Health Science Journal

Keywords

Resilience; Health; Mental health; Mental disorders; Clinical psychology; Questionnaire; Short scale; Screening tool

Introduction

Resilience is the ability to adequately deal with stress and adapt in a functional manner [1,2]. This includes physical stress – such as injuries or illnesses - as well as psychological stress, which can stem from any major or minor life event, e.g. the loss of a loved one, unemployment, a family crisis or similar [3]. Therefore, a resilient individual can cope with adverse circumstances in healthier ways than someone with low resilience, because of their more positive and optimistic selfconcept and outlook on life. In this light, resilience is also a very influential protective factor against mental disorders [4] and a common goal in their treatment [5]. Resilience is associated with self-esteem and self-efficacy [6,7]. Furthermore, life satisfaction is a closely-related construct [8-10]. As mentioned above, resilience can protect individuals against mental disorders and is thus associated with well-being and measures of mental health [11-13]. This means, assessment, practice, as well as maintenance of resilience can be important topics in the treatment of mental disorders [14].

The Resilience Scale (RS) was developed by Wagnild and Young [15]. It is generally considered to be the most reliable and valid instrument for measuring an individual’s resilience [16-18]. Namely, it is valid towards psychological constructs such as hopelessness, social connectedness, life satisfaction, anxiety, depression, stress, and health promoting activities [16,19,20]. Von Eisenhart Rothe et al. [1] developed the Resilience Scale-5 (RS-5) for application in settings that do not allow for long questionnaires, such as large cohort studies and specifically older populations. They found a uni-factorial model consisting of the RS-11 items 3, 6, 7, 8, and 9 (or C, F, G, H, and I) to display the best fit, explaining 57% of total variance.

The main objective of the present study was to validate the RS-5 in a representative sample of the general population. This includes the analysis of item characteristics, validity, reliability, and factor structure, as well as an analysis of measurement invariance, especially across different age groups. Furthermore, differences in resilience based on sociodemographic variables were investigated. Finally, norm values were to be established.

Methods

Sample

The study sample was acquired with the assistance of a demographic research institute (USUMA, Berlin), abiding by the German law of data protection (§30a BDSG, German law of protection of data privacy). Furthermore, the study conformed to the guidelines outlined in the Declaration of Helsinki [21]. The sampling procedure first targeted random sample point areas, then a random household within those areas, and finally chose a person within these households. Of the 8106 potential participants, which had been randomly selected, 3070 (37.9%) either did not respond or refused to take part in the study. All participants gave their informed consent before participating in the study. Where applicable, a caretaker or legal guardian gave consent instead of the participant. The total sample consisted of n=5036 participants, who were at least 14 years of age and living in Germany in 2006. Detailed sample characteristics are displayed in Table 1. The sample can be considered representative of the German population by the criteria of age, sex, and educational level based on official statistics [22]. Sixty-four participants (1.3%) did not complete all items relevant to the RS-5. Those participants differed significantly from the main sample in terms of their age distribution (U=129010.5, n1=4972, n2=64, p=.009) and were excluded from any further analysis leading to a final sample size of n=4972. Participants answered the questionnaires listed below among others in Table 1.

Measures

The Resilience Scale-11 (RS-11; [23,24]) was used to measure resilience. Answer options range from 1 (“strongly disagree”) to 7 (“strongly agree”), and a scale score can be obtained by calculating the sum of the items in question. Von Eisenhart Rothe et al. [1] found a Cronbach’s α of .80 for the shorter RS-5 scale.

To measure symptoms of depression, the Patient Health Questionnaire-2 (PHQ-2; [25,26]) was employed. The two items of the scale, which range from 0 (“not at all”) to 3 (“nearly every day”), are added up to obtain the scale score. Retest-reliability is reported as r=.83.

The General Anxiety Disorder Scale-7 (GAD-7; [27,28]) was utilized to assess the anxiousness of participants. It consists of seven items, which are answered on a 4-point Likert scale, ranging from 0 (“Not at all”) to 3 (“Almost every day”). The sum score can therefore range from zero to 21. Participants with a score above or equal to 10 are generally classified as anxious according to Kroenke, Spitzer, Williams, Monahan, and Löwe [29]. Cronbach’s α is reported as .89 [30].

Table 1 Sample characteristics, including RS-5 sum score means and standard deviations.

Self-esteem was measured utilizing the Rosenberg Self- Esteem Scale (RSES; [31-33]), which consists of ten items, half of which are to be inverted before calculating a scale sum score. Participants indicate the extent to which they agree with presented statements on a 4-point scale, ranging from 0 (“do not agree at all”) to 3 (“completely agree”). Internal consistency is reported as α=84.

For the measurement of life satisfaction, the Questionnaire for Life Satisfaction-M (QLS-M; [31-34]), consisting of 16 items was used. Participants first indicate on a 7-point scale how important a given topic is to them, and then specify how satisfied they are with their lives in terms of this topic. A weighted score is obtained by multiplying subjective importance and satisfaction. The sum of all 8 products represents the scale score. Cronbach’s α is reported as .83 by Daig et al. [34].

The screening version of the Recalled Parental Rearing Behavior Questionnaire [35] was utilized to assess the upbringing of participants. It consists of six items for two scales, asking for memories of the participant’s father and mother, respectively, on a 4-point scale, ranging from 1 (“No, never”) to 4 (“Yes, always”). Two items each make up one of three latent factors, which are “Rejection and Punishment” (RP), “Emotional Warmth” (EW), and “Control and Overprotection” (CO). No measures of reliability are reported because of the measure’s brevity.

Statistical analysis

IBM SPSS Statistics 23 was used for most statistical calculations. The confirmatory factor analysis (CFA) was conducted in IBM AMOS 23. The Pearson product-moment correlation coefficient was used for all correlations. The α level of significance tests was .05 unless noted otherwise. Means and standard deviations of the RS-5 scale and its items were determined, in addition to item difficulty and corrected itemtotal correlations. The RS-5 scale and items were tested for normality of distribution by calculating skewness and kurtosis. For the CFA, covariance matrices and the maximum likelihood method were utilized. Common fit indices were employed to judge model fit, including χ², the minimum discrepancy divided by degrees of freedom (CMIN/DF), the comparative fit index (CFI), the Tucker–Lewis Index (TLI), the standardized root mean square residual (SRMR), and the root mean square error of approximation (RMSEA) and its 90% confidence interval. Recommended levels for these measures are reported as lower than five for CMIN/DF, larger than .95 for CFI and TLI, lower than .08 for SRMR and RMSEA [36-38].

Measurement invariance was tested in three steps using multiple-group analysis. First, the configural model – without any constraints – was compared to the metric model, which constrains unstandardized item loadings to be equal across groups. Secondly, the metric model and the scalar model, which constrains unstandardized item loadings and intercepts across groups, were compared. Commonly used fit indices for these comparisons are the difference in CFI and gamma hat [39,40]. The χ²-statistic is also considered and reported despite its sensitivity to sample size.

Analyses of variance were conducted in order to test for differences in RS-5 scores across sociodemographic groups of gender, age, and education level. Additionally, post hoc tests in the form of Tukey’s HSD were conducted. Counteracting the accumulation of α error probability, a significance level of .01 was employed in both the ANOVAs and the post hoc tests. Cohen’s d is also reported, with greater than .2 being a small, greater than .5 being a medium, and greater than .8 being a large effect [41].

Results

Reliability and item characteristics

Internal consistency of the RS-5 scale was α=.87. Skewness and Kurtosis are within the commonly agreed upon thresholds of lower than 1 for skewness and lower than 3 for kurtosis, indicating a normal distribution of the RS-5 items and scale [42,43]. The difficulty indices of RS-5 items were between .70 and .76, which means the items were generally answered in the affirmative by most participants. Furthermore, the items satisfied the common cutoff point for corrected item-total correlations of being higher than .50 [44]. Details can be found in Table 2.

Table 2: Descriptive item characteristics.

Factor structure

Von Eisenhart Rothe et al. [1] proposed a model consisting of the RS-items C, F, G, H, and I. In the present study, the CFA of those same items shows acceptable to good model fit for the entire population, as can be seen in Table 3.

Table 3 Model fit indices in the CFA.

Loadings of individual items on the latent variable were between .66 and .88. Total variance explained for the five variables was approximately 65%.

The results of the analysis of measurement invariance across sociodemographic groups of gender, age, and education are displayed in Table 4.

Table 4 Fit indices for the multigroup analysis.

The differences in CFI and gamma hat between models did not exceed .01. Therefore, scalar invariance could be shown for males and females as well as for different age and education groups.

Mean differences with regard to sociodemographic variables

Men were found to score significantly higher when compared to women, t(4933.08)=2.86, p=.004, d=.08. Age groups also differed with statistical significance in RS-5 score, F(24969)=64.35, p<.001, η²=.03. So did education groups, F(34968)=80.49, p<.001, η²=.05. Groups of employment status differed in their resilience scores, F(44967)=55.48, p<.001, η²=. 04, as well did groups of family status F(54966)=24.78, p<.001, η²=.02. Finally, participants of different monthly net household income showed significant differences in RS-5 scores, F(34968)=55.48, p<.001, η²=.04. Means and standard deviations for all groups can be found in Table 1.

Validity

To investigate the validity of the RS-5 scale, correlations to related psychological constructs were calculated and are reported in Table 5. A high positive correlation with the RSES was expected and found. Furthermore, there were moderate negative correlations to measures of psychopathology such as the PHQ-2 and the GAD-7. The QLS-M, which measures life satisfaction, was also moderately associated with the RS-5 scale. The FEE subscales were weakly correlated with the RS-5.

Table 5 Correlations between the RS-5 and related psychological measures.

Discussion

The main objective of the present study was to validate the RS-5 in the general population, specifically younger participants, and examine its psychometric properties. The RS-5 scale was shown to have good internal consistency with an α of .87, which is only slightly lower than that found in Schumacher’s analysis of the longer RS-11 (α=.91) [23]. This is evidence of the RS-5 scale’s capability to measure resilience reliably with just a fifth of the items of the original RS-25 scale. Furthermore, factor loadings for all items of the RS-5 on a common factor were well above .50, indicating the validity of the single factor solution [44]. CFI, TLI, and SRMR demonstrate very good fit, while RMSEA along with the χ²-statistic and the CMIN/DF revealed mediocre to unacceptable fit. Both, the χ²- test and the CMIN/DF, however, are well-known to be sensitive to sample size [45] and should thus be interpreted with caution. Overall, model fit can thus be considered acceptable. Additionally, measurement invariance could be shown across groups of gender, age, and education. This means, the model fits the data equally well for any of these sociodemographic subgroups and thus allows for statistical comparisons between them.

The construct validity of the RS-5 was shown via correlations to several related psychological constructs. Firstly, the scale correlates highly with the RSES. This was expected, as the extent to which an individual can be resilient is closely linked to their self-esteem [6,7]. Furthermore, the expected correlation to the QLS-M, measuring life satisfaction, was moderately high. This finding is consistent with prior research indicating that resilient individuals are often more satisfied with life [8-10]. Secondly, there was a negative association between RS-5 and measures of psychopathology (PHQ-2 and GAD-7). Per definition, resilience describes an individual’s fortitude against obstacles and adverse circumstances, and, therefore, moderate negative correlations to aforementioned measures were anticipated and could be confirmed [11-13]. Finally, the FEE correlated very weakly with the RS-5 questionnaire, indicating that parental rearing behavior is just barely or not at all associated with an individual’s resilience later in life.

The analysis of differences between individuals in resilience based on sociodemographic characteristics revealed effects of varying size that should be more thoroughly investigated in further studies.

Study limitations

Table 6, the present study utilized the 11-item version of the Resilience Scale. Thus, further validation of the RS-5 should be carried out, in order to rule out any external influences on the measurement.

Table 6 Normative percentile values for the general population.

Conclusion

To sum up, the RS-5 is a reliable and valid measure of resilience for older and younger populations alike. It displays a good model fit and can be recommended for usage in research and clinical applications.

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