Having a purpose in life and possessing a sense of mastery over life events
appear to be associated with resilience and the ability to "bounce
back" after a traumatic
Credit: istockphoto/©Benjamin Goode
But assaultive traumas—such as being raped, beaten, or
kicked—and a higher exposure to multiple traumatic events appear to
render an individual less resilient than he or she might otherwise be.
Those were two findings from a unique study looking at psychosocial factors
associated with resilience and recovery in a high-risk sample of African
Americans in a primary care setting. The report appears in the December 2008
American Journal of Psychiatry.
Lead investigators Tanya Alim, M.D., and Adriana Feder, M.D., told
Psychiatric News that the cross-sectional study does not establish a
causal relationship between psychosocial factors and resilience, but lays the
groundwork for a longitudinal study looking at strategies to prevent traumatic
reactions or increase resilience for people who have suffered trauma.
"It may be that having a higher purpose in life is protective
[against the effects trauma], or it may be that for people who experience
trauma regaining a sense of purpose is conducive to recovery," Feder
said in an interview.
Also associated with resilience was a higher frequency of attendance at
religious services, optimism, and a sense of mastery, the researchers
"Most of what we know about traumatized individuals come from
treatment studies," Feder added. "What is unique about this study
is that it focused on a general medical population with low rates of
psychiatric treatment, a setting in which we were more likely to find
Alim added that the findings may be especially important for clinicians
working in primary care settings, where African Americans are more likely to
seek treatment for trauma. "A lot of these factors are going to be
picked up in the primary care setting," she said.
Alim is an assistant professor of psychiatry and behavioral sciences and
director of the mental health clinic at Howard University. Feder is an
assistant professor of psychiatry at Mt. Sinai School of Medicine in New
In the study, researchers evaluated patients for past traumatic experiences
at four primary care offices at Howard University in Washington, D.C. All
patients who identified at least one significant traumatic event meeting
criterion A1 for PTSD in DSM-IV were invited to participate in a
face-to-face assessment of lifetime psychiatric disorders.
After exclusion of patients with bipolar or psychotic disorders, the final
sample had 259 patients. These were divided into three groups: 47 patients who
had never experienced psychiatric disorder (defined as the"
resilient" group); 85 patients who had recovered from at least
one disorder and did not currently have a psychiatric disorder; and 127
patients who had a psychiatric disorder.
Posttraumatic stress disorder was the most common past disorder for the
recovered group and the most common current diagnosis for the currently ill
group. But substance abuse disorders—including alcohol abuse, alcohol
dependence, substance abuse, and substance dependence—were more common
in the past of recovered patients.
Being female was predictive of being in the currently ill group: of the 127
in the currently ill group, 95 were women. There was a significantly lower
lifetime trauma "load"—the number and frequency of traumas
experienced over a lifetime—among those in the resilient group.
Assaultive traumas, including being physically or sexually assaulted,
assaulted with a weapon, or held in captivity, were more common among both the
recovered and currently ill groups.
Interestingly, trauma load did not significantly differ between the
recovered and currently ill groups, suggesting that other factors are
important in recovery.
Also of note is the fact that the only factor that possibly differentiated
the resilient from the recovered group was higher posttraumatic"
growth," with higher growth being reported in the recovered
"A person might say, 'After I was assaulted, I actually got closer to
people, and I realized I was strong,'" Feder said. "Psychological
growth after trauma was marginally more predictive of recovery, suggesting
that people in that group had to struggle [to achieve recovery]."
The absence of other significant differences in psychological factors
associated with resilient or recovered status suggests that some of the same
mechanisms that protect individuals from developing psychiatric disorders are
likely also involved in recovery, the researchers stated.
In an editorial accompanying the report, American Journal of
Psychiatry Editor in Chief Robert Freedman, M.D., noted the importance of
the findings for understanding possible preventive strategies. "Sadly,
physical assault seems to crush the ability of women to achieve purpose and
mastery," he wrote. "However, the African-American women in the
study who showed resilience seemed to benefit from increased attendance at
religious services, which has traditionally been a strong social support for
many groups. Optimism and emotional expression also supported resilience.
"Many of these coping factors were positively correlated and may be
an expression of a single underlying character strength."
Feder and Alim and colleagues concluded, "It is our hope that further
research on psychological factors identified by this and other studies will
ultimately lead to the development of new types of preventive and treatment
interventions. Further studies need to identify which psychosocial factors are
consistently associated with resilience and determine to what extent these
factors may be modifiable through clinical intervention."
"Trauma, Resilience, and Recovery in a High-Risk
African-American Population" is posted at<http://ajp.psychiatryonline.org/cgi/content/full/165/12/1566>.▪