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Resilience to health challenges is related to different ways of thinking: mediators of physical and emotional quality of life in a heterogeneous rare-disease cohort

Abstract

Background

We sought to understand what distinguishes people who confront health challenges but still manage to thrive. This study investigated whether resilience helps to explain the impact of health challenges on quality of life (QOL) outcomes, and how resilience relates to appraisal.

Methods

A web-based survey of rare-disease panel participants included the Centers for Disease Control Healthy Days Core Module, the PROMIS-10, and comorbidities. The QOL Appraisal Profile—v2 assessed cognitive processes underlying QOL. Resilience was operationalized statistically using residual modeling, and hierarchical regressions tested the mediation hypothesis that resilience accounts for a significant amount of the relationship of appraisal to QOL.

Results

The study sample (n = 3,324; mean age 50; 86% female; 90% White) represented a range of diagnostic codes, with cancer and diseases of the nervous system being the most prevalent health conditions. After adjusting for comorbidities (catalysts), resilience was associated with better physical and emotional functioning, and different appraisal processes were associated with better or worse physical or emotional functioning. After controlling for catalysts, 62% of the association of Physical Functioning and 23% of the association between Emotional Functioning and appraisal were mediated by resilience. Physical and emotional resilience comprised some of the same appraisal processes, but physically resilient people were characterized by more appraisal processes than their emotionally resilient counterparts.

Conclusions

Resilient people employ different appraisal processes than non-resilient people, and these processes differ for physical and emotional outcomes. Resilience was a stronger mediator of the relationship between physical rather than emotional functioning and appraisal.

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Acknowledgements

We are grateful to Victoria Powell, M.P.H., for assistance with data management and Jie Zhang, M.P.H., for assistance with manuscript preparation.

Funding

This work was funded by in part by a grant from the Patient-Centered Outcome Research Institute (PCORI #ME-1306-00781) to Dr. Rapkin.

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Correspondence to Carolyn E. Schwartz.

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Conflict of interest

Dr. Rapkin declares that he is the author of the QOL Appraisal Profile, but has no conflict of interest. Drs. Schwartz and Mr. Michael declare that they have no potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Schwartz, C.E., Michael, W. & Rapkin, B.D. Resilience to health challenges is related to different ways of thinking: mediators of physical and emotional quality of life in a heterogeneous rare-disease cohort. Qual Life Res 26, 3075–3088 (2017). https://doi.org/10.1007/s11136-017-1633-2

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Keywords

  • Appraisal
  • Resilience
  • Mediator
  • Cognitive processes
  • Quality of life
  • Patient-reported outcomes
  • Rare disease
  • Chronic disease