Whatever does not kill us: cumulative lifetime adversity, vulnerability, and resilience

In a logistic regression with linear lifetime adversity as the predictor, higher adversity was associated with lower likelihood of dropout.

“Next, in a logistic regression with linear lifetime adversity as the predictor, higher adversity was associated with lower likelihood of dropout (OR = 0.848, p = .002).”

A history of some lifetime adversity, relative to both no and high adversity, predicted lower PTS symptoms.

“Supporting Hypothesis 1, our findings revealed that a history of some lifetime adversityrelative to both no and high adversity-predicted lower global distress, lower functional impairment, lower PTS symptoms, and higher life satisfaction.”

When quadratic lifetime adversity was added to the model, it did not significantly predict attrition.

“However, when quadratic lifetime adversity was added to this model, it did not significantly predict attrition.”

A substantial majority of the sample (n = 1,994, 83.2%) provided longitudinal data over Waves 2-4.

“A substantial majority of the sample ( n = 1,994, 83.2%) provided longitudinal data over Waves 2-4.”

People with low lifetime adversity reported better outcomes over time than did people who had experienced no adversity.

“People with low lifetime adversity reported better outcomes over time than did people who had experienced no adversity.”

No significant differences in current employment status emerged between the zero, 1, and 2-4 adversity groups.

“In contrast, analyses revealed no significant differences between the zero, 1, and 2-4 groups.”

No significant differences in extraversion or agreeableness emerged between respondents with a history of no adversity and respondents in the 1-event and 2-4 groups.

“However, no significant differences emerged between respondents with a history of no adversity and respondents in the 1-event and 2-4 groups.”

U-shaped quadratic relationships indicated that a history of some but nonzero lifetime adversity predicted relatively lower global distress, lower self-rated functional impairment, fewer posttraumatic stress symptoms, and higher life satisfaction over time.

“Specifically, U -shaped quadratic relationships indicated that a history of some but nonzero lifetime adversity predicted relatively lower global distress, lower self-rated functional impairment, fewer posttraumatic stress symptoms, and higher life satisfaction over time.”

Greater recent adversity predicted significantly higher functional impairment (B = 0.087, p < .001).

“Greater recent adversity predicted significantly higher global distress ( B = 0.110, p &lt; .001), functional impairment ( B = 0.087, p &lt; .001), PTS symptoms ( B = 0.090, p &lt; .001), and significantly lower life satisfaction ( B = -0.051, p = .003).”

High lifetime adversity predicted worse outcomes over time than did low adversity.

“such that high lifetime adversity predicted worse outcomes over time than did low adversity”

A history of some lifetime adversity, relative to both no and high adversity, predicted higher life satisfaction.

“Supporting Hypothesis 1, our findings revealed that a history of some lifetime adversityrelative to both no and high adversity-predicted lower global distress, lower functional impairment, lower PTS symptoms, and higher life satisfaction.”

People with a history of some lifetime adversity appeared less negatively affected by recent adverse events than did other individuals.

“Supporting Hypothesis 2, across these same longitudinal outcome measures, people with a history of some lifetime adversity appeared less negatively affected by recent adverse events than did other individuals.”

Individuals in the zero adversity group endorsed significantly lower conscientiousness and emotional stability than those in the 2-4 group.

“Individuals in the zero group endorsed significantly lower conscientiousness and emotional stability than those in the 2-4 group.”

A history of some lifetime adversity, relative to both no and high adversity, predicted lower functional impairment.

“Supporting Hypothesis 1, our findings revealed that a history of some lifetime adversityrelative to both no and high adversity-predicted lower global distress, lower functional impairment, lower PTS symptoms, and higher life satisfaction.”

No significant differences in marital status or household size emerged between the zero adversity group and the 1-event and 2-4 groups.

“For both marital status and household size, no significant differences emerged between the zero group and the 1-event and 2-4 groups.”

More lifetime adversity was associated with higher PTS symptoms.

“Consistent with prior research on the impact of adversity, linear effects emerged in our results, such that more lifetime adversity was associated with higher global distress, functional impairment, and PTS symptoms, as well as lower life satisfaction.”

More lifetime adversity was associated with lower life satisfaction.

“Consistent with prior research on the impact of adversity, linear effects emerged in our results, such that more lifetime adversity was associated with higher global distress, functional impairment, and PTS symptoms, as well as lower life satisfaction.”

A history of some lifetime adversity, relative to both no and high adversity, predicted lower global distress.

“Supporting Hypothesis 1, our findings revealed that a history of some lifetime adversityrelative to both no and high adversity-predicted lower global distress, lower functional impairment, lower PTS symptoms, and higher life satisfaction.”

Recent adversity's effect on outcomes was significantly moderated by quadratic lifetime adversity: U-shaped for negative outcomes (global distress, functional impairment, PTS symptoms) and inverse U-shaped for life satisfaction (ps < .016).

“Consistent with predictions, results revealed significant U -shaped quadratic moderation of the effect of recent adversity on negative outcomes (i.e., a significant interaction term for Recent Adversity × Lifetime Adversity × Lifetime Adversity, predicting global distress, functional impairment, and PTS symptoms) and an inverse U shape for life satisfaction ( p s &lt; .016).”

More lifetime adversity was associated with higher functional impairment.

“Consistent with prior research on the impact of adversity, linear effects emerged in our results, such that more lifetime adversity was associated with higher global distress, functional impairment, and PTS symptoms, as well as lower life satisfaction.”

People with a history of some lifetime adversity reported better mental health and well-being outcomes than not only people with a high history of adversity but also than people with no history of adversity.

“In a multiyear longitudinal study of a national sample, people with a history of some lifetime adversity reported better mental health and well-being outcomes than not only people with a high history of adversity but also than people with no history of adversity.”

The pattern of results remained consistent when including covariates.

“The pattern of results remained consistent when including covariates, which is summarized in the Supplementary Analyses sections.”

In a simultaneous logistic regression model predicting dropout after Wave 1, age was the only significant predictor, such that older respondents were less likely to drop out.

“In a simultaneous logistic regression model, age was the only significant predictor, such that older respondents were less likely to drop out (odds ratio [OR] = 0.966, p < .001).”

All simple interaction terms at high lifetime adversity were significant (ps < .005).

“all simple interaction terms at high lifetime adversity were significant ( p s &lt; .005)”

Greater recent adversity predicted significantly lower life satisfaction (B = -0.051, p = .003).

“Greater recent adversity predicted significantly higher global distress ( B = 0.110, p &lt; .001), functional impairment ( B = 0.087, p &lt; .001), PTS symptoms ( B = 0.090, p &lt; .001), and significantly lower life satisfaction ( B = -0.051, p = .003).”

People with some prior lifetime adversity were the least affected by recent adverse events.

“Furthermore, people with some prior lifetime adversity were the least affected by recent adverse events.”

Respondents with a history of 2-4 adverse events tended to report the best outcomes across the four outcome variables.

“respondents with a history of 2-4 adverse events tended to report the best outcomes across the four outcome variables (see Figure 2)”

All of the highest order interaction terms were again significant (ps < .019).

“All of the highest order interaction terms were again significant ( p s &lt; .019)”

More lifetime adversity was associated with higher global distress.

“Consistent with prior research on the impact of adversity, linear effects emerged in our results, such that more lifetime adversity was associated with higher global distress, functional impairment, and PTS symptoms, as well as lower life satisfaction.”

The relationship between lifetime adversity and outcomes is quadratic (U-shaped).

“However, our results also yielded quadratic, U -shaped patterns, demonstrating a critical qualification to the seemingly simple relationship between lifetime adversity and outcomes.”

No significant differences in age emerged between the zero adversity group and the 1-event and 2-4 groups.

“However, no significant differences emerged between the zero group and the 1-event and 2-4 groups.”

In the sample, cumulative lifetime adversity had a significant quadratic relationship with each of the four outcomes (global distress, functional impairment, life satisfaction, and PTS symptoms), p < .001.

“results revealed significant quadratic relationships between cumulative lifetime adversity and each outcome (i.e., a significant interaction term for Lifetime Adversity × Lifetime Adversity, p s < .001).”

Greater recent adversity predicted significantly higher global distress (B = 0.110, p < .001).

“Greater recent adversity predicted significantly higher global distress ( B = 0.110, p &lt; .001), functional impairment ( B = 0.087, p &lt; .001), PTS symptoms ( B = 0.090, p &lt; .001), and significantly lower life satisfaction ( B = -0.051, p = .003).”

No significant differences in openness to experience emerged between respondents in the zero adversity group and others.

“but no significant differences emerged between respondents in the zero group and others.”

Greater recent adversity predicted significantly higher PTS symptoms (B = 0.090, p < .001).

“Greater recent adversity predicted significantly higher global distress ( B = 0.110, p &lt; .001), functional impairment ( B = 0.087, p &lt; .001), PTS symptoms ( B = 0.090, p &lt; .001), and significantly lower life satisfaction ( B = -0.051, p = .003).”

Across all outcomes, the curvilinear pattern is clearly established.

“But across all the outcomes, the curvilinear pattern is clearly established.”

When using untransformed variables, the results presented in Table 4 were substantively unchanged.

“Second, when using untransformed variables, the results presented in Table 4 were substantively unchanged”

When analyses were repeated with demographic and individual difference variables included as covariates, the results were substantively unchanged.

“However, when we repeated analyses with these variables included as covariates, the results were substantively unchanged.”

Findings for PTS symptoms paralleled findings for other outcomes, despite PTS symptoms being assessed specifically in reference to the September 11, 2001 terrorist attacks.

“Findings for PTS symptoms paralleled findings for other outcomes, despite the fact that PTS symptoms were assessed specifically in reference to the terrorist attacks of September 11, 2001, whereas the other outcomes were not tied to a specific event.”

Respondent attrition was predicted by age and linear lifetime adversity.

“Respondent attrition was predicted by age and linear lifetime adversity.”

Respondents who reported no previous adversity reported worse outcomes than respondents who reported some adversity.

“Inconsistent with a recall or reporting bias, respondents who reported no previous adversity reported worse outcomes than respondents who reported some adversity.”

Among veterans, an inverse U-shaped quadratic relationship between degree of perceived threat from combat and degree of exposure to death of others and self-reported psychological benefits, such that moderate threat and exposure predicted the greatest benefits.

“Similarly, Fontana and Rosenheck (1998) found an inverse U -shaped quadratic relationship when degree of perceived threat from combat and degree of exposure to death of others were used to predict self-reported psychological benefits among veterans, such that moderate threat and exposure predicted the greatest benefits.”

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Adversities often cooccur.

“However, adversities often cooccur (Dong et al., 2004; Green et al., 2010), making it difficult to isolate the impact associated with any single event, especially over a lifetime.”

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In the face of work stressors in young adulthood, individuals who experienced prior work stress during adolescence did not exhibit the negative effects on self-esteem, self-efficacy, and depressed mood shown by individuals with little prior work stress.

“For example, in the face of work stressors in young adulthood, individuals who experienced prior work stress during adolescence did not exhibit the negative effects on self-esteem, self-efficacy, and depressed mood shown by individuals with little prior work stress (Mortimer & Staff, 2004).”

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Resilience is a common, rather than an extraordinary, phenomenon, even in the context of substantial adversity.

“In fact, early research in child psychiatry suggests that resilience is a common, rather than an extraordinary, phenomenon (Rutter, 1985), even in the context of substantial adversity (e.g., Masten, 2001; Werner & Smith, 1992).”

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Infant monkeys who had the opportunity to control aspects of their environment during development later exhibited less fear and more exploratory behavior than did monkeys who lacked such opportunity to exert control.

“For example, infant monkeys who had the opportunity to control aspects of their environment during development (i.e., delivery of food and water) later exhibited less fear and more exploratory behavior than did monkeys who lacked such opportunity to exert control (Mineka, Gunnar, & Champoux, 1986).”

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Coping with some amount of stress could promote perceptions of control and mastery.

“Coping with some amount of stress could similarly promote perceptions of control and mastery.”

In experimental studies, young monkeys exposed to an intermittent stressor during development demonstrated greater resilience to subsequent novel stressors than did monkeys without any exposure.

“In experimental studies, young monkeys exposed to an intermittent stressor during development demonstrated greater resilience to subsequent novel stressors than did monkeys without any exposure (Parker, Buckmaster, Schatzberg, & Lyons, 2004; Parker, Buckmaster, Sundlass, Schatzberg, & Lyons, 2006).”

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On average, a low but nonzero total count of lifetime adverse events should be most likely to lead to subsequent mastery and toughness.

“The specific characteristics of given events could certainly vary across individuals on dimensions relevant for developing mastery and toughness, but on average, a low but nonzero total count should be most likely to lead to subsequent mastery and toughness.”

Early life experience of low perceived control and low mastery facilitates interpreting subsequent situations as uncontrollable.

“Early life experience of low perceived control and low mastery facilitates interpreting subsequent situations as uncontrollable.”

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In humans, children with moderate levels of early life adversity exhibited lower cortisol activity than did others during a laboratory stressor.

“In humans, children with moderate levels of early life adversity exhibited lower cortisol activity than did others during a laboratory stressor (Gunnar, Frenn, Wewerka, & Van Ryzin, 2009), a response potentially consistent with Dienstbier's (1989, 1992) toughened physiological pattern.”

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There is an important distinction between recovering back to baseline functioning after a negative event and deriving from it a greater capacity for future resilience.

“There is an important distinction, however, between recovering back to baseline functioning (or largely avoiding decrements entirely) after a negative event and deriving from it a greater capacity for future resilience.”

Adversities that fail to meet typical definitions of 'trauma' nonetheless contribute to predicting psychiatric disorder onset and symptoms.

“It is important to note that adversities that fail to meet typical definitions of 'trauma' nonetheless contribute to predicting psychiatric disorder onset (Lloyd & Turner, 2003) and symptoms (Galea et al., 2008; Silver, Holman, McIntosh, Poulin, & Gil-Rivas, 2002).”

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Once toughness develops, it can permeate across domains.

“Once toughness develops, it can permeate across domains.”

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A given type of event can have general effects across domains of psychological functioning, thus overlapping with the effects of other adversity types.

“Furthermore, a given type of event can have general effects across domains of psychological functioning, thus overlapping with the effects of other adversity types (McMahon, Grant, Compas, Thurm, & Ey, 2003).”

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Quadratic effects of lifetime adversity have rarely been tested.

“Quadratic effects of lifetime adversity have rarely been tested (Schilling, Aseltine, & Gore, 2008).”

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When adversities occur, their negative effects can be long lasting.

“When adversities occur, their negative effects can be long lasting.”

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Exposure to moderate levels of adversity can predict better mental health and well-being than exposure to either a high level of adversity or to no adversity.

“Evidence also suggests that exposure to moderate levels of adversity can predict better mental health and well-being than exposure to either a high level of adversity or to no adversity.”

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Most people experience some serious adversity in their lives.

“Most people experience some serious adversity in their lives (Bonanno, 2004);”

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Disability and unemployment have predicted lower life satisfaction that persisted over at least several years.

“For example, disability and unemployment have predicted lower life satisfaction that persisted over at least several years (Lucas, 2007; Lucas, Clark, Georgellis, & Diener, 2004).”

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Among Vietnam War veterans, peripheral exposure to combat predicted improvements in psychological functioning from pre- to postmilitary service, relative to veterans with both no exposure and direct exposure to combat.

“Specifically, among Vietnam War veterans, Schnurr, Rosenberg, and Friedman (1993) reported that peripheral exposure to combat predicted improvements in psychological functioning (i.e., Minnesota Multiphasic Personality Inventory scores) from pre- to postmilitary service, relative to veterans with both no exposure and direct exposure to combat.”

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Histories of a given adverse event (e.g., physical/sexual assault, parental loss, homelessness, natural disasters) have all been associated with poorer mental health outcomes.

“Histories of a given adverse event (e.g., physical/sexual assault, parental loss, homelessness, natural disasters) have all been associated with poorer mental health outcomes (e.g., Edwards, Holden, Felitti, & Anda, 2003; Emery & Laumann-Billings, 1998; Golding, 1999; KendallTackett, Williams, & Finkelhor, 1993).”

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The distribution of the KN panel closely tracks the distribution of census counts for the U.S. population on age, race, Hispanic ethnicity, geographical region, employment status, income, and education.

“The distribution of the KN panel closely tracks the distribution of census counts for the U.S. population on age, race, Hispanic ethnicity, geographical region, employment status, income, and education.”

Using untransformed variables, the simple slope at high adversity was significant for all outcomes (ps < .001).

“The simple slope at high adversity was significant for all outcomes ( p s &lt; .001).”

The sample was drawn from a nationally representative Web-enabled research panel established by Knowledge Networks, Inc. (KN).

“The sample was drawn from a nationally representative Webenabled research panel established by Knowledge Networks, Inc. (KN).”

Adding the five Big Five personality dimensions as covariates did not substantively affect the relationship between continuous lifetime adversity and mental health and well-being outcomes.

“These analyses revealed that including personality covariates did not substantively affect the relationship between continuous lifetime adversity and mental health and well-being outcomes.”

Adding a term representing linear cumulative lifetime adversity to these models did not substantively change the results.

“Adding a term representing linear cumulative lifetime adversity to these models did not substantively change the results.”

The fewer adversities measured, the more likely that people with histories of no adversity and low adversity will show the same total, thereby obscuring the critical differences between them.

“The fewer adversities measured, the more likely that people with histories of no adversity and low adversity will show the same total, thereby obscuring the critical differences between them.”

Across the outcome variables as a whole, people with low lifetime adversity were less negatively affected by recent adversity than people who had experienced either no or high lifetime adversity.

“Thus, across the outcome variables as a whole, people with low lifetime adversity were less negatively affected by recent adversity than people who had experienced either no or high lifetime adversity”

With covariates added, at high adversity the simple interaction term was significant and in the same direction for all outcomes (ps < .019).

“At high adversity, the simple interaction term was significant and in the same direction as in the primary analyses for all outcomes ( p s &lt; .019).”

With covariates added, at no adversity the Lifetime Adversity × Recent Adversity simple interaction term was in the same direction and significant (ps < .034) for all outcomes except PTS symptoms (p = .099).

“At a history of no adversity, the Lifetime Adversity × Recent Adversity simple interaction term was in the same direction as in the primary analyses for all outcomes and was significant ( p s &lt; .034) for all outcomes except PTS symptoms, which approached significance ( p = .099).”

The magnitude of recent adversity's negative impact on longitudinal outcomes depended on previous lifetime adversity history.

“Thus, the magnitude of recent adversity's negative impact on longitudinal outcomes depended on previous lifetime adversity history.”

These results suggest that, in moderation, whatever does not kill us may indeed make us stronger.

“These results suggest that, in moderation, whatever does not kill us may indeed make us stronger.”

Using untransformed variables, all four quadratic terms remained significant and in the same shape as when using transformed variables (ps < .001).

“when using untransformed variables (as described above), all four quadratic terms remained significant and in the same shape as when using transformed variables ( p s &lt; .001).”

People can benefit from the experience of some adversity, in moderation.

“Beyond recovering to past levels of functioning in the aftermath of adversity, we found evidence consistent with people actually benefiting from the experience of some adversity.”

• Also stated in: § Fostering Resilience and Mental Health and Well-Being · p. 15 · hedged

  “To modify an adage, in moderation, whatever does not kill us may indeed make us stronger.”

• AssumptionRests on an assumption: People recover to past levels of functioning in the aftermath of adversity.

It is likely impossible to identify a precise 'ideal' number of prior adverse events that are protective of future mental health difficulties.

“In part for these reasons, it is likely impossible to identify a precise 'ideal' number of prior adverse events that are protective of future mental health difficulties”

Relying on individuals to judge severity for themselves potentially confounds severity with individuals' response to adversity.

“Relying on individuals to judge severity for themselves potentially confounds severity with individuals' response to adversity, which is the outcome of interest (Kessler, 1997).”

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At least in the relative short term (within the 2 years followed), the experience of new adversity served no obvious benefit for people with a history of no prior adversity.

“At least in the relative short term (i.e., within the 2 years we followed our sample), the experience of new adversity served no obvious benefit for people with a history of no prior adversity.”

Data collection was longitudinal rather than cross-sectional, decreasing the probability of confounding predictors and outcomes.

“First, data collection was longitudinal rather than crosssectional, decreasing the probability of confounding predictors and outcomes.”

The adversity measure represented the number of events experienced rather than detailed characteristics of events, so meaningful variability in adversity may not have been captured.

“Our adversity measure represented the number of events experienced rather than detailed characteristics of events, so meaningful variability in adversity may not have been captured.”

It seems difficult to attribute the findings to biases in recall or reporting.

“In sum, given these elements of our design and analyses, it seems difficult to attribute our findings to biases in recall or reporting.”

Some types of adverse events may be particularly likely to cluster together.

“Furthermore, some types of adverse events may be particularly likely to cluster together (e.g., Green et al., 2010).”

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Isolating effects of single adversities is difficult because events are experienced in the context of individuals' adversity history.

“For example, isolating effects of single adversities is difficult, given that events are not experienced in a vacuum but, rather, in the context of individuals' adversity history (Dong et al., 2004; Green et al., 2010).”

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This leaves little reason to believe that differential attrition can account for the results.

“This leaves little reason to believe that differential attrition can account for our results.”

Analyses testing quadratic moderation of recent events (Hypothesis 2) controlled for outcomes experienced at Wave 1, before the recent events had occurred.

“Second, analyses testing quadratic moderation of recent events (Hypothesis 2) controlled for outcomes experienced at Wave 1, before the recent events had occurred.”

The results suggest that previous research does not paint a complete picture of adversity's role in building resilience and, more broadly, mental health and well-being.

“Our results suggest that previous research does not paint a complete picture of adversity's role in building resilience and, more broadly, mental health and well-being.”

People are not doomed to be damaged by adversity.

“Instead, they highlight that people are not doomed to be damaged by adversity.”

The evidence for both hypotheses is consistent with the proposition that in moderation, experiencing lifetime adversity can contribute to the development of resilience.

“Although these data cannot establish causation, the evidence for both hypotheses is consistent with the proposition that in moderation, experiencing lifetime adversity can contribute to the development of resilience.”

This likely contributed to revealing quadratic relationships between adversity history and mental health and well-being outcomes, as opposed to only the typical linear relationships.

“This likely contributed to revealing quadratic relationships between adversity history and mental health and well-being outcomes, as opposed to only the typical linear relationships identified in both prior research and our own data.”