment and supportive relationships were consistently linked to resilience. Individual personality traits were also found to be associated with resilience, but not so frequently as family environment and supportive relationships, thereby underscoring the importance of looking not only at individual psychological factors but also the contextual environment in which they are embedded. The authors comment that the subtypes of child maltreatment (physical, sexual, emotional, neglect, and exposure to intimate partner violence) need to be specified more clearly in future research on protective factors. Unlike many reviews on this topic that combine studies, Dr Afifi and Professor MacMillan have separated the longitudinal and cross-sectional studies and then divided them into those extending from childhood and adolescence into early adulthood, and those within childhood and adolescence. …

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