A commentary on Ehrlich et al. (2023): a resilience paradox for child development.

Paradoxically, resilience carries with it the risk of disorder. When understood systemically, this should come as no surprise. All complex systems demonstrate this same propensity for both positive and negative feedback loops. A thriving ecosystem eventually succumbs to its own dominance over its environment, using up available resources until its survival is threatened and its population declines (e.g. predators like coyotes in a national park where hunting is prohibited) (Ward et al., 2018). For this reason, systems that demonstrate powerful resistance to threat are, paradoxically, often made vulnerable by their success.

How sustainable is resilience? A mixed-methods study on the COVID-19-pandemic as a challenge to resilience resources of older adults who previously recovered from depression.

OBJECTIVES: Despite expanding knowledge about the internal and external resources that contribute to resilience among individuals who have experienced depression, the long-term accessibility and protectiveness of these resources across different stressors is unknown. We investigated whether and how the resilience resources of individuals who previously recovered from late-life depression remained protective during the COVID-19 pandemic. METHODS: We used a sequential explanatory mixed methods design. Quantitative data were derived from two psychiatric case-control cohorts and included twelve repeated measures during the COVID-19 pandemic (n = 465, aged ≥ 60). Qualitative data included two sequential interviews held in 2020 (n = 25) and 2021 (n = 19). We used thematic analysis to determine the protective resources after depression and during the COVID-19 pandemic and linear mixed models to examine the effect of these resources on change in depressive symptoms during the COVID-19 pandemic. RESULTS: While resources of 'Taking agency', 'Need for rest', 'Managing thought processes' and 'Learning from depression' remained accessible and protective during the pandemic, 'Social support' and 'Engaging in activities' did not. 'Negotiating with lockdown measures', 'changing social contact' and 'changing activities' were compensating strategies. Quantitative data confirmed the protectiveness of social contact, social cohesion, sense of mastery, physical activity, staying active and entertained and not following the media. CONCLUSION: Many of the resources that previously helped to recover from depression also helped to maintain good mental health during the COVID-19 pandemic. Where accessibility and protectiveness declined, compensatory strategies or new resources were used. Hence, the sustainability of resilience is enabled through adaptation and compensation processes.

Multisystemic approaches to researching young people's resilience: Discovering culturally and contextually sensitive accounts of thriving under adversity.

As our understanding of the process of resilience has become more culturally and contextually grounded, researchers have had to seek innovative ways to account for the complex, reciprocal relationship between the many systems that influence young people's capacity to thrive. This paper briefly traces the history of a more contextualized understanding of resilience and then reviews a social-ecological model to explain multisystemic resilience. A case study is then used to show how a multisystemic understanding of resilience can influence the design and implementation of resilience research. The Resilient Youth in Stressed Environments study is a longitudinal mixed methods investigation of adolescents and emerging adults in communities that depend on oil and gas industries in Canada and South Africa. These communities routinely experience stress at individual, family, and institutional levels from macroeconomic factors related to boom-and-bust economic cycles. Building on the project's methods and findings, we discuss how to create better studies of resilience which are able to capture both emic and etic accounts of positive developmental processes in ways that avoid the tendency to homogenize children's experience. Limitations to doing multisystemic resilience research are also highlighted, with special attention to the need for further innovation.

Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study.

In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.

The association between family adversity and youth mental health outcomes.

BACKGROUND: The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the South African context. Furthermore, the overtime interaction between resilience factors, family adversity, and young people's psychological functioning in African settings, like South Africa, is under-investigated. PURPOSE: This study investigates the relationship between family adversity and conduct problems and depression at two-time points in a sample of youths in two South African communities stressed by their dependency on economically volatile oil and gas industries. METHOD: This article draws on longitudinal data generated by the Resilient Youth in Stressed Environments (RYSE) study in South Africa, which included 914 and 528 (wave 1 and 3) adolescents and emerging adults (14-27-year-olds; M age = 18.36 years) living in Secunda/eMbalenhle and Sasolburg/Zamdela. Participants were sampled at baseline (wave 1) and 18-24 months later (wave 3). They self-reported experience of community violence, family adversity, resilience-enabling resources, conduct difficulties, and depression symptoms. Regression analyses were used to examine the unadjusted and adjusted association of family adversity on conduct problem and depression. RESULTS: About 60% of participants reported high family adversity. Regressions, however, revealed no association between family adversity and conduct problems and depression cross-sectionally and over time. Individual resilience, biological sex, and experience of victimization in the community, however, were associated with conduct difficulty while all three resilience factors were associated with decreased depression among participants. CONCLUSION: Our study sheds light on the risk and protective factors for mental health outcomes of adolescents and youths who reside in volatile, turbulent communities and experience ongoing familial challenges. To effectively support the mental well-being of young individuals in such contexts, interventions must consider the potential ambivalence of the resilience factors they aim to strengthen.

Shifting Professional Identity Among Indonesian Medical Practitioners During the COVID-19 Pandemic.

The COVID-19 pandemic has had a significant impact on medical practitioners' professional identities due to its novelty and intensity. Using constructivist grounded theory, we investigated how the COVID-19 pandemic shifted individuals' identities as medical practitioners in Indonesia, where the pandemic caused high death rates among healthcare workers, particularly medical practitioners. By interviewing 24 medical practitioners and analyzing relevant documents and reports, we developed a grounded theory of professional identity shifts. We found two patterns: (1) identity growth, in which the medical practitioners thrive and claimed stronger professional identities, and (2) psychological and moral distress leading to attrition, facilitated adaptation, or professional identity collapse. We also found several primary protective factors including religious beliefs, good leadership, team cohesion, healthy work boundaries, connection to significant others, and public acknowledgment. Without adequate protective factors, medical practitioners experienced difficulties redefining their professional identities. To cope with the situation, they focused on different identities, took some time off, or sought mental health support, resulting in facilitated adaptation. Others resorted to attrition or experienced professional identity collapse. Our findings suggest that medical practitioners' experience of professional identity shifts can be improved by providing medical practitioners with opportunities for knowledge updates, better organizational leadership and work boundaries, strategies to enhance team cohesion, and other improvements to medical systems.

Multisystemic Resources Matter for Resilience to Depression: Learning From a Sample of Young South African Adults.

This article interrogates the continuing emphasis on personal sources of resilience; it also amends the inattention to the protective factors and processes (PFPs) that support the mental health resilience of African emerging adults. To that end, we report a study that explored which PFPs distinguished risk-exposed South African 18- to 29-year-olds with negligible depression symptoms from those who reported moderate to severe symptoms. Using an arts-based approach, young people volunteered the PFPs they had personally experienced as resilience-enabling. An inductive thematic analysis of visual and narrative data, generated by young people self-reporting high exposure to family and community adversity (n = 233; mean age: 24.63, SD: 2.43), revealed patterns in the PFPs relative to the severity of self-reported depression symptoms. Specifically, young people reporting negligible depression symptoms reported a range of PFPs associated with psychological, social, and ecological systems. In contrast, the PFPs identified by those reporting more serious depression symptoms were mostly restricted to personal strengths and informal relational supports. In the interests of youth mental health, the findings direct society's attention to the criticality of facilitating young people's access to a composite of resources rooted in personal, social, and ecological systems.

Student resilience to COVID-19-related school disruptions: The value of historic school engagement.

Does historic school engagement buffer the threats of disrupted schooling - such as those associated with the widespread COVID-19-related school closures - to school engagement equally for female and male high school students? This article responds to that pressing question. To do so, it reports a study that was conducted in 2018 and 2020 with the same sample of South African students (n = 172; 66.30% female; average age in 2020: 18.13). A moderated moderation model of the 2018 and 2020 data showed that historic levels of school engagement buffered the negative effects of disrupted schooling on subsequent school engagement (R² = .43, ß = -5.09, p < .05). This protective effect was significant for girl students at moderate and high levels of historic school engagement, but not at lower levels of historic school engagement. Disrupted schooling did not significantly affect school engagement for male students at any level of historic school engagement. In addition, student perceptions of teacher kindness were associated with higher school engagement and having experienced an adverse event at school with lower school engagement. The results point to the importance of facilitating school engagement and enabling school environments - also when schooling is disrupted.

Respiratory health among adolescents living in the Highveld Air Pollution Priority Area in South Africa.

BACKGROUND: Air pollution is a global, public health emergency. The effect of living in areas with very poor air quality on adolescents' physical health is largely unknown. The aim of this study was to investigate the prevalence of adverse respiratory health outcomes among adolescents living in a known air pollution hotspot in South Africa. METHODS: Ambient air quality data from 2005 to 2019 for the two areas, Secunda and eMbalenhle, in the Highveld Air Pollution Priority Area in Mpumalanga province, South Africa were gathered and compared against national ambient air pollution standards and the World Health Organization Air Quality Guidelines. In 2019, adolescents attending schools in the areas completed a self-administered questionnaire investigating individual demographics, socio-economic status, health, medical history, and fuel type used in homes. Respiratory health illnesses assessed were doctor-diagnosed hay fever, allergies, frequent cough, wheezing, bronchitis, pneumonia and asthma. The relationship between presence (at least one) or absence (none) of self-reported respiratory illness and risk factors, e.g., fuel use at home, was explored. Logistic regression was used to estimate the odds ratio and 95% confidence interval (CI) of risk factors associated with respiratory illness adjusted for body mass index (measured by field assistants), gender, education level of both parents / guardians and socio-economic status. RESULTS: Particulate matter and ozone were the two pollutants most frequently exceeding national annual air quality standards in the study area. All 233 adolescent participants were between 13 and 17 years of age. Prevalence of self-reported respiratory symptoms among the participants ranged from 2% for 'ever' doctor-diagnosed bronchitis and pneumonia to 42% ever experiencing allergies; wheezing chest was the second most reported symptom (39%). Half (52%) of the adolescents who had respiratory illness were exposed to environmental tobacco smoke in the dwelling. There was a statistically significant difference between the presence or absence of self-reported respiratory illness based on the number of years lived in Secunda or eMbalenhle (p = 0.02). For a one-unit change in the number of years lived in an area, the odds of reporting a respiratory illness increased by a factor of 1.08 (p = 0.025, 95% CI = 1.01-1.16). This association was still statistically significant when the model was adjusted for confounders (p = 0.037). CONCLUSIONS: Adolescents living in air polluted areas experience adverse health impacts Future research should interrogate long-term exposure and health outcomes among adolescents living in the air polluted environment.

Investigating the Interrelations Between Systems of Support in 13- to 18-Year-Old Adolescents: A Network Analysis of Resilience Promoting Systems in a High and Middle-Income Country.

Adolescents' ability to function well under adversity relies on a network of interrelated support systems. This study investigated how consecutive age groups differ in the interactions between their support systems. A secondary data analysis of cross-sectional studies that assessed individual, caregiver, and contextual resources using the Child and Youth Resilience Measure (Ungar & Liebenberg, 2005) in 13- to 18-year-olds in Canada (N = 2,311) and South Africa (N = 3,039) was conducted applying network analysis. Individual and contextual systems generally showed the highest interconnectivity. While the interconnectivity between the individual and caregiver system declined in the Canadian sample, a u-shaped pattern was found for South Africa. The findings give first insights into cross-cultural and context-dependent patterns of interconnectivity between fundamental resource systems during adolescence.

Family Resilience in a Resource-Cursed Community Dependent on the Oil and Gas Industry.

The economic and social well-being of rural, "resource-cursed" communities can depend on the boom-bust cycles of a single industry like oil and gas. This study used a constructivist, inductive approach to identify the challenges placed on families in one such community and the processes that strengthen family resilience. Semi-structured interviews were conducted with 35 adult residents (30-76 years old, 19 women) from a community in Alberta, Canada, that has specialized in oil and gas extraction for 70 years and experienced its worst economic downturn while the study was underway. Results showed that many families have experienced an endless cycle of poor work-life balance and income instability throughout the economic cycle. Family life often lacked social cohesion as a consequence of demanding work schedules and economic pressures. Additional challenges were the perceived negative effects of rigid gender roles, substance abuse, family conflicts, and domestic violence. Crucial strengthening processes for family resilience were fundamental financial and living standard adaptations (e.g., living within or below one's economic means; having both spouses become earners), maintaining regular contact by having a flexible home routine, and mutually agreeing to change roles during busts (former earners take responsibility for caregiving and running of the household and vice versa). Alternatively, accepting economic volatility and its impact on normal family life processes were essential for family resilience. Findings suggest the need for clinicians to help families foster resilience in communities that depend on resource extraction industries with concurrent adaptations required by individuals, families, and socio-political and economic systems.

El bienestar económico y social de las comunidades rurales "malditas por los recursos" puede depender de los ciclos de auge y caída de una industria única como la del petróleo y el gas. En este estudio se usó un método constructivista e inductivo para identificar las dificultades que enfrentan las familias en una comunidad de este tipo y los procesos que fortalecen la resiliencia familiar. Se realizaron entrevistas semiestructuradas con 35 adultos residentes (de entre 30 y 76 años, 19 mujeres) de una comunidad de Alberta, Canadá, que se ha especializado en la extracción de petróleo y gas durante 70 años y sufrió su peor recesión económica mientras el estudio estaba en marcha. Los resultados indicaron que muchas familias han pasado por un ciclo interminable de desequilibrio entre la vida personal y la laboral, y por la inestabilidad de ingresos durante todo el ciclo económico. La vida familiar con frecuencia careció de integración social como consecuencia de horarios de trabajo demandantes y presiones económicas. Otras dificultades fueron los efectos negativos percibidos de los roles de género rígidos, el abuso de sustancias, los conflictos familiares y la violencia doméstica. Los procesos de fortalecimiento esenciales para la resiliencia familiar fueron las adaptaciones fundamentales de los niveles de vida y económicos (p. ej.: vivir dentro o por debajo de los medios económicos propios; hacer que ambos cónyuges sean asalariados), mantener contacto periódico teniendo una rutina flexible en el hogar y acordar mutuamente cambiar de roles durante las recesiones (los exasalariados asumen la responsabilidad del cuidado y el funcionamiento del hogar, y viceversa). Alternativamente, aceptar la volatilidad económica y su efecto en los procesos normales de la vida familiar fue esencial para la resiliencia familiar. Los resultados indican la necesidad de que los profesionales clínicos ayuden a las familias a fomentar la resiliencia en las comunidades que dependen de las industrias de extracción de recursos mediante adaptaciones simultáneas necesarias para las personas, las familias y los sistemas sociopolíticos y económicos.

Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach.

BACKGROUND: Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4-17 years). This paper outlines a protocol for implementing such complex community-driven research. METHODS/DESIGN: Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children's social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. DISCUSSION: The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.

Resilience in Context: A Brief and Culturally Grounded Measure for Syrian Refugee and Jordanian Host-Community Adolescents.

Validated measures are needed for assessing resilience in conflict settings. An Arabic version of the Child and Youth Resilience Measure (CYRM) was developed and tested in Jordan. Following qualitative work, surveys were implemented with male/female, refugee/nonrefugee samples (N = 603, 11-18 years). Confirmatory factor analyses tested three-factor structures for 28- and 12-item CYRMs and measurement equivalence across groups. CYRM-12 showed measurement reliability and face, content, construct (comparative fit index = .92-.98), and convergent validity. Gender-differentiated item loadings reflected resource access and social responsibilities. Resilience scores were inversely associated with mental health symptoms, and for Syrian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth.

Children and youth's biopsychosocial wellbeing in the context of energy resource activities.

BACKGROUND: Children and youth emerge as key populations that are impacted by energy resource activities, in part because of their developmental vulnerabilities, as well as the compounding effects of energy systems on their families, communities, and physical environments. While there is a larger literature focused on fossil fuel emissions and children, the impacts of many aspects of energy systems on children and youth remain under examined and scattered throughout the health, social science, and environmental science literatures. OBJECTIVES: This systematic interdisciplinary review examines the biological, psychosocial, and economic impacts of energy systems identified through social science research - specifically focused on household and industrial extraction and emissions - on children and youth functioning. METHODS: A critical interpretive search of interdisciplinary and international social sciences literature was conducted using an adaptive protocol focusing on the biopsychosocial and economic impacts of energy systems on children and youth. The initial results were complemented with a purposeful search to extend the breadth and depth of the final collection of articles. DISCUSSION: Although relatively few studies have specifically focused on children and youth in this context, the majority of this research uncovers a range of negative health impacts that are directly and indirectly related to the development and ongoing operations of natural resource production, particularly oil and gas, coal, and nuclear energy. Psychosocial and cultural effects, however, remain largely unexamined and provide a rich avenue for further research. CONCLUSIONS: This synthesis identifies an array of adverse biopsychosocial health outcomes on children and youth of energy resource extraction and emissions, and identifies gaps that will drive future research in this area.

Practitioner Review: Diagnosing childhood resilience--a systemic approach to the diagnosis of adaptation in adverse social and physical ecologies.

BACKGROUND: With growing interest in resilience among mental health care providers globally, there is a need for a simple way to consider the complex interactions that predict adaptive coping when there is exposure to high levels of adversity such as family violence, mental illness of a child or caregiver, natural disasters, social marginalization, or political conflict. METHODS: This article presents diagnostic criteria for assessing childhood resilience in a way that is sensitive to the systemic factors that influence a child's wellbeing. The most important characteristics of children who cope well under adversity and avoid problems like depression, PTSD, and delinquency are highlighted. RESULTS: A multidimensional assessment of resilience is presented that examines, first, the severity, chronicity, ecological level, children's attributions of causality, and cultural and contextual relevance of experiences of adversity. Second, promotive and protective factors related to resilience are assessed with sensitivity to the differential impact these have on outcomes depending on a child's level of exposure to adversity. These factors include individual qualities like temperament, personality, and cognitions, as well as contextual dimensions of positive functioning related to the available and accessibility of resources, their strategic use, positive reinforcement by a child's significant others, and the adaptive capacity of the environment itself. Third, an assessment of resilience includes temporal and cultural factors that increase or decrease the influence of protective factors. A decision tree for the diagnosis of resilience is presented, followed by a case study and diagnosis of a 15-year-old boy who required treatment for a number of mental health challenges. CONCLUSIONS: The diagnostic criteria for assessing resilience and its application to clinical practice demonstrate the potential usefulness of a systemic approach to understanding resilience among child populations.

Social ecological complexity and resilience processes.

A social ecological model of resilience avoids the reductionism of simple explanations of the complex and multisystemic processes associated with well-being in contexts of adversity. There is evidence that when stressors are abnormally high, environmental factors account for more of an individual's resilience than do individual traits or cognitions. In this commentary, a social ecological model of resilience is discussed.

Meanings of well-being from the perspectives of youth recently diagnosed with psychosis.

BACKGROUND: The phenomenon of well-being has attracted a surge of attention in mental health policy, clinical practice and research internationally. Yet, the definitions of well-being remain elusive, and there is limited understanding on its meanings from the perspectives of youth mental health service users. OBJECTIVE: This study explored the meanings of well-being from the perspectives of youth mental health service users diagnosed with psychosis in the past 3 years. METHODS: Using a qualitative approach, we conducted semi-structured interviews and participant-photography elicited focus groups with 17 youth recruited from an early intervention program for psychoses and a mental health program specializing in the delivery of psychiatric services to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. FINDINGS: The findings illustrate five key themes in participants' conceptualizations of well-being: multidimensionality; active oriented states; social environment; identity; and normality. Dimensions of well-being identified in participants' accounts include: psychological, physical, emotional, moral/virtuous, financial/material, spiritual, and social aspects. CONCLUSIONS: Our heuristic framework for conceptualizing well-being, grounded in the narrative accounts of youth participants, can inform the future planning and design of interventions, research, and outcome measures pertaining to the well-being of youth recently diagnosed with psychosis.

Annual Research Review: What is resilience within the social ecology of human development?

BACKGROUND:   The development of Bronfenbrenner's bio-social-ecological systems model of human development parallels advances made to the theory of resilience that progressively moved from a more individual (micro) focus on traits to a multisystemic understanding of person-environment reciprocal processes. METHODS:   This review uses Bronfenbrenner's model and Ungar's social-ecological interpretation of four decades of research on resilience to discuss the results of a purposeful selection of studies of resilience that have been done in different contexts and cultures. RESULTS:   An ecological model of resilience can, and indeed has been shown to help researchers of resilience to conceptualize the child's social and physical ecologies, from caregivers to neighbourhoods, that account for both proximal and distal factors that predict successful development under adversity. Three principles emerged from this review that inform a bio-social-ecological interpretation of resilience: equifinality (there are many proximal processes that can lead to many different, but equally viable, expressions of human development associated with well-being); differential impact (the nature of the risks children face, their perceptions of the resources available to mitigate those risks and the quality of the resources that are accessible make proximal processes more or less influential to children's development); and contextual and cultural moderation (different contexts and cultures provide access to different processes associated with resilience as it is defined locally). CONCLUSION:   As this review shows, using this multisystemic social-ecological theory of resilience can inform a deeper understanding of the processes that contribute to positive development under stress. It can also offer practitioners and policy makers a broader perspective on principles for the design and implementation of effective interventions.

Well-being and engagement in valued activities: experiences of young people with psychosis.

The purpose of this study was to understand how engagement in valued activities contributes to the well-being of young people diagnosed as having psychosis within the past 3 years. Using a qualitative approach, the authors conducted semi-structured interviews and photography-elicited focus groups with 17 participants between the ages of 18 and 24 years who were recruited from an early intervention program for psychoses and a psychiatric service specializing in providing care to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Participants derived six well-being enhancing experiences from engaging in highly valued activities: making meaning; expressing thoughts and emotions; changing physical, emotional, and cognitive states; cultivating skills, strengths, and virtues; connecting and belonging; and making a contribution. These findings highlight the importance of identifying activities that young people perceive as being valuable to their well-being, the meanings and experiences derived from these activities, and how best to support engagement in them. [OTJR: Occupation, Participation and Health. 2013;33(4):190-197.].

Resilience to Self-Harm.

Background: Although a wide range of studies discuss prevalence and risk factors associated with self-harm, protective factors that are equally important are rarely explored. Moreover, much of our understanding of young individuals who engage in self-harm come from studies conducted in Western countries with very little emphasis on marginalized groups. Aim: This scoping review identifies research on resilience among marginalized youth and youth living in low- and middle-income countries (LMICs) who show evidence of self-harm. Method: A scoping review following Arksey and O'Malley's (2005) framework was conducted. This effort included drawing upon peer-reviewed research published between January 2000 and September 2020 to identify protective factors and coping strategies that are employed by individuals 10-29 years old with self-harming tendencies. Results: A total of 15 original papers met the inclusion criteria. The majority of the LMIC publications were from China. Social support, positive youth development, and religiosity were the most frequently reported protective factors. Conclusion: Despite widespread concern about self-harm, there are few peer-reviewed articles that look at resilience or recovery among youth in LMICs and among marginalized young people. In addition to various internal and external protective factors, this scoping review identifies gaps in our understanding of resilience to self-harm among youth belonging to these groups.