COGNITIVE HABITS LINKED TO RESILIENCE: SURPRISING COMMONALITIES ACROSS THE UNITED STATES

Abstract

Background: Research has documented many geographic inequities in health. Research has also documented that the way one thinks about health and quality of life (QOL) affects one’s experience of health, treatment, and one’s ability to cope with health problems. Purpose: We examined United-States (US) regional differences in QOL appraisal (i.e., the way one thinks about health and QOL), and whether resilience-appraisal relationships varied by region. Methods: Secondary analysis of 3,955 chronic-disease patients and caregivers assessed QOL appraisal via the QOL Appraisal Profile-v2 and resilience via the Centers for Disease Control Healthy Days Core Module. Covariates included individual-level and aggregate-level socioeconomic status (SES) characteristics. Zone improvement plan (ZIP) code was linked to publicly available indicators of income inequality, poverty, wealth, population density, and rurality. Multivariate and hierarchical residual modeling tested study hypotheses that there are regional differences in QOL appraisal and in the relationship between resilience and appraisal. Results: After sociodemographic adjustment, QOL appraisal patterns and the appraisal-resilience connection were virtually the same across regions. For resilience, sociodemographic variables explained 26 % of the variance; appraisal processes, an additional 17 %; and region and its interaction terms, just an additional 0.1 %. Conclusion: The study findings underscore a geographic universality across the contiguous US in how people think about QOL, and in the relationship between appraisal and resilience. Despite the recent prominence of divisive rhetoric suggesting vast regional differences in values, priorities, and experiences, our findings support the commonality of ways of thinking and responding to life challenges. These findings support the wide applicability of cognitive-based interventions to boost resilience. Abbreviations: MANOVA = Multivariate Analysis of Variance; PCA = principal components analysis; QOL = quality of life; SES = socioeconomic status; US = United States; ZIP = Zone Improvement Plan (postal code)