Abstract
ImportancePoor mental health places a burden on individuals and populations. Resilient persons are able to adapt to life’s challenges and maintain high quality of life and function. Finding effective strategies to bolster resilience in individuals and populations is of interest to many stakeholders.ObjectivesTo synthesize the evidence for resiliency training programs in improving mental health and capacity in 1) diverse adult populations and 2) persons with chronic diseases.Data SourcesElectronic databases, clinical trial registries, and bibliographies. We also contacted study authors and field experts.Study SelectionRandomized trials assessing the efficacy of any program intended to enhance resilience in adults and published after 1990. No restrictions were made based on outcome measured or comparator used.Data Extraction and SynthesisReviewers worked independently and in duplicate to extract study characteristics and data. These were confirmed with authors. We conducted a random effects meta-analysis on available data and tested for interaction in planned subgroups.Main OutcomesThe standardized mean difference (SMD) effect of resiliency training programs on 1) resilience/hardiness, 2) quality of life/well-being, 3) self-efficacy/activation, 4) depression, 5) stress, and 6) anxiety.ResultsWe found 25 small trials at moderate to high risk of bias. Interventions varied in format and theoretical approach. Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled SMD 0.37 (95% CI 0.18, 0.57) p = .0002; I2 = 41%] within 3 months of follow up. Improvement in other outcomes was favorable to the interventions and reached statistical significance after removing two studies at high risk of bias. Trauma-induced stress-directed programs significantly improved stress [−0.53 (−1.04, −0.03) p = .03; I2 = 73%] and depression [−0.51 (−0.92, −0.10) p = .04; I2 = 61%].ConclusionsWe found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes. Further study is needed to better define the resilience construct and to design interventions specific to it.Registration NumberPROSPERO #CRD42014007185
Highlights
Rationale Resilience has been defined as the ability of individuals to absorb life’s challenges and to carry on and persevere in the face of adversity. [1] Overlapping extensively with the concept of hardiness, psychological resilience personifies and reflects characteristics of toughness, elasticity, and the ability to recover
Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled standardized mean differences (SMDs) 0.37 p = .0002; I2 = 41%] within 3 months of follow up
We found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes
Summary
Rationale Resilience has been defined as the ability of individuals to absorb life’s challenges and to carry on and persevere in the face of adversity. [1] Overlapping extensively with the concept of hardiness, psychological resilience personifies and reflects characteristics of toughness, elasticity, and the ability to recover. The term has been used in many disciplines and applied to many contexts, a recent concept analysis defined resilience as the ‘‘process of effectively negotiating, adapting to, or managing significant sources of stress or trauma.’’[2]. When conceptualized in this way (i.e. as a response to stress or trauma), it is practically helpful to briefly consider the position resilience holds within a relevant stress model, such as Lazarus’ Transactional Model of Stress and Coping. To the extent this is true, the potential public health impact of identifying and translating a reliable and efficacious method of achieving resilience in people is great
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