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

In the paper

“It is also important to note that the observed U -shaped patterns are not completely symmetrical. In many cases, outcomes at the high end of adversity appear more negative than those at zero adversity, and some curves could be described as more J -shaped than U -shaped”

In the paper

“Neither Wave 1 outcomes themselves nor their interactions with linear or quadratic lifetime adversity significantly predicted attrition.”

In the paper

“At a history of no adversity, the Lifetime Adversity × Recent Adversity simple interaction term was in the predicted direction for all outcomes and was significant ( p s < .05) for all outcomes except PTS symptoms, which approached significance ( p = .103).”

In the paper

“The pattern of results remained consistent using untransformed variables; these findings are summarized in the Supplementary Analyses sections.”

In the paper

“This simple slope was significant and in the opposite direction of the no-adversity slope for all outcomes ( p s < .001)”

In the paper

“At high adversity, the simple interaction term was significant and in the predicted direction for all outcomes ( p s &lt; .004).”

In the paper

“As predicted, this simple slope was negative and significant for negative outcomes and positive and significant for life satisfaction ( p s < .001)”

In the paper

“A total of 2,398 respondents reported their lifetime exposure to negative events and some outcome measures.”

In the paper

“Effects of this nature emerged for all four longitudinal outcome variables: greater cumulative lifetime adversity predicted significantly higher global distress ( B = 0.174, p < .001), functional impairment ( B = 0.136, p < .001), and PTS symptoms ( B = 0.090, p < .001), and significantly lower life satisfaction ( B = -0.059, p = .007).”

In the paper

“Both points are within the sample's range.”

In the paper

“Results did reveal that respondents with low adversity endorsed greater emotional stability (i.e., lower neuroticism) and conscientiousness than respondents with no adversity.”

In the paper

“None of these alternatives were supported by our supplementary analyses.”

In the paper

“It is important to note, however, that quadratic lifetime adversity, outcome measures reported at Wave 1 (before any dropout), and interactions between Wave 1 outcomes and linear and quadratic lifetime adversity all failed to predict attrition significantly.”

In the paper

“Moreover, this pattern appears using both modeled data (see Figures 1 and 3) and averaged raw data (see Figure 2).”

In the paper

“In terms of cumulative lifetime adversity, a low level of adversity should equate to a low but nonzero number of total lifetime adverse events.”

In the paper

“Toughness leaves individuals more likely to appraise situations positively (i.e., perceiving them as more manageable), more emotionally stable, and better able to cope psychologically and physiologically with difficult stressors and minor challenges, relative to nontoughened individuals.”

What the sources say

• Not checked yetcites Dienstbier, 1989
• Not checked yetcites Dienstbier, 1992

In the paper

“It is important to note that Dienstbier (1989, 1992) further argued that both sheltering from all stressors and continuous exposure to stressors leads to lack of toughness.”

What the sources say

• Not checked yetcites Dienstbier, 1989
• Not checked yetcites Dienstbier, 1992

In the paper

“Nonetheless, in addition to the aforementioned adage, theoretical and empirical work does suggest that under the proper conditions, experiencing life adversity may foster subsequent resilience.”

In the paper

“Thus, mastery and toughness should substantially overlap; across both perspectives, coping with stressors may promote subsequent benefits.”

In the paper

“but mitigated negative consequences in the near term do not necessarily contribute to building future resilience to adversity.”

In the paper

“Gilbert et al. (1998) suggested that a psychological immune system works to actively dispel negative affect when people experience it.”

What the sources say

• Not checked yetcites Gilbert et al., 1998

In the paper

“As described above, experiencing low levels of adversity should be most likely to foster mastery and toughness, thereby leading to subsequent resilience.”

In the paper

“This should yield a quadratic, curvilinear relationship between continuous cumulative adversity count and outcome measures.”

In the paper

“In contrast, the experience of high control and high mastery has the opposite effect, facilitating future perceptions of control, which in turn can enhance coping capabilities.”

What the sources say

• Not checked yetcites Chorpita & Barlow, 1998
• Not checked yetcites Mineka & Zinbarg, 2006

In the paper

“Dienstbier argued that exposure to stressors has a positive toughening effect when the exposure is limited, with an opportunity for recovery.”

What the sources say

• Not checked yetcites Dienstbier, 1989
• Not checked yetcites Dienstbier, 1992

In the paper

“Although sheltering from stressors may temporarily protect against distress, it should not result in long-term advantages.”

In the paper

“Consistent with prior evidence for linear relationships in which greater cumulative adversity predicts worse outcomes, an overall linear trend in this direction could still emerge, but with a reversal of this relationship between no adversity and low adversity (cf. May & Bigelow, 2005).”

What the sources say

• Not checked yetcites May & Bigelow, 2005

In the paper

“Panel members were randomly selected to participate in our research (Holman et al., 2008; Silver et al., 2002; Silver et al., 2006).”

What the sources say

• Not checked yetcites Holman et al., 2008
• Not checked yetcites Silver et al., 2002
• Not checked yetcites Silver et al., 2006

In the paper

“The simple slope at no adversity was significant for functional impairment, PTS symptoms, and life satisfaction ( p s &lt; .007) but did not reach significance for global distress ( p = .16).”

In the paper

“To create prospective tests, our models included outcome variables measured in waves subsequent to those in which predictors were assessed. This helped to rule out the possibility that observed relationships could be explained by contemporaneous reporting of predictors and outcomes.”

In the paper

“Global distress was assessed using the Brief Symptom Inventory ( 𝛂 = .92 to .93; 0-4 response scale), a well-validated standardized scale that measures prior-week symptoms of psychological distress (depression, anxiety, and somatization; Derogatis, 2001).”

What the sources say

• Not checked yetcites Derogatis, 2001

In the paper

“Thus, findings fail to support the idea that background characteristics and personality dimensions meaningfully contribute to differentiating respondents with a history of no versus low adversity and further fail to support alternative explanations based on age, social isolation, and seeking life opportunities.”

In the paper

“Starting in September, 2001, our research team collected longitudinal data from a national sample of the adult U.S. population randomly selected from the KN panel (Holman et al., 2008; Silver et al., 2002, 2006).”

What the sources say

• Not checked yetcites Holman et al., 2008
• Not checked yetcites Silver et al., 2002
• Not checked yetcites Silver et al., 2006

In the paper

“Unlike our other measures of mental health and well-being, PTS symptoms were assessed specifically in reference to a recent collective traumathe terrorist attacks of September 11, 2001 (9/11)-that generated psychological responses nationwide, including among people who were not directly exposed (Silver et al., 2002, 2006).”

What the sources say

• Not checked yetcites Silver et al., 2002
• Not checked yetcites Silver et al., 2006

In the paper

“Analyses were conducted with generalized estimating equations (GEE), a populationaveraged analysis appropriate for repeated-measures longitudinal data that accommodates missing assessments and provides necessary adjustments of standard errors.”

In the paper

“we also tested models with quadratic age terms, thereby paralleling quadratic lifetime adversity; doing so yielded essentially identical results.”

• Also stated in: § Hypothesis 2: Moderation of Recent Adversity by Quadratic Cumulative Lifetime Adversity · p. 11 · plain

  “We also tested models with quadratic age terms (paralleling quadratic lifetime adversity), which yielded essentially identical results.”

In the paper

“In sum, these supplementary analyses suggest that neither the covariates nor statistical artifact arising from variable transformations can account for the observed pattern of findings.”

In the paper

“Unlike typical Internet panels, in which people who already have Internet access choose to opt in, no one can volunteer for the KN panel.”

In the paper

“when we added covariates (in addition to Wave 1 outcome values) to the models, all of the Recent Adversity × Lifetime Adversity × Lifetime Adversity interaction terms remained significant ( p s &lt; .019) and in the same form as the results presented in Table 4.”

In the paper

“In sum, these supplementary analyses suggest that neither the covariates nor statistical artifact arising from variable transformations can account for the observed pattern of findings for cumulative lifetime adversity.”

In the paper

“To ensure representation of population segments that would not otherwise have Internet access, KN provided panel households with an Internet connection and Web TV to serve as a computer monitor.”

In the paper

“Even though panel members complete surveys regularly, there are no significant differences over time in responses given by 'seasoned' participants from 'naı ¨ve' ones (Dennis, 2001).”

What the sources say

• Not checked yetcites Dennis, 2001

In the paper

“Moreover, measures of cumulative adversity commonly assess only a few types of stressors and often exclude multiple instances of the same type, thereby limiting measurement sensitivity.”

In the paper

“The sample closely resembled the national population.”

In the paper

“To confirm that transformations did not create spurious nonlinear relationships, we conducted supplementary analyses using (a) untransformed outcome variables; (b) recoded untransformed lifetime adversity, setting the most extreme cases (approximately 10% with adversity count greater than 15) to 15”

In the paper

“We included these covariates to rule out alternative explanations based on their expected association with adversity (e.g., health history) and subsequent mental health and well-being (e.g., 9/11 exposure).”

In the paper

“The KN panel is developed using traditional probability methods for creating national survey samples and, at the time of our study, was recruited using stratified random-digit-dial telephone sampling.”

In the paper

“when we repeated the analyses with covariates (gender, ethnicity, age, income, marital status, household size, education, employment status, mental and physical health history, and degree of exposure to the 9/11 attacks), the results presented in Table 2 remained substantively unchanged.”

• Also stated in: § Hypothesis 1: Quadratic Cumulative Lifetime Adversity · p. 7 · plain

  “For all four outcome variables, the quadratic term ( p s < .002), simple slope at no adversity ( p s < .017), and simple slope at high adversity ( p s < .001) were significant and in the same shape and direction as in analyses without these covariates.”

In the paper

“This created a conservative test, in that only the unique relationships between adversity and mental health were tested for significance.”

In the paper

“(although Figure 2 suggests that experiencing on average around three events may be a turning point)”

In the paper

“Hence, there was no evidence that the pattern of attrition overlapped with the pattern of substantive findings, or that respondents with relatively high or low levels of mental health and well-being were disproportionately likely to drop out of the study.”

In the paper

“In contrast, assessing a wide variety of events that better represents the full range to which people may be exposed (i.e., including those outside the cluster) should maximize the opportunity to reveal individuals who fall between either extreme of cluster endorsement. This should better differentiate no versus low adversity history, thereby facilitating discovery of evidence for resilience.”

In the paper

“We assessed more types of adversity than is typical in research investigating adversity history, and we allowed respondents to endorse multiple instances of each type, which should have further helped to differentiate no versus low adversity.”

In the paper

“The fact that these supplementary analyses yielded the same pattern of findings as our primary analyses should increase confidence in our interpretation of the results.”

In the paper

“We did not consider the specific type of prior adverse event and the impact of different types of experiences on outcomes over time.”

In the paper

“Dienstbier (1989, 1992) suggested that toughness should be associated with emotional stability, which fits the difference that emerged in our data between individuals with no versus low adversity.”

What the sources say

• Not checked yetcites Dienstbier (1989, 1992)

In the paper

“This fits with previous research in which PTS symptoms were exacerbated by other negative events (Classen et al., 2002).”

What the sources say

• Not checked yetcites Classen et al., 2002

In the paper

“To test differences between a history of no cumulative lifetime adversity and low adversity effectively, it was particularly important to assess a wide range of events and facilitate maximal reporting of them.”

In the paper

“Self-report assessments of life events are not without criticism (Dohrenwend, 2006), but sensitive topics are more likely to be acknowledged in selfreport assessments than in interviews.”

What the sources say

• Not checked yetcites Dohrenwend, 2006

In the paper

“Given the consistent pattern across all measures-despite their differing foci-our results may best be viewed in terms of implications for general mental health and well-being, which overlaps conceptually with each of the four specific outcomes assessed.”