Resilience in chronic diseases: A systematic review

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. Result of review of literature on resilience and chronic disease

Author	Diagnosis	Scales		Study Design	Results
		Resilience	Outcomes		Resilience	Health outcomes
Mangelli et al. (2002)	Rheumatoid Arthritis (American College Rheumatology ACR) (n = 89)	PWB	RADAI, HAQ, HADS	Cross-sectional	PWB < community sample. Inverse bivariate correlations between depression and anxiety and each of the PWB subscales scores, although these correlations were stronger for depression. Inverse correlation between HAQ score and the environmental mastery (PWB subscale)	There were significant bivariate correlations between each of the variables (pain, RADAI and HAQ) and depression or anxiety (Spearman RS range 0.39–0.55, all p < 0.001)
Strauss et al. (2007)	Cancer (n = 208)	RS Scale	MFI, SF-12	Clinical trial (non randomized)	RS had little influence on treatment during RT. RS is a powerful predictor of QoL	MFI showed fatigue level > normal population and at end of radiotherapy (RT) the level was even higher IC (0.46–4.53), p = 0.040
Erim et al. (2010)	Hepatitis (clinical) (n = 81)	SOC	SCL-9-R, F-SOZU, BDI	Cross-sectional	In general the scores for SOC were similar to those of a normal sample M = 4.95, SD = 0.9	Altos escores para depressão e ansiedade principalmente nos pacientes com pouco tempo de diagnóstico
					Negativa correlação entre SOC e depressão, ansiedade e sintomas gerais	BDI (t = 3.32, p = 0.001) HAS (t = 3.06, p = 0.003) HADS (t = 4.08, p = 0.01)
DeNisco (2011)	Diabetes mellitus (clinical) (n = 71)	RS Scale	HAbA1c	Cross-sectional	Significant negative correlation between HbA1c level and RS scores, r = −.270 e p = 0.023. RS may influence glycemic control in this sample
					Income was significantly correlated with RS, lower income reporting low RS. Duration of illness and diet played no significant role in RS scores	One third of the sample identified themselves as disabled (n = 24, 33.8%)
					Regular exercises had higher RS score, but no significant	The HbA1c levels ranged from a low of 4.9 to a high of 13.2. The mean HbA1c level was 7.2%, the median was 6.7%, and the SD was 1.6
Wingo et al. (2010)	Depression (n = 792)	CDRISC	CTQ, BDI	Cross-sectional	Severity of depression inversely related to RS (β = −0.5 p < 0.0001). Increase of 5 points on the CDRISC (range 0–40) was associated with a decrease of 2.5 points on the CDRISC	48% of the participants had no depression (BDI ≤ 9), 22% had mild depression (9 < BDI ≤ 18), and 30% had moderate or severe depression (BDI ≥ 19)
					Childhood abuse and trauma exposure contributed to depressive symptom severity while resilience mitigated it	In the moderate/severe range, 62% had experienced no abuse, 20% had one type of sexual, physical, or emotional abuse, 8% had two types of abuse, and 9% had three types of abuse
Brionez et al. (2010)	Ankylosing spondylitis (ACR) (n = 294)	BRCS	BASDAI- AS, VPMI, PHQ-9, AHI	Cross-sectional	Resilience coping (p = 0.203) fell short of significance	Psychological variables contributed to the variance in BASDAI (additional 33%)
						Higher helplessness (p < 0.001) and depression (p < 0.001) were significantly associated with higher BASDAI score
Ponarovsky et al. (2011)	Skin disorders (clinical) (n = 112)	SOC	MINI, HAS, HDS	Cross-sectional	Negative correlations between scores on the SOCs and scores on the HAS (p < 0.01) and HDRS (p < 0.01). High SOCS scores may protect against the development of psychiatric illness	Rates of anxiety and depression were higher than in the general population. This difference was notable in patients with allergic skin diseases, reaching 58.3 and 48.3%, compared with 15.4 and 23.1% for participants with non-allergic conditions
Robottom et al. (2012)	Parkinson’s disease (n = 83)	RS-15	OARS, SF-12, BRI-18, AES, FSS LOT-R, RSE, LOC, UPDRS, MMSE, HY	Cross-sectional	>RS correlated with less disability and better physical and mental QOL (p = 0.006). <RS was correlated with decreased psychiatric symptom burden, less depression (p < 0.001), less anxiety (p = 0.002), less somatization (p = 0.002). >RS correlated with less total apathy (p < 0.001), and with less fatigue (p < 0.001)	Average disease duration was 6.8 (\xFE/5.4) years. The average T-UPDRS was 39.2 (\xFE/18.9) and average Hoehn and Yahr stage was 2.3 (\xFE/0.9)
Holden et al. (2012)	Depression (n = 63)	CDRISC	BDI, ATQ, RSES, RAS, The Stressful Life Events Scale, SS-A SWBS, DSS:12	Cross-sectional	Depressive symptoms were significant and negatively associated with resiliency (r = −0.48, p < 0.01) and spiritual well-being [r = −.47, p < 0.01)	Depressive symptoms were significant and positively associated with negative and ruminative thinking (r = 0.79, p < 0.01), low self-esteem (r = 0.58, p < 0.01), stressful life events (r = 0.43, p < 0.05), low social support (r = 0.46, p < 0.01), depression stigma (r = 0.36, p < 0.01), and indication of chronic diseases (r = 0.34, p < 0.01)
Cal and Santiago (2013)	Lupus (ACR) (n = 45)	RS	MINI-PLUS	Cross-sectional	Patients with risk of suicide had lower	53% of patients had depressive disorder (n = 24). 35% (n = 16) presented risk of suicide, of whom 9 (17%) low risk, 1 (2%) moderate risk, and 6 (13%) high risk
					RS scores. Patients <35 years had <RS scores. Means of RS 136.1 ± 13.704 in a range of 104–163, with 8.9% with low RS, 70% medium RS, 20% high RS
Ma et al. (2013)	Chronic kidney disease (CKD) (n = 150)	RS Scale	CDF, GFR calculation	Cross- sectional	A significant positive correlation was found between health promoting behavior and resilience in all study subjects. RS between groups was influenced by educational level (x^2 = 7.714, p < 0.05), occupation (x^2 = 6.818, p < 0.05) and presence or absence of diabetes (x^2 = 16.617, p < 0.001). Pre-ESRD (end stage renal disease) group had lower resilience than either high-risk or early CKD groups	Out of a total of 150 participants, 26.6% (n = 40) were high-risk group subjects. The pre-ESRD group included 40% (n = 60) participants, and 33.3% (n = 50) participants in the early CKD group. Most were married, unemployed, and had diabetes
Min et al. (2013)	Cancer (n = 152)	CDRISC	HADS, FSSQ	Cross-sectional	RS levels were negatively associated with emotional distress p < 0.001 In patients with metastatic cancer, RS was a significant protective factor for emotional distress (adjusted OR = 0.14, 95% CI = 0.02–0.79, p = 0.02)	83 (54.6%) were considered as having “emotional distress”. FSSQ score was significantly lower in distressed cancer patients than those in their non-distressed

Notes: ACR is the American College Reumatology, PWB is the Ryff’s six subscale model to evaluate psychological well-being, RADAI is the Rheumatoid Arthristis Disease Activity Index, HAQ-Health Assessment Questionnaire, HADS is the Hospital Anxiety and Depression Scale, RS is the Wagnild and Young’s Resilience Scale, MFI is the Multidimensional Fatigue Inventory, SF-12 is the Medical Outcomes Study Short Form 12, SCL-9-R is the Symptom Check List, F-SOZU is the Social Support Questionnaire, SOC is the Sense of Coherence, BDI is the Beck Depression Inventory, HAbA1c is the Glycosylated hemoglobin level, CDRISC is the Connor Davidson Resilience Scale, CTQ is the Childhood Trauma Questionnaire, Traumatic Events Inventory is the 10 items, BASDAI is the AS Disease Activity Index, VPMI is the Vanderbilt Pain Management Inventory, PHQ-9 is the Patient Health Questionnaire, BRCS is the Brief Resilient Coping Scale, AHI is the Arthritis Helplessness Index, MINI is the Mini International Europsychiatric, Interview, HAS is the Hamilton Anxiety Scale, HDS is the Hamilton Depression Rating Scale, ATQ is the Automatic Thoughts Questionnaire, RSES is the Rosenberg Self-Esteem Scale, RAS is the Relationship Assessment Scale, The Stressful Life Events Scale, SS-A is the Social Support Appraisals Scale, SWBS is the Spiritual Well-Being Scale, DSS:12 is the Depression Stigma Scale, RS-15 is the Resilience Scale OARS is the Older American Resource and Services Scale, BRI-18 is the Brief Symptom Inventory, AES is the Apathy Evaluation Scale, FSS is the Fatigue Severity Scale, LOT-R is the Life Orientation Test, LOC is the Multidimensional Health Locus of Control, UPDRS is the Unified Parkinson’s Disease Rating Scale, MMSE is the Mini-Mental State Examination, HY is the Hoehn and Yahr, MINI-PLUS is the Mini International Neuropsychiatric Interview, CDF is the Health to Promote Lifestyle Scale, GFR calculation, FSSQ is the Duke-University of North Carolina Functional Social Support Questionnaire, T-UPDRS is the measures of disease severity.

*Mangelli, L., Gribbin, N., Buchi, S., Allard, S., & Sensky, T. (2002). Psychological well-being in rheumatoid arthritis: Relationship to “disease” variables and affective disturbance. Psychotherapy and Psychosomatics, 71, 112–116.10.1159/000049354

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*Erim, Y., Tagay, S., Beckmann, M., Bein, S., Cicinnati, V., Beckebaum, S., … Schalaak, J. F. (2010). Depression and protective factors of mental health in people with hepatitis C: A questionnaire survey. International Journal of Nursing Studies, 47, 342–349.

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*DeNisco, S. (2011). Exploring the relationship between resilience and diabetes outcomes in African Americans. Journal of the American Academy of Nurse Practitioners, 23, 602–610.10.1111/jaan.2011.23.issue-11

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*Wingo, A. P., Wrenn, G., Pelletier, T., Gutman, A. R., Bradley, B., & Ressler, K. J. (2010). Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. Journal of Affective Disorders, 126, 411–414.10.1016/j.jad.2010.04.009

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*Brionez, T. F., Assassi, S., Reveille, J. D., Green, C., Learch, T., Diekman, L., … Nicassio, P. (2010). Psychological correlates of self-reported disease activity in ankylosing spondylitis. The Journal of Rheumatology, 37, 829–834.10.3899/jrheum.090476

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*Robottom, B. J., Gruber-Baldini, A. L., Anderson, K. E., Reich, S. G., Fishman, P. S., Weiner, W. J., & Shulman, L. M. (2012). What determines resilience in patients with Parkinson’s disease? Parkinsonism & Related Disorders, 18, 174–177.10.1016/j.parkreldis.2011.09.021

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