The Efficacy of Resiliency Training Programs: A Systematic Review and Meta-Analysis of Randomized Trials

Importance
Poor mental health places a burden on individuals and populations. Resilient persons are able to adapt to life’s challenges and maintain high quality of life and function. Finding effective strategies to bolster resilience in individuals and populations is of interest to many stakeholders.
Objectives
To synthesize the evidence for resiliency training programs in improving mental health and capacity in 1) diverse adult populations and 2) persons with chronic diseases.
Data Sources
Electronic databases, clinical trial registries, and bibliographies. We also contacted study authors and field experts.
Study Selection
Randomized trials assessing the efficacy of any program intended to enhance resilience in adults and published after 1990. No restrictions were made based on outcome measured or comparator used.
Data Extraction and Synthesis
Reviewers worked independently and in duplicate to extract study characteristics and data. These were confirmed with authors. We conducted a random effects meta-analysis on available data and tested for interaction in planned subgroups.
Main Outcomes
The standardized mean difference (SMD) effect of resiliency training programs on 1) resilience/hardiness, 2) quality of life/well-being, 3) self-efficacy/activation, 4) depression, 5) stress, and 6) anxiety.
Results
We found 25 small trials at moderate to high risk of bias. Interventions varied in format and theoretical approach. Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled SMD 0.37 (95% CI 0.18, 0.57) p = .0002; I2 = 41%] within 3 months of follow up. Improvement in other outcomes was favorable to the interventions and reached statistical significance after removing two studies at high risk of bias. Trauma-induced stress-directed programs significantly improved stress [−0.53 (−1.04, −0.03) p = .03; I2 = 73%] and depression [−0.51 (−0.92, −0.10) p = .04; I2 = 61%].
Conclusions
We found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes. Further study is needed to better define the resilience construct and to design interventions specific to it.
Registration Number
PROSPERO #CRD42014007185

研究意义：不良心理健康状况会给个体及群体带来沉重负担。心理弹性（resilience）良好的个体能够适应生活中的各类挑战，并维持较高的生活质量与社会功能。探寻能够有效提升个体与群体心理弹性的策略，受到众多利益相关方的广泛关注。
研究目的：系统综述心理弹性训练项目在改善两类人群的心理健康状况与功能水平方面的证据：1）多样化成年人群体；2）慢性病患者。
数据来源：电子数据库、临床试验注册平台及参考文献列表。此外，研究团队还联系了相关研究作者与领域专家。
研究筛选标准：纳入1990年后发表的、评估任何旨在提升成人群体心理弹性的干预项目有效性的随机对照试验，未对所纳入研究的结局指标或对照干预类型设置限制。
数据提取与合成方法：由两名评审员独立、重复地提取研究特征与相关数据，并与原研究作者核对确认。研究团队对可获取的数据进行随机效应模型Meta分析，并对预设亚组进行交互效应检验。
主要结局指标：心理弹性训练项目对以下6类指标的标准化均数差（standardized mean difference，SMD）效应：1）心理弹性/坚韧性；2）生活质量/主观幸福感；3）自我效能/功能激活；4）抑郁症状；5）心理压力；6）焦虑症状。
研究结果：本研究共纳入25项样本量较小且偏倚风险为中至高的随机对照试验。干预项目的实施形式与理论基础存在较大异质性。随机效应模型Meta分析结果显示，在随访3个月内，针对普遍性压力的心理弹性训练项目对提升心理弹性具有中等程度的效应[合并SMD=0.37，95%置信区间(0.18, 0.57)，p=0.0002；I²=41%]。其余结局指标的改善均有利于干预组，在剔除2项高偏倚风险的研究后，该差异达到统计学显著性。针对创伤相关压力的心理弹性训练项目可显著改善受试者的心理压力水平[SMD=-0.53，95%置信区间(-1.04, -0.03)，p=0.03；I²=73%]与抑郁症状[SMD=-0.51，95%置信区间(-0.92, -0.10)，p=0.04；I²=61%]。
研究结论：现有证据表明，心理弹性训练项目对提升心理弹性及其他心理健康结局具有小到中等程度的效应，但证据的可信度较低。未来仍需开展进一步研究，以明确心理弹性的构念内涵，并设计针对性的干预方案。
注册编号：PROSPERO #CRD42014007185