What factors are associated with resilient outcomes in children exposed to social adversity? A systematic review

Abstract

ObjectivesChildren exposed to social adversity—hardship as a result of social circumstances such as poverty or intergenerational trauma—are at increased risk of poor outcomes across the life course. Understanding what promotes resilient outcomes is essential for the development of evidence informed intervention strategies. We conducted a systematic review to identify how child resilience is measured and what factors are associated with resilient outcomes.DesignSystematic search conducted in CINAHL, MEDLINE and PsychInfo from January 2004 to October 2018 using the keywords ‘resilien* and child* in the title or abstract. Eligible studies: (1) described children aged 5–12 years; (2) identified exposure to social adversity; (3) identified resilience; and (4) investigated factors associated with resilience.Outcome measures(1) approaches to identifying resilience and (2) factors associated with resilient outcomes.ResultsFrom 1979 studies retrieved, 30 studies met the inclusion criteria. Most studies were moderate to high quality, with low cultural competency. Social adversity exposures included poverty, parent loss, maltreatment and war. Only two studies used a measure of child resilience; neither was psychometrically validated. Remaining studies classified children as resilient if they showed positive outcomes (eg, mental health or academic achievement) despite adversity. A range of child, family, school and community factors were associated with resilient outcomes, with individual factors most commonly investigated. The best available evidence was for cognitive skills, emotion regulation, relationships with caregivers and academic engagement.ConclusionsWhile there is huge variation in the type and severity of adversity that children experience, there is some evidence that specific individual, relational and school factors are associated with resilient outcomes across a range of contexts. Such factors provide an important starting point for effective public health interventions to promote resilience and to prevent or ameliorate the immediate and long-term impacts of social adversity on children.

The complex neurobiology of resilient functioning after childhood maltreatment

“…Finally, although a thorough discussion is beyond the scope of this manuscript, there are many intraindividual cognitive characteristics as well as interindividual family, school, social, and cultural influences that play a critical role in resilient functioning after CM [135][136][137]158]. For instance, low ruminative tendencies, high autonomy, high self-esteem and self-efficacy affect resilient functioning after CM [33,206,207].…”

“…For instance, low ruminative tendencies, high autonomy, high self-esteem and self-efficacy affect resilient functioning after CM [33,206,207]. A recent systematic review of the literature suggests key roles for emotion regulation, cognitive skills, empathy and positive outlooks in resilient outcomes in children [136]. Indeed, positive views regarding the cognitive triad of self, the world and the future as well as the ability to remember specific positive events have been associated with a higher level of resilient functioning after CM [165,[208][209][210].…”

“…Moreover, self-reliance, self-confidence and interpersonal reserve promote resilient adaptations in children with a history of CM [211]. On an interindividual level, positive relationships with caregivers, friends, teachers or other adults, a safe and orderly school environment, student academic achievement, community cohesion and links with cultural identity, including spiritual beliefs, are related with resilient outcomes in children [136]. These findings are crucial, as they suggest, at least in principle, promising intervention targets to facilitate resilient functioning.…”

“…There is over 50 years of research showing the importance of social environmental influences on resilient functioning after CM [135]; whilst an appropriate inclusion of this literature would be warranted, this is outside the scope of the current review. As such, we refer readers to key papers on the importance of the social environment [26,33,[131][132][133][134][135][136][137][138] and provide some examples below. Family support in adolescence as well as peer support is associated with reduced depressive symptoms and promotes resilient functioning across a range of domains in those who have experienced CM [12,139].…”

A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia

“…Disadvantaged families often suffer from the convergence of adverse social, mental and physical health issues that can be overwhelming. Data shows that social disadvantage tends to concentrate geographically [ 3 ] and can create intergenerational cycles of trauma and disadvantage [ 4 ].…”