Resilience after Childhood Maltreatment: The Establishment of a Resilience Network Model and the Investigation of Its Fluctuations over Time
Lead Research Organisation:
University of Cambridge
Department Name: Psychiatry
Abstract
Resilience after Childhood Adversity:
The Establishment of a Resilience Network Model
PhD Candidate: Jessica Fritz MSc
Primary Supervisor: Dr. Paul O. Wilkinson
Associate Supervisor: Dr. Anne-Laura van Harmelen
Facing adversities in childhood is a serious environmental hazard with deleterious mental consequences over the subsequent lifecourse (Gilbert et al., 2009; Kessler, Davis, & Kendler, 1997). Up to 53.4% of the population suffers from at least one type of childhood adversities (CA; US National Comorbidity Replication Survey; Greif Green et al., 2010). Many studies have shown that CAs are highly associated with the development of psychopathology (e.g. Dunn et al., 2011; Greif Green et al., 2010; Heim, Shugart, Craighead, & Nemeroff, 2010; Hovens, Giltay, Spinhoven, van Hemert, & Penninx, 2015; Kessler et al., 1997; McLaughlin, Greif Green, Gruber, Berglund, et al., 2010; McLaughlin, Greif Green, Gruber, Sampson, et al., 2010; Scott, McLaughlin, Smith, & Ellis, 2012; Spinhoven et al., 2010). Yet, a strong network of interrelated resilience promoting factors (e.g. friendship support, impulse control, positive future orientation, daily life skills: Afifi & MacMillan, 2011; Kinard, 1998; Schultze-Lutter, Schimmelmann, & Schmidt, 2016) could potentially support mental health in these individuals.
Resilience can be described as beneficial adaptation following exposure to adverse experiences (Curtis & Cicchetti, 2007; Kalisch, Muller, & Tuscher, 2016; van der Werff, van den Berg, Pannekoek, Elzinga, & van der Wee, 2013; Zolkoski & Bullock, 2012) and should not be understood as exclusive capacity but as a concept of multiple resilience promoting factors (Afifi & MacMillan, 2011; Kinard, 1998; Schultze-Lutter et al., 2016). To date, resilience promoting factors have been studied on social (e.g. family support, social connectedness), behavioural (e.g. daily living skills, impulse control), cognitive (e.g. locus of control, future orientation) and emotional (e.g. low neuroticism, low self-blame) domains (e.g. Afifi & MacMillan, 2011; Aslan, in press; Curtis & Cicchetti, 2007; Dang, 2015; Folger & Wright, 2013; Holmes, Yoon, Voith, Kobulsky, & Steigerwald, 2015; Masten et al., 1999; Schultze-Lutter et al., 2016; van Harmelen et al., 2015; Williams & Nelson-Gardell, 2012). Importantly, resilience promoting factors do not function in isolation, rather, they have strong interrelationships (Afifi & MacMillan, 2011; Rutter, 1985). For instance, an individual with better self-regulation may be better company to be around and therefore may evoke better social support from others. To the best of our knowledge, no research has yet investigated the interconnectedness of these factors. I shall use cutting edge network analysis techniques (see Figure 1), to find the best fitting resilience network model which conceptualizes the interconnectedness of resilience promoting factors (Borsboom, & Cramer, 2010; Borsboom, Cramer, Schmittmann, Epskamp, & Waldorp, 2011; Costantini et al., 2015; Cramer et al., 2012; Cramer & Waldorp, 2010; Epskamp, Cramer, Waldorp, Schmittmann, & Borsboom, 2011; Freeman, 1978; Fried, Epskamp, Nesse, Tuerlinckx, & Borsboom, 2015; van Borkulo, Waldorp, Boschloo, Schoevers, & Borsboom, 2015).
I propose five projects for my PhD: Firstly, I shall establish the network structure of resilience factors in the general population. Next, I will validate the proposed network model of resilience factors, through establishing accuracy, stability, as well as external and predictive validity. Third, I intend to examine the network structure of resilience in individuals with a history of CA and to compare it to the resilience network of the general population. Moreover, I shall prospectively investigate whether resilience network structures are stable over time during the course of adolescence, to discover potential resilience network fluctuations. Finally, I aim to disentangle, whether resilience network fluctuations differ between
The Establishment of a Resilience Network Model
PhD Candidate: Jessica Fritz MSc
Primary Supervisor: Dr. Paul O. Wilkinson
Associate Supervisor: Dr. Anne-Laura van Harmelen
Facing adversities in childhood is a serious environmental hazard with deleterious mental consequences over the subsequent lifecourse (Gilbert et al., 2009; Kessler, Davis, & Kendler, 1997). Up to 53.4% of the population suffers from at least one type of childhood adversities (CA; US National Comorbidity Replication Survey; Greif Green et al., 2010). Many studies have shown that CAs are highly associated with the development of psychopathology (e.g. Dunn et al., 2011; Greif Green et al., 2010; Heim, Shugart, Craighead, & Nemeroff, 2010; Hovens, Giltay, Spinhoven, van Hemert, & Penninx, 2015; Kessler et al., 1997; McLaughlin, Greif Green, Gruber, Berglund, et al., 2010; McLaughlin, Greif Green, Gruber, Sampson, et al., 2010; Scott, McLaughlin, Smith, & Ellis, 2012; Spinhoven et al., 2010). Yet, a strong network of interrelated resilience promoting factors (e.g. friendship support, impulse control, positive future orientation, daily life skills: Afifi & MacMillan, 2011; Kinard, 1998; Schultze-Lutter, Schimmelmann, & Schmidt, 2016) could potentially support mental health in these individuals.
Resilience can be described as beneficial adaptation following exposure to adverse experiences (Curtis & Cicchetti, 2007; Kalisch, Muller, & Tuscher, 2016; van der Werff, van den Berg, Pannekoek, Elzinga, & van der Wee, 2013; Zolkoski & Bullock, 2012) and should not be understood as exclusive capacity but as a concept of multiple resilience promoting factors (Afifi & MacMillan, 2011; Kinard, 1998; Schultze-Lutter et al., 2016). To date, resilience promoting factors have been studied on social (e.g. family support, social connectedness), behavioural (e.g. daily living skills, impulse control), cognitive (e.g. locus of control, future orientation) and emotional (e.g. low neuroticism, low self-blame) domains (e.g. Afifi & MacMillan, 2011; Aslan, in press; Curtis & Cicchetti, 2007; Dang, 2015; Folger & Wright, 2013; Holmes, Yoon, Voith, Kobulsky, & Steigerwald, 2015; Masten et al., 1999; Schultze-Lutter et al., 2016; van Harmelen et al., 2015; Williams & Nelson-Gardell, 2012). Importantly, resilience promoting factors do not function in isolation, rather, they have strong interrelationships (Afifi & MacMillan, 2011; Rutter, 1985). For instance, an individual with better self-regulation may be better company to be around and therefore may evoke better social support from others. To the best of our knowledge, no research has yet investigated the interconnectedness of these factors. I shall use cutting edge network analysis techniques (see Figure 1), to find the best fitting resilience network model which conceptualizes the interconnectedness of resilience promoting factors (Borsboom, & Cramer, 2010; Borsboom, Cramer, Schmittmann, Epskamp, & Waldorp, 2011; Costantini et al., 2015; Cramer et al., 2012; Cramer & Waldorp, 2010; Epskamp, Cramer, Waldorp, Schmittmann, & Borsboom, 2011; Freeman, 1978; Fried, Epskamp, Nesse, Tuerlinckx, & Borsboom, 2015; van Borkulo, Waldorp, Boschloo, Schoevers, & Borsboom, 2015).
I propose five projects for my PhD: Firstly, I shall establish the network structure of resilience factors in the general population. Next, I will validate the proposed network model of resilience factors, through establishing accuracy, stability, as well as external and predictive validity. Third, I intend to examine the network structure of resilience in individuals with a history of CA and to compare it to the resilience network of the general population. Moreover, I shall prospectively investigate whether resilience network structures are stable over time during the course of adolescence, to discover potential resilience network fluctuations. Finally, I aim to disentangle, whether resilience network fluctuations differ between
Organisations
People |
ORCID iD |
| Paul Wilkninson (Primary Supervisor) | |
| Jessica Fritz (Student) |
Publications
Fritz J
(2018)
A Systematic Review of Amenable Resilience Factors That Moderate and/or Mediate the Relationship Between Childhood Adversity and Mental Health in Young People.
in Frontiers in psychiatry
Fritz J
(2020)
Mood and neural responses to social rejection do not seem to be altered in resilient adolescents with a history of adversity.
in Development and psychopathology
Fritz J
(2018)
A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity.
in Scientific reports
Fritz J
(2019)
Unravelling the complex nature of resilience factors and their changes between early and later adolescence.
in BMC medicine
Kalisch R
(2019)
Deconstructing and Reconstructing Resilience: A Dynamic Network Approach.
in Perspectives on psychological science : a journal of the Association for Psychological Science
| Description | Citation in Andrea Danese's JCPP Review (https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13160) |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in clinical reviews |
| Description | Citation in Michael Ungar & Linda Theron's Lancet Psychiatry Review (https://www.sciencedirect.com/science/article/pii/S2215036619304341) |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in clinical reviews |
| Description | MRC DTP Flexible Supplement Funding |
| Amount | £1,730 (GBP) |
| Organisation | MRC Doctoral Training Program |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 06/2017 |
| End | 06/2017 |
| Description | Young Researcher Talk at the 3rd International Symposium on Resilience Research including a Travel Grant |
| Amount | € 339 (EUR) |
| Organisation | Johannes Gutenberg University of Mainz |
| Sector | Academic/University |
| Country | Germany |
| Start | 09/2017 |
| End | 09/2017 |
| Title | Datasets: Data of the RESIST study |
| Description | RESIST (Resilience Study What Helps Students to Adapt to Exam Stress?) consists of three occasions and was performed with Cambridge University medical students. At all three occasions students were asked to complete an online questionnaire. RESIST has the main aim of disentangling which resilience factors predict better mental health during and after exam stress. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2019 |
| Provided To Others? | No |
| Impact | We are currently still working on computing meaningful index scores and validating some of the measures used. |
| Description | Anne Marijn de Graaff |
| Organisation | Free University of Amsterdam |
| Country | Netherlands |
| Sector | Academic/University |
| PI Contribution | I (JF) was involved in the project as follows: PW, A-LvH, and JF were responsible for the study conception and the development of the study protocol. The literature screening (N = 1969) was conducted by AdG, HC, and JF. The literature re-screening (N = 220) was conducted by AdG and JF. Data extraction and quality ratings were conducted by AdG and JF. In case of disagreement or uncertainty PW was included in the discussion. Post hoc quality ratings for statistical analyses were conducted by PW and JF. JF led the conduction process of the review under the supervision of PW and A-LvH. The writing up was performed by JF under the supervision of PW and A-LvH. All authors contributed to and approved the final manuscript. PW was responsible for the funding of the review. |
| Collaborator Contribution | Anne Marijn de Graaff (AdG) from the Free University of Amsterdam was involved in the project as follows: The literature screening (N = 1969) was conducted by AdG, HC, and JF. The literature re-screening (N = 220) was conducted by AdG and JF. Data extraction and quality ratings were conducted by AdG and JF. In case of disagreement or uncertainty PW was included in the discussion. |
| Impact | Fritz, J., de Graaff, A. M., Caisley, H., van Harmelen, A.-L., & Wilkinson, P. O. (2018). A Systematic Review of Amenable Resilience Factors that Moderate and/ or Mediate the Relationship between Childhood Adversity and Mental Health in Young People. Frontiers in Psychiatry. Special Issue: Resilience, Life Events, Trajectories and The Brain, 9: 230. https://doi.org/10.3389/fpsyt.2018.00230 |
| Start Year | 2016 |
| Description | Claudia van Borkulo |
| Organisation | University of Amsterdam |
| Country | Netherlands |
| Sector | Academic/University |
| PI Contribution | I (JF) was involved in the project as follows: IMG was responsible for the data collection. JF formulated the research proposal in collaboration with JS, IMG, ALvH, and PoW. JF performed the analyses and the writing in collaboration with JS, EIF, IMG, CDvB, POW, and ALvH. All authors approved the final manuscript. POW and ALvH are joint last authors of this manuscript. |
| Collaborator Contribution | Claudia van Borkulo (CDvB) was involved in the project as follows: IMG was responsible for the data collection. JF formulated the research proposal in collaboration with JS, IMG, ALvH, and PoW. JF performed the analyses and the writing in collaboration with JS, EIF, IMG, CDvB, POW, and ALvH. All authors approved the final manuscript. POW and ALvH are joint last authors of this manuscript. |
| Impact | Fritz, J., Stochl, J., Fried, E. I., Goodyer, I. M., van Borkulo, C. D., Wilkinson, P. O., & van Harmelen, A.-L. (2019). Unravelling the Complex Nature of Resilience Factors and their Changes between Early and Later Adolescence. BMC Medicine, 17: 203. https://doi.org/10.1186/s12916-019-1430-6 |
| Start Year | 2018 |
| Description | Helen Caisley |
| Organisation | Cambridgeshire and Peterborough NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | I (JF) was involvedin the project as follows: PW, A-LvH, and JF were responsible for the study conception and the development of the study protocol. The literature screening (N = 1969) was conducted by AdG, HC, and JF. The literature re-screening (N = 220) was conducted by AdG and JF. Data extraction and quality ratings were conducted by AdG and JF. In case of disagreement or uncertainty PW was included in the discussion. Post hoc quality ratings for statistical analyses were conducted by PW and JF. JF led the conduction process of the review under the supervision of PW and A-LvH. The writing up was performed by JF under the supervision of PW and A-LvH. All authors contributed to and approved the final manuscript. PW was responsible for the funding of the review. |
| Collaborator Contribution | Helen Caisley (HC) from the Cambridgeshire and Peterborough NHS Foundation trust was involved int he project as follows: The literature screening (N = 1969) was conducted by AdG, HC, and JF. |
| Impact | Fritz, J., de Graaff, A. M., Caisley, H., van Harmelen, A.-L., & Wilkinson, P. O. (2018). A Systematic Review of Amenable Resilience Factors that Moderate and/ or Mediate the Relationship between Childhood Adversity and Mental Health in Young People. Frontiers in Psychiatry. Special Issue: Resilience, Life Events, Trajectories and The Brain, 9: 230. https://doi.org/10.3389/fpsyt.2018.00230 |
| Start Year | 2016 |
| Description | Prof. Eiko Fried |
| Organisation | University of East Anglia |
| Department | Clinical Psychology |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | I (J.F.) was involved in the project as follows: I.G. was responsible for the conduction of the longitudinal Roots study. J.F. formulated the study proposal under the supervision of P.W., A.L.v.H., and I.G. J.F. performed the analyses under the supervision of A.L.v.H., P.W. and E.F. The writing up was performed by J.F. under the supervision of A.L.v.H., P.W., I.G. and E.F. All authors contributed to and approved the final manuscript. |
| Collaborator Contribution | Eiko Fried (E.F.) form Leiden University was involved in the project as follows: J.F. performed the analyses under the supervision of A.L.v.H., P.W. and E.F. The writing up was performed by J.F. under the supervision of A.L.v.H., P.W., I.G. and E.F. All authors contributed to and approved the final manuscript. |
| Impact | Fritz, J., Fried, E. I., Goodyer, I. M., Wilkinson, P. O., van Harmelen, A.-L. (2018). A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity. Scientific Reports, 8: 15774. And recently also this one: Fritz, J., Stochl, J., Fried, E. I., Goodyer, I. M., van Borkulo, C. D., Wilkinson, P. O., & van Harmelen, A.-L. (2019). Unravelling the Complex Nature of Resilience Factors and their Changes between Early and Later Adolescence. BMC Medicine, 17: 203. https://doi.org/10.1186/s12916-019-1430-6 |
| Start Year | 2017 |
| Description | Prof. Ian Goodyer |
| Organisation | University of Cambridge |
| Department | Department of Psychiatry |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | I (J.F.) was involved in the project as follows: I.G. was responsible for the conduction of the longitudinal Roots study. J.F. formulated the study proposal under the supervision of P.W., A.L.v.H., and I.G. J.F. performed the analyses under the supervision of A.L.v.H., P.W. and E.F. The writing up was performed by J.F. under the supervision of A.L.v.H., P.W., I.G. and E.F. All authors contributed to and approved the final manuscript. |
| Collaborator Contribution | Ian Goodyer (I.G.) from the University of Cambridge was involved in the project as follows: I.G. was responsible for the conduction of the longitudinal Roots study. J.F. formulated the study proposal under the supervision of P.W., A.L.v.H., and I.G. The writing up was performed by J.F. under the supervision of A.L.v.H., P.W., I.G. and E.F. All authors contributed to and approved the final manuscript. |
| Impact | Fritz, J., Fried, E. I., Goodyer, I. M., Wilkinson, P. O., van Harmelen, A.-L. (2018). A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity. Scientific Reports, 8: 15774. And recently also this one: Fritz, J., Stochl, J., Fried, E. I., Goodyer, I. M., van Borkulo, C. D., Wilkinson, P. O., & van Harmelen, A.-L. (2019). Unravelling the Complex Nature of Resilience Factors and their Changes between Early and Later Adolescence. BMC Medicine, 17: 203. https://doi.org/10.1186/s12916-019-1430-6 |
| Start Year | 2017 |
| Description | I was in the organization committee for the symposium on: Examining Resilience in Longitudinal Cohort Studies using Multi-Modal Data Analysis |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Fritz, J., Kalisch, R., & van Harmelen, A.L. (2016, December). Examining Resilience in Longitudinal Cohort Studies using Multi-Modal Data Analysis. Symposium conducted at the University of Cambridge, Cambridge, United Kingdom. We discussed with an international group of researchers, with a specific interest in resilience research, novel ways of how to go forward in terms of multivariate data analysis and complex models. |
| Year(s) Of Engagement Activity | 2016 |
| Description | I was part of the organization committee of the 1st International Spring School on Resilience Research (May 21 - 25, 2018, Seeon Abbey, Germany) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | I was part of the organization committee of the 1st International Spring School on Resilience Research (May 21 - 25, 2018, Seeon Abbey, Germany). see: https://www.german-resilience-center.uni-mainz.de/1st-international-spring-school-on-resilience-research/ . At the spring school about 25 postgraduate students and about 5 lecturers/ Professors participated and/or held workshops in topics related to cutting-edge resilience research. |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.german-resilience-center.uni-mainz.de/1st-international-spring-school-on-resilience-rese... |
| Description | Interview with the Cambridge Children's Hospital. Available at: https://www.cambridgechildrens.org.uk/research-focus-how-do-people-overcome-childhood-trauma-and-adversity/ |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Public/other audiences |
| Results and Impact | Interview with the Cambridge Children's Hospital. Available at: https://www.cambridgechildrens.org.uk/research-focus-how-do-people-overcome-childhood-trauma-and-adversity/ |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://www.cambridgechildrens.org.uk/research-focus-how-do-people-overcome-childhood-trauma-and-adv... |
| Description | Member of the editorial team for www.psych-networks.com led by Dr. Eiko Fried. The website hosts tutorials and guest blogs on psychological network models and network theory, mainly with a focus on topics related to clinical psychology. |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Member of the editorial team for www.psych-networks.com led by Dr. Eiko Fried. The website hosts tutorials and guest blogs on psychological network models and network theory, mainly with a focus on topics related to clinical psychology. |
| Year(s) Of Engagement Activity | 2020 |
| URL | http://www.psych-networks.com |
| Description | Mental Health MOOC for adolescents (Massive Open Online Course, led by the University of Groningen) |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | I wrote parts of Dr. Anne-Laura van Harmelen's resilience module of a Mental Health MOOC for adolescents (Massive Open Online Course, led by the University of Groningen). Available at: https://www.futurelearn.com/courses/young-people-mental-health#section-topics |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.futurelearn.com/courses/young-people-mental-health#section-topics |
| Description | Presentation: A network approach to mental health resilience: Theory, practice and applications. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | Invited seminar: Fritz, J. (2019, 17th December). A network approach to mental health resilience: Theory, practice and applications. Presented at the Oxford OCEAN Lab Seminar, Oxford, UK. Slides available at: https://osf.io/g4j9n/ |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://osf.io/g4j9n/ |
| Description | Presentation: Psychological Network Models: Everything Is Connected or Not? |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | Workshop on network modelling: Fritz, J. (26th November 2019). Psychological Network Models: Everything Is Connected or Not? Held at the Cambridge Methods Day, MRC CBU, Cambridge, UK. Slides available at: https://osf.io/dxwft/ |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://osf.io/dxwft/ |
| Description | Resilience Pre-Conference Workshop: An Introduction to Network Modelling. |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | About 30 people attended the following workshop on network modelling: Fritz, J., & Lunansky, G. (24th September 2019). Resilience Pre-Conference Workshop: An Introduction to Network Modelling. Held at the Pre-symposium Workshop for Methods in Resilience Research of the 5th International Symposium on Resilience Research, Mainz, Germany. Slides available at: https://osf.io/dqmpu/ |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://osf.io/dqmpu/ |