Reviews in Clinical Gerontology 2011 21; 152–169 First published online 21 December 2010C© Cambridge University Press 2010 doi:10.1017/S0959259810000420

What is resilience? A review and concept analysisGill WindleDementia Services Development Centre, Institute of Medical Social Care Research, Bangor University, UK

Summary

The complexities of defining what appears to bethe relatively simple concept of resilience are widelyrecognized. This paper analyses the concept of resiliencefrom a range of disciplinary perspectives and clarifies adefinition in order to inform research, policy and practice.The work takes a life course approach to resilience,examining evidence derived from research across thelifespan. It incorporates the methods of systematic review,concept analysis and consultation through face-to-facemeetings. The synthesis of methodological approachesenables a clear identification of the antecedents, definingattributes and consequences of resilience, validated withstakeholder partners. Through this process, resilience isdefined as the process of effectively negotiating, adaptingto, or managing significant sources of stress or trauma.Assets and resources within the individual, their lifeand environment facilitate this capacity for adaptationand ‘bouncing back’ in the face of adversity. Acrossthe life course, the experience of resilience will vary. Alarge proportion of resilience research is routed withinthe discipline of developmental psychology, and hasmainly been developed with children and adolescents. Amajor contribution to resilience research could be madethrough more multi-disciplinary studies that examine thedynamics of resilience across the lifespan, its role inhealthy ageing and in managing loss, such as changesin cognitive functioning.

Key words: resilience, systematic review, conceptanalysis, life course.

Introduction

Research on resilience has increased substantiallyover the past two decades1 and is now alsoreceiving increasing interest from those involvedwith policy and practice in relation to its potentialimpact on health, well-being and quality of life.This interest is due to a move away from‘deficit’ models of illness and psychopathology, as

Address for correspondence: Dr Gill Windle, DementiaServices Development Centre, Institute of MedicalSocial Care Research, Bangor University, Ardudwy,Holyhead Road, Bangor, Gwynedd LL57 2PX, UK.Email: g.windle@bangor.ac.uk

resilience theory focuses on understanding healthydevelopment despite risk, and on strengths ratherthan weaknesses.2

Unfortunately the complexities of defining whatappears to be the relatively simple conceptof resilience are widely recognized, especiallywithin the behavioural sciences.1,3–5 This createsconsiderable challenges when developing anoperational definition of resilience; definitionalvariation leads to inconsistencies relating to thenature of potential risk and protective processes,and in the estimates of prevalence.1,3 A review ofresilience research reporting prevalence data notedthat the proportions found to be resilient variedfrom 25 to 84%.6

This has strong implications for improvingknowledge about the factors that contribute tothe development, maintenance or reduction ofresilience and how resilience might be promotedto improve health and well-being. It is notedthat many of the debates around the definitionof resilience could be addressed by betterscience, including ‘rigorous attention to sharpeningconcepts’.5 In order to inform future research moreclarity is required. This should be derived from athorough methodological assessment to ensure it isunderpinned by a robust scientific approach.

Limitations of current research on the concept ofresilience

A number of discussion papers have contributedsubstantially to the study of resilience and theirvalue to the advancement of knowledge on thetopic is immense.2,3,5,7–10 However, in most casesthese critiques have been mainly embedded withinthe discipline of developmental psychology andderived from studies of children and adolescents.Their content is rich and extremely informative,but it has not been developed from a clearmethodological approach; for example, methodsfor obtaining the papers discussed are notpresented.

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What is resilience? 153

Previous work has examined the concept ofresilience within a recognized analytical frame-work: concept analysis.11,12 Concept analysis is amethod of conceptual knowledge representationand data analysis that is routinely appliedto clarify meanings and develop operationaldefinitions, through considering evidence frommultiple disciplines.13 The application of thisrecognized methodological framework enables amore objective approach to concept clarificationand addresses differences in application withindiverse scientific disciplines.

Unfortunately there are a number of method-ological limitations with both of these previousconcept analyses of resilience.11,12 In the analysispresented by Dyer and McGuiness11 the aims ofthe analysis are not clear, which is a first stepof concept analysis.13 The search strategies forthe literature reviews are not provided, nor isa rationale for which data should be includedor excluded in the analysis. This presents a keydrawback regarding the extent of the coverageof the research literature, as without a thorough,systematic approach it is quite possible that keyomissions were made. This is particularly evidentin both papers. For example, Gillespie et al.12 statethat self efficacy, hope and coping are the definingattributes of resilience. Dyer and McGuiness11 statethat a sense of self, determination and pro-socialattitude are the defining attributes. Whilst theseconstructs may be implicated in resilience, it is notclear why these specific ones were chosen whilstother, equally possible constructs (e.g. self esteem,competence) were excluded. Neither of the paperssynthesize the literature to provide an operationaldefinition of resilience.

As highlighted previously, the method ofconcept analysis can be poorly applied. Beckwithet al.14 note that various concept analysisframeworks have been applied uncritically, andmay not contain sufficient scientific rigour to addto theoretical development. Paley15 also notes that,within concept analysis, there is often a lackof clarity regarding the specification of how thedefining attributes of the concept under questionare identified. This has implications for identifyingwhat might be viewed as a model case of resilience,or identifying other concepts that may be relatedto resilience, or indeed have been used in researchto demonstrate resilience, but on closer inspectionmay not actually share all of the defining attributes.

Research objective

To address the need for concept clarificationand improve the methodological approach inachieving this outcome, the aim of this paperis to present a review of the literature within aconcept analysis framework. This will enable amore robust, theoretically informed measurementframework for future research on resilience. Thispaper synthesizes methodological approaches anddraws on a range of disciplinary perspectives toaddress the question: ‘how can resilience be bestdefined in order to inform research, policy andpractice?’

Specifically, the analysis will:

(i) clarify the meaning of the concept of resiliencefrom a multi-disciplinary perspective;

(ii) develop an operational definition that ismeaningful across different disciplines andstakeholders, and can be universally under-stood and applied across research, policy andpractice;

(iii) highlight implications for future research.

To determine the definition of resilience, thispaper draws on three approaches: concept analysis,literature review using systematic principles, andstakeholder consultation. Full details of themethods can be downloaded from: http://resilience.bangor.ac.uk/Work%20Programme%20Methodology.pdf

Resilience – identifying uses of the concept

Dictionary definitions

Resilience originates from the Latin ‘resilire’ (toleap back). General dictionary definitions note thatthe noun ‘resilience’ is a derivative of the adjective‘resilient,’ which has two uses:

(i) 1. able to recoil or spring back into shapeafter bending, stretching, or being compressed;2. (of a person) able to withstand or recoverquickly from difficult conditions.16

(ii) 1. (of a person) recovering easily and quicklyfrom misfortune or illness; 2. (of an object)capable of regaining its original shape orposition after bending or stretching.17

Resilience is also defined in discipline-specificdictionaries as:

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154 Gill Windle

Figure 1. Flow diagram of review process

(i) the rate at which a system regainsstructure and function following a stress orperturbation;18

(ii) the personal quality of a person exposed tohigh risk factors that often lead to delinquentbehaviour, but they do not do so;19

(iii) a measure of a body’s resistance todeformation. Resilience is usually defined asthe work required to deform an elastic bodyto its elastic limit divided by the volume of thebody.20

The academic search yielded a large amountof potential papers, which were primarily routedin the disciplines of psychology and the socialsciences. The disciplines of education, health andmedicine feature to a lesser extent. Figure 1summarizes the process of the review.

Common within many of the papers was therecognition of the difficulties in defining resilience.Many authors went to commendable lengths tojustify their description of the concept, drawingon theory and other research to inform theirchoice. In many instances authors did not presenttheir own definition of resilience, but discussed

the definitions and applications of other keyresearchers in the field of resilience research. Dueto the volume of papers identified and to avoidrepetition, a representative overview is presented.This was ascertained through examining theauthors’ definition, and the supporting citations.These reflect the uses of the concept within differentdisciplines.

Developmental psychology

Underpinning the rationale for many researchersis the early work from developmental psychologyon stress-resistant children by Garmezey,21 whoset the scene for subsequent research to explorehow protective factors might function. Mastenet al.22 defined resilience as the process of,capacity for, or outcome of successful adaptationdespite challenging or threatening circumstances.Observations from longitudinal research span-ning four decades describe resilience as aninnate self-righting mechanism.23 More recentlyresilience has been defined as good outcomesin spite of serious threats to adaptation ordevelopment.24

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What is resilience? 155

Context – the life course

In many instances the risk or adversity is notan isolated event that the person is able toactively change. For example, a common adversityin studies of resilient children and adolescentsis poverty and deprivation. From a life courseperspective poverty and deprivation can persist.However, as adults develop there are a number ofother adverse occurrences that create irreversiblelosses, such as bereavement of friends and relatives,unemployment, divorce and ill-health.

In relation to the study of older age, Staudingeret al.25 propose that the management of lossshould also be considered. Adaptation to situationssuch as chronic illness may be at a lower levelof functioning, but should still be consideredresilience, given the context of the adversity.26 Inhis research of adult trauma and bereavement,Bonnano7,27 recognizes this distinction in theexperience of adversity and notes that adultadversities are more likely to be isolated, butare potentially highly disruptive. He defines adultresilience as an individual’s capacity to resistmaladaptation in the face of risky experiencesand to maintain a stable equilibrium. Froma longitudinal perspective, resilience has beendefined as the ability to ‘bounce back’ fromadversity and go on with life.28 Within a lifespandevelopment framework, the examination of theability to bounce back from earlier dysfunctioncan highlight adaptation and turning points at allstages of the life course.32 This reflects the notionof ‘steeling effects’, an important aspect of Rutter’swork30 in relation to the life course, where effectivenegation of risk exposure earlier in life facilitates aresilient response later.

Environmental perspectives on resilience

As with the dictionary definitions, there aredefinitions used within specific academic discip-lines. From the ecological perspective comes theidea of social resilience, the ability of groupsor communities to cope with external stressesand disturbances as a result of social, politicaland environmental change.31 In the face of anenvironmental disaster, social–ecological resilienceis defined as how far a particular relationshipbetween social processes (e.g. informal networkswithin civil society and the private sector) andecological dynamics can be disturbed without

dramatic loss of complexity of both, rather thanthe speed at which the status quo can be restoredafter disturbance.32 In the context of schooland education, resilience is the ability to thriveacademically despite adverse circumstances.33,34

Biology and psychiatry

From the field of psychiatry, overcoming stressor adversity is how Rutter33 views resilience,with a focus on relative resistance to psychosocialrisk experiences. He notes that the identificationof resilience requires examining a range ofpossible psychological outcomes, not just a focuson an unusually positive one or on super-normal functioning. The limited number ofpapers that looked at the neuroscience/biologicalcontributors to resilience define it as competentfunctioning despite adversity, but emphasize it isa ‘dynamic process that is influenced by neuraland psychological self-organisation, as well astransactions between the ecological context andthe developing organism’.8 Nigg et al.35 alsohighlight that the avoidance of psychopathologyis critical to resilience. From a genetics perspective,resilience can be viewed as the degree to whichthe person at genetic risk for maladaptation andpsychopathology are not affected.3

Personal characteristics

Others suggest that resilience represents personalqualities that enable the individual to thrive inthe face of adversity,36 or that resilience is arelatively stable personality trait37 characterizedby the ability to overcome, steer through andbounce back from adversity.38 Alternatively itmay be viewed as a personality factor thatprotects against life adversities and negativeemotions by resourceful adaptation, flexibility andinventiveness.39 From the policy perspective, in‘Equally Well’, a report from the Ministerial TaskForce in Health Inequalities,40 resilience is alsoviewed as an individual attribute and is defined asa personal strength/vulnerability that can influencesocio-economic inequalities in health. The focus ofresilience as a personal attribute has generally beenaddressed more within the adult literature thanwith children.9 Also, the examination of resilienceby assessment of personality characteristics is apoint of debate in the literature and warrants

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156 Gill Windle

discussion. The main point of contention is thatpsychological resilience is viewed by some asa fixed, stable personality trait37,41 and thatresilience is not, and cannot be, an observed trait.42

Others exercise caution against referring to anyrepresentations of resilience as a stable personalitytrait/characteristic, as this implies that a personwho does not have this attribute is somehow afailure.3

Resilience as a process

As resilience research has developed, so has thefocus of study, away from identifying some ofthe key factors associated with resilience, tounderstanding the mechanisms by which theymight operate. In this context, resilience refersto a dynamic process encompassing positiveadaptation within the context of significantadversity.3 Resilience has been described asprocesses and patterns of positive adaptationin development, during or following threats toadaptation.43 Hjemdal et al.44 define resilience asthe protective factors, processes and mechanismsthat contribute to a good outcome despiteexperiences with stressors that carry significantrisks for mental ill health. Policy from the WorldHealth Organisation views resilience as somethingthat embraces positive adaptation, with protectivefactors and assets that moderate risk factors andtherefore reduce the impact of risk on outcomes.45

The American Psychological Association46 definesresilience as the process of adapting well in theface of adversity, trauma, tragedy, threats, or evensignificant sources of stress – such as family andrelationship problems, serious health problems,or workplace and financial stressors. It means‘bouncing back’ from difficult experiences.

Diversity in the operation of resilience

In a review of the literature, Masten7 suggests thatthe concept of resilience has been described as(1) developing well in the context of high cumu-lative risk for developmental problems (beatingthe odds, better than predicted development);(2) functioning well under currently adverse con-ditions (stress-resistance/coping); (3) recovery tonormal functioning after catastrophic adversity orsevere deprivation (bouncing back, normalization).As well as examining resilience, research in the UK

by Bartley and colleagues also includes capability,referring to the ability to react and adapt positivelywhen things go wrong.47 They use a multi-dimensional definition of resilience, which refers tothe process of withstanding negative effects of riskexposure, demonstrating positive adjustment in theface of trauma or adversity and beating the oddsassociated with risks, focusing on socio-economicdisadvantage and poverty.

Stakeholder perspectives

In order to extend scientific definitions andreflect a wider perspective from service users andproviders, stakeholders were asked in consultationworkshops to consider how they would defineresilience. Their responses reflected experiencesfrom their own lives, which they felt might enhanceor be detrimental to resilience. Considering thatthe stakeholder group was not familiar withthe academic research on resilience, their ‘realitydriven’ perspectives generally reflect those posedby science and dictionaries (see Figure 2). Thestakeholders felt that the term ‘bouncing back’ wasmeaningful and gave an implicit understanding ofthe concept and what it represents.

Determining the defining attributes of resilience

The overview of uses of resilience so far highlightssome diversity but many similarities in how it hasbeen defined across a range of areas, confirmingthe complexity that underlies the concept. Allthe identified uses of the concept are consideredbeneficial for the further stages of the analysis.How resilience is defined reflects how it might bemeasured and so assessment is intricately tied upwith issues of definition. Through the next stepsof the analysis, an in-depth exploration of theantecedents, defining attributes and consequenceswill assist with concept clarification; whetherresilience is best viewed within a dynamic, multi-dimensional model or as a unitary construct.

This step requires identification of the attributesmost frequently associated with the concept. Thisphase has important implications for measurementas, alongside the identification of the antecedentsand consequences, it can provide a useful basisfor developing measures and evaluating existingones.15 The definitions highlight a number offactors that could be considered defining attributes

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What is resilience? 157

Figure 2. Examples of stakeholder comments

of resilience (e.g. adversity, resistance, adaptation).However, to understand resilience it is alsoimportant to understand what underlies theseattributes and the subsequent outcomes.

In order for resilience to be achieved, a consensuswithin research is for the role of protectivefactors, also referred to as ‘assets’, ‘resources’or ‘strengths’.12,23,33,51–56 These are recognized ascrucial in achieving resilience and, through theirdynamic interplay, enable the ability to respondpositively to risks and alter or reduce the effectsof adversity. In other words, they facilitate thecompetence/capability that enables resistance toadversity and underlies the process of adaptation.54

Competence is the capacity or motivation for,or process of effective adaptation43 and enablesadaptive use of resources within and outside theperson. It is based on the beliefs of perceivedeffectiveness in adaptation and arises frominteractions with the environment. Experiencesthat enable successful adaptation can inspire

further confidence to overcome future challengesand set-backs. Competence has been identifiedas an essential component of the resilienceexperience.2 The protective factors have commonlybeen identified across three levels of functioning:(1) individual (e.g. psychological, neurobiological),(2) social (e.g. family cohesion, parental support)and (3) community/society (e.g. support systemsgenerated through social and political capital,institutional and economic factors).55,56 Someresearchers2,57 distinguish the individual levelprotective factors as assets, whereas resourcesare viewed as external to the individual. Assetsmight include factors such as competence andefficacy; resources encompass the contextual orenvironmental influences, such as family supportand community services. Figure 3 presents anexample of the multiple layers at which healthpromoting factors might occur. A full discussionof protective factors is beyond the scope of thispaper (for more detailed reviews see Charney,58

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158 Gill Windle

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Figure 3. Example of the layers of resources and assets that facilitate resilience (from A. Sacker, personalcommunication, September 2009; adapted from Dahlgren & Whitehead, 1991, with permission)

Curtis & Cicchetti,8 Luthar,29 Mowbray et al.,52

Masten5 and Vanderbilt-Adriance & Shaw6).

Antecedents

Antecedents are the events that must happenprior to the occurrence of the concept.13 Withinresilience research, a necessary requirement is theexperience of a risk or adversity that carriesa significant threat for the development of anegative outcome. The context of the adversitycould be biological, psychological, economic orsocial, and cover areas such as stress,59 diagnosisof Alzheimer’s disease,48 the impact of povertyand economic disadvantage,60 refugee children,61

children in care,62 caring,63 ill-health in olderage,64 and bereavement.65 Within neurobiologicalapproaches, from a developmental perspective,resilience has been identified from studying whychildhood adversity leads to maladjustment insome children but not others.66 Others haveexplored why some individuals exposed to traumadevelop post-traumatic stress disorder (PTSD)while others do not.67 Neighbourhood deprivationhas been found to contribute to depression is someindividuals, but not others.41

A key point is that it is misleading to usethe term resilience if a stressor, under normalcircumstances with a majority of people, would notordinarily pressure adaptation and lead to negative

outcomes.68 Vanderbilt-Adriance & Shaw6 alsocaution that not all risks are equivalent in severity;some may be acute and others chronic andpersistent. Thus any findings for the occurrence ofresilience can only be considered within the contextof that specific adversity.

Consequences

Consequences are the end-points that occuras a result of the antecedents and attributesof resilience. Having considered the previouslyoutlined definitions within resilience research, therequired outcomes of resilience should reflectthe maintenance of normal development orfunctioning (mental or physical health), or betterthan expected development or functioning, givenexposure to the adversity under question. Thismight not necessarily be an exceptionally positiveoutcome. Within a life span developmentalperspective, the resilience process is often referredto as positive adaptation or adjustment.2,3,30

It is worth noting that some of the conceptualdifficulties around resilience are determined by thecriteria researchers use to assess how the outcomeis a ‘good’ one and reflects adaptation. Withinchild and adolescent research, the achievement ofsalient developmental tasks in the face of adversity,such as learning to read and write, attending andbehaving properly at school, are viewed as positiveoutcomes.24

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What is resilience? 159

The nature of the risk/adversity could be usedto guide the strength of resilience, for examplefor severe to catastrophic events, the maintenanceof near-average functioning is adequate.69 Alsowithin the context of severe adversity, a returnto normal functioning or ‘recovery’ may besufficient.24 It is also important to consider themeaning of the adversity to the individual, asit may amplify or attenuate subjective distress,70

which suggests that in an ideal research design,both subjective and objective outcome measuresbe incorporated.

Other research with older adults defines aresilient outcome as flourishing despite adversity.71

However, within a resilience framework, superiorfunctioning is not the expected outcome. The term‘flourishing’ tends to be placed more in the realmsof positive psychology, where the focus is on goodoutcomes for all individuals, not just those whoexperience significant difficulties.29 Rutter30 alsocautions that the study of resilience should examinea range of possible [psychological] outcomes,rather than focus on an unusually positive one, oron super-normal functioning. If too narrow a rangeof outcomes are considered, or reliance is placed onone data source, or if there is measurement at onlyone point in time, resilience may be artefactual.

Similarly, within the disciplines of prevention ofsubstance abuse and psychopathology, the absenceor avoidance of psychopathology, or low levels ofsymptoms, are viewed as a good outcome.29,72 Thisapproach has been criticised by Olsson et al.,54

who note that considerable adolescent researchhas demonstrated that young people functioningwell under high stress often show higher levels ofemotional distress compared with their low-stresspeers, and so resilience may not be the absenceof distress and measuring such outcomes may bemisleading. Indeed, the presence of distress ANDthe maintenance of competence may be one of thestrongest forms of resilience. The key point is thatthere is no necessary expectation that protectionfrom stress and adversity should lead to positiveexperiences.30

Defining empirical referents

According to Walker & Avant13 empirical referentsare ‘classes or categories of actual phenomena thatby their existence or presence demonstrate theoccurrence of the concept itself’. This aspect ofconcept analysis is concerned with how resilience

would be measured. There are three key featuresemerging from the analysis that demonstratethe experience of resilience: the encounter withadversity, the ability to resist and adapt to theadversity, and the avoidance of a negative outcome.A simple assessment of resilience then needsto consider: (a) what is the risk or adversity?,(b) which assets/resources might offset the effect ofthe risk?, and (c) is the outcome better than couldbe expected (comparing with a group of individualsnot at risk, or comparing on the presence orabsence of the assets/resources)? Researchers haveutilized two main approaches to the study ofresilience that address these three key features,described by Masten24 as variable focused andperson focused approaches.

Variable focused approaches

These use multi-variate statistics to examinethe relationships between adversity, outcomeand the protective factors/assets. Within thevariable focused approach are three models –compensatory, protective and challenge – whichexplain how the protective factors can alter theeffects of adversity on outcome.

The compensatory model reflects the inde-pendent contribution of risks or resources tothe outcome and involves examining their direct(main) effects. Resources with direct effects can bebeneficial at both high- and low-risk conditions(see Figure 4A). This main effects approach iscommonly examined through multiple regressionprocedures or structural equation modelling.

The protective model describes how the presenceof resources will influence the direction and/orstrength of the risk, usually depicted as moderatingor reducing the effects of the risk under questionon a negative outcome. Conversely, it couldmoderate the effects in a positive direction. Thistype of model is commonly tested through theinclusion of an interaction term between therisk and protective factor in multiple regression.The effects of the interactions in protectionmodels can also demonstrate the operation ofdifferent processes. Luthar73 proposes a moredetailed range of operational criteria to describethese interactive processes. ‘Protective-stabilizing’describes stability despite increasing risk whenthe protective factor is present (see Figure 4B).‘Protective reactive’ describes how the protectivefactor might present an advantage, but this is less

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What is resilience? 161

so when the risks are higher (see Figure 4C). Thisis an important approach for explaining resiliencein later life in the face of chronic illness. Windleet al.64 found evidence for both of these twomodels across different age cohorts. In those aged60–69 years, higher levels of psychologicalresilience gave stability in well-being despiteincreases in ill health (protective stabilizing). Forthose aged 70–79 and 80–90 years, psychologicalresilience provided an advantage, but slightly lessso when ill health was higher (protective reactive).

The challenge model describes a curvilinearrelationship between a risk factor and outcome.Here exposure to low levels and high levelsof risk are associated with negative outcomes,but moderate levels are associated with betteroutcomes. In these models, the risk and protectivefactors examined are the same variable, thedistinguishing feature being the level of exposure.This model assumes that moderate levels ofrisk can be important for learning how toovercome challenges. This approach is commonlyexamined with polynomial terms in multipleregression.2 When examined longitudinally, itenables an examination of whether the experienceof overcoming adversity strengthens people’sresistance to later risks and challenges. Toillustrate, Schoon75 found that at age 5, childrenwith good reading ability but who experiencedfamily economic disadvantage were similar toothers with good reading ability but whose familyhad no economic problems. However, by the age of16, the economically disadvantaged children haddeclined dramatically and were doing worse inexams than economically privileged children whohad poor reading skills at age 5. This suggeststhat despite the advantage of educational resilienceearlier in life, it was not able protect against thepersistent effects of economic disadvantage.

Person focused approach

This aims to identify comparative groups ofindividuals from within similar high levels ofadversity who show patterns of good or pooradaptation, simultaneously assessed by multiplecriteria, so as to identify the factors that mightlead to risk or be assets.24 This approach isoften used to classify the proportion who may bedetermined resilient. For example, in examining thecharacteristics of youths living in poverty, Buckneret al.60 operationalize resilience as the presence

of competences, adaptive functioning and lack ofsignificant mental health problems. Through thiscategorization, 29% were classed as resilient andthe authors were able to distinguish differencesbetween groups. The non-resilient experiencedmore negative life events, chronic strains andabuse, whereas the resilient has greater self-regulatory skills and self esteem and received moreactive parental monitoring.

In the context of ‘bouncing back’, using datafrom the British Household Panel Survey, resiliencewas suggested for those people who had increasingscores on a mental status measure (GHQ-12)after exposure to adversity (functional limitation,bereavement or marital separation, poverty), butreturned to its pre-exposure level after 1 year.28

Resilience measurement scales

Other researchers have developed resiliencemeasurement scales, some of which have beenexamined in a review of instruments appropriatefor the study of resilience in adolescents76

and all age groups.77 Notably, the majorityof self report scales are based primarily onindividual, psychological resilience and requiremore validation work.

Identifying model case

This is an example of the use of the concept thatdemonstrates all the defining characteristics. Thefollowing illustrate examples of resilience researchthat encompass the necessary antecedents, thedefining attributes and the consequences.

Lin and colleagues78 investigated variables atmultiple levels (the environment, the family andthe individual child) that differentiate childrenwho manifest clinically significant levels of mentalhealth problems from those children who do not,after experiencing the death of a primary caregiver. Bereaved children were classified into oneof two subgroups (resilient or affected) basedon their scores on measures of mental healthproblems. Those who scored below the clinicalcut-off level on every measure of mental healthwere considered resilient. Children who scoredabove the clinical cut-off level on any measurewere considered affected. The analyses found thatdifferences between the bereaved resilient versusbereaved affected status was related to family and

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child variables. Higher levels of caregiver warmthand discipline and lower levels of caregiver mentalhealth problems were family-level variables thatsignificantly differentiated resilient children fromaffected children. Bereaved children’s perceptionsof less threat in response to negative events andgreater personal efficacy in coping with stress werechild-level variables that differentiated resilientfrom affected status.

Schoon et al.79 examined the influence ofsocioeconomic adversity on school adjustmentduring adolescence (age 16) and long-term con-sequences of school adjustment for the transitionfrom school to work (age 33), whilst consideringfactors (parental and individual resources, teacherexpectations) that might buffer such adversity.They found that overall, socioeconomic adversitywas a significant risk factor for educational failureand that it influences consequent adjustment inwork and health related outcomes at the age of 33,as assessed by qualifications, socio-economic status(SES) and self reports of general health and mentalstatus. In examining the protective factors at age16, the negative effects of economic adversity onexam score was halved through including parentalinvolvement and aspirations, own educationalmotivation and aspirations, teacher expectationsand behaviour. Interactions amongst the protectivefactors and socioeconomic adversity were negativeand demonstrated that any protective effectswere found more amongst those at lowerrisk. For this group the important predictorsof exam performance were own educationalmotivation and teacher expectations and alsobehaviour adjustment, own job aspirations andparental involvement with the school. For thoseexperiencing socioeconomic adversity, the mostimportant factor predicting exam performance wasteacher expectations, followed by own educationalmotivation and own job aspirations, parentalaspirations and parental involvement with theschool, respectively.

Identifying additional cases

It is recommended that other concepts beexamined in order to address possible overlap,and more importantly to clarify the true natureof the concept in question.13 A number ofconcepts (addressed below) are often substitutedfor describing resilience; they may contain some

aspects of resilience, or a component of resilience,but are not true examples.

Borderline case

A borderline case very closely resembles theconcept in question, and could often be mistakenfor it. Further distinguishing features are that aborderline case should also differ substantiallyin one of the defining characteristics.13 A closelyrelated concept is the Sense of Coherence (SOC).This is a core component of the theory of theorigins of health – salutogenesis.80 Both resilienceand salutogenesis are developed from observationsof how people manage difficult situations anddisplay positive adaptation and stay well. Boththeories incorporate protective factors, known asgeneralized resistance resources in salutogenesis.However, where these two approaches may differrelates to the operation of the constructs. Insalutogenesis, the generalized resistance resourceslead to life experiences that promote a strong SOCand this sense of coherence is the key focus. Incontrast, resilience would subsume SOC as oneof the defining attributes, but not the only one.Thus SOC could be considered part of the processleading to a resilient outcome, but not the onlyaspect. Resilience research would ideally focus onmeasuring and analysing multiple levels of functionand their interactions. SOC may be one of theselevels, but a resilience framework would placean emphasis on an actual examination of SOCacross other levels or resilience, in relation toadversity.

Although both theories have focused on healthoutcomes, resilience can also be applied to wideroutcomes. For example, Sacker and Schoon57

looked at educational resilience, examining therole of educational and personal assets and familyresources in supporting young people from sociallydisadvantaged family backgrounds to stay on inschool beyond the mandatory school leaving age.Another distinction is that Antonovsky postulatedthat SOC was mainly formed in the first threedecades of life. Resilience theory acknowledgesthe dynamic nature of assets and resources, thusnothing is fixed.

Nevertheless, salutogenesis is intricately tied inwith resilience, and it has been suggested thata historical lack of multi-disciplinary integra-tion has meant that theoretical perspectives on

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What is resilience? 163

salutogenesis (from the discipline of medicalsociology) and resilience (largely from thedisciplines of psychiatry and developmentalpsychology) have perhaps not been synthesized tothe extent that they should have.81

Related case

These are related to the concept being studied,but do not contain all of the defining attributes.13

Kobasa82 introduced the concept of hardiness,which has been defined as a stable personalityresource that consists of three psychologicalattributes: commitment, challenge, and control.Commitment refers to an ability to turn eventsinto something meaningful and important; controlrefers to the belief that, with effort, individualscan influence the course of events around them,and challenge refers to a belief that fulfilment inlife results from the growth and wisdom gainedfrom difficult or challenging experiences.83 Likeresilience, hardiness has been used in the study of itsassociations with lower levels of psychopathologyin the face of stress. However, the defining pointwhich distinguishes hardiness from resilience isthat it is a stable personality trait whereas resilienceis viewed as something dynamic that will changeacross the lifespan. Moreover, hardiness measuresare designed to detect stability.

Ego-resiliency84 has been used on occasionby researchers to measure resilience. It isproposed as an enduring psychological constructthat characterizes human adaptability. It is adevelopmental process of impulse control, wherethe individual learns to regulate behaviour so asto turn events into pleasant experiences and notinto adverse consequences. It is assumed that ego-resilience renders a pre-disposition to resist anxietyand to engage positively with the world.

Whilst it shares a number of similarities withthe attributes and consequences of the resilienceconcept under question in this paper, in contrast toresilience, ego-resiliency does not depend on riskor adversity. Rather it is part of the process ofdealing with general, day-to-day change. Also ego-resiliency is a personality trait, whereas resilienceis a far broader phenomenon. As with the senseof coherence, ego-resiliency may be one of theprotective factors implicated in a resilient outcome,but it would be incorrect to use this as an indicatorof resilience per se.

Contrary case

A contrary case is a clear example of somethingthat is not resilience. The high functioning ofindividuals under conditions of no/low risk oradversity is not considered resilience. The modelof successful ageing85 is an example of a contrarycase. In order to meet the criteria for successfulageing, there must be a low probability ofdisease and disease-related disability, including theabsence of risk factors for disease, high cognitiveand physical functional capacity and activeengagement with life.85 A resilience frameworkwould acknowledge the possibility that ill-healthand functional incapacity might be present, butthat their potentially negative influence would notnecessarily lead to a poor outcome. Importantly,people are not invulnerable, but resilient.

Discussion

The analysis identifies three necessary requirementsfor resilience: the need for a significantadversity/risk, the presence of assets or resourcesto offset the effects of the adversity, and positiveadaptation or the avoidance of a negative outcome.Based on this analysis, the following definitionencompasses all of the key characteristics:

Resilience is the process of effectively negotiat-ing, adapting to, or managing significant sourcesof stress or trauma. Assets and resources withinthe individual, their life and environment facilitatethis capacity for adaptation and ‘bouncing back’in the face of adversity. Across the life course, theexperience of resilience will vary.

This analysis has taken a novel approachto clarifying the nature of resilience, drawingon three approaches that cover both academicand stakeholder perspectives – systematic review,concept analysis and consultation workshops.This process has enabled the identification ofimportant areas that might have otherwisebeen overlooked if just using one approach,enabling a deeper understanding of what is meantby resilience. Consultation with stakeholdersprovided a valuable contribution to the academicwork. Their perspectives on resilience as a multi-level construct, encompassing the individual andthe wider environment has helped to ensure thatthe final definition is one that has the potential for

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164 Gill Windle

wider application, and could be universally appliedand understood in ‘real world’ settings.

The robust methodological approach in thispaper improves on that of the previous conceptanalyses of resilience.11,12 In contrast to theprevious two papers, the systematic frameworkin this paper provides a replicable search strategyand transparent inclusion and exclusion criteria,thereby minimizing the possibility of selectionbias. The process of systematically identifyingresilience literature over the past 20 years enabledearlier theoretical formulations of the concept tobe synthesized with more recent developments.This also ensured that early landmark paperson resilience were incorporated. Diverse uses ofthe concept were identified through exploringresilience within different disciplines.

This paper utilized actual examples fromthe research literature to illustrate examples ofactual cases and related cases of resilience. Thiscontrasts with the methods of other researchersusing concept analysis,11,86,87 who restricted theirillustrations of the defining attributes of theconcepts under question by using hypotheticalscenarios. Whilst this may have served as a usefulmethod of clarification, the lack of engagementwith actual, theoretically derived examples doesnot assist with clarifying any scientific overlap.

Analysing and synthesizing this large volumeof research has enabled the key characteristicsof resilience to be thoroughly examined. Thismethodical approach demonstrates that resilienceis the product of a dynamic process thatfirst requires exposure to a significant threator adversity. Protective resources or assets arethe defining attributes of resilience. Examiningthe interplay between resources and risk is animportant aspect of resilience research and canhighlight mechanisms underlying vulnerability oradaptation.5,29,88 It is important to understandhow such factors interact with or mediate adversityand risk to increase or decrease the opportunity forresilience.

Within a lifespan developmental framework,the dynamic nature of resilience indicates itis not fixed, but will fluctuate over time, asnew vulnerabilities and strengths arise fromchanging life circumstances29 (p. 741). Researchfrom children and adolescents suggests that theprotection from risk is also influenced by earlierexperiences, and that across the lifespan differentfactors may play a distinct role from earlier.30,89

It is suggested that the mental health impact ofadversity in later life is mediated by psychologicalresources and social factors inherited from earlieryears.90 Certain factors might predispose toother experiences that actually mediate the risk.Poverty is a risk for psychopathology in children,but this may be more due to the effects ofpoverty on impaired family functioning andfamily relationships.30 Understanding the processof resilience, through the consideration of itsdefining attributes, can enable examination of howa resilient response at one point in life may helpfacilitate further resilience in later life, identifyingboth its stability and changes.

The life course approach considers thedevelopmental pathways of the concept. It is thenclear that a requirement for understanding theprocess of resilience is the acknowledgement ofits complexity; resilience operates across multiplelevels, which interact with each other. Theselevels reflect the human ecology framework,also described as Ecological Systems Theory.91

Although mainly used for understanding childdevelopment, this theory has been receivingconsiderable attention in the gerontology literatureand is cited in the resilience literature. Thisframework aims to understand people in theenvironments in which they live, and to evaluatetheir interactions with these environments. Peopledo not exist in isolation but interact with, andare influenced by, their physical, social andenvironmental contexts. Thus the functioning ofthe defining attributes of resilience can be furtherexplained within this theoretical framework.

Implications for further research

It is also noteworthy that a large proportion ofresilience research is routed within the disciplineof developmental psychology, and has mainly beendeveloped with children and adolescents. There isa consensus from child and adolescent researchas to what the most important factors may be,5

especially for the role of relationships.29 However,the salience of these factors may vary across thelife span. Far less is known about the processof resilience in adulthood7,92 and even less hasfollowed individuals over their life time to ascertainthe value of protective factors as people age. Mostresearch with adults into trauma and loss has onlyincluded treatment-seeking populations7. A key

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What is resilience? 165

question is whether the factors that lead to adultresilience follow a similar profile to those foundfor children and adolescents, and whether theyfunction in a cumulative and interactive manner7.

Neuroscience/biological approaches to resilienceare notably missing from resilience research.9

To date, most of the biological contribution tothe area is derived from the effects of earlycare-giving environment. A major contributionto resilience research could be made throughmore multi-disciplinary studies that examine thedynamics of resilience across the lifespan, its rolein healthy ageing and managing loss, such aschanges in cognitive functioning. As the methodsfor measuring and analysing multiple levels offunctioning and their interactions improves,5 thedynamics underlying resilience should be a keyfocus for future research.

The theoretical basis for resilience clearlyacknowledges that protective factors operateacross a number of levels. In order for interventionsto be most effective, theory would imply thatinterventions need to consider the dynamicinterplay across these different levels, and not justfocus on developing individual strengths. Littleresearch has looked at the mechanisms by whichadversities, protective resources, or interventionswork.93 Research on children has examined diversesources of resilience, whereas research on adultshas focused more on personal attributes, such aspersonality characteristics. Less attention has beenpaid to the extent to which these attributes areinfluenced by other factors.9 This has importantimplications for what might be considered thetarget for the development of interventions. Willstrengthening individual, psychological resilienceachieve better results than if the focus was onimproving the resources available in the immediateenvironment (e.g. social support), or within thewider environmental context (e.g. support throughhealth and social services?), and how might onelevel interact with another?

Another point is that positive adaptation maynot occur across all spheres of life. A reviewnotes that although some high-risk children showpositive outcomes in one domain, in 10 out of13 studies examined this did not generalize toother domains.6 Luthar et al.3 suggest that at-risk children who are resilient in specific domains(e.g. high academic grades), should show positiveperformance on conceptually related measures,such as classroom behaviour. Thus resilience may

be best measured in its related context. It has beensuggested that more precision could be gained byusing terms to describe the nature of the resilienceexperience being studied,3 e.g. psychologicalresilience,74 educational resilience57,94 or cognitiveresilience.95 From their review of the literature,Vanderbilt-Adriance & Shaw6 conclude that thelack of consistency in positive outcomes over thelife course and across domains suggest that ‘globalresilience’ is rare and recommend researchersare more specific about relating the concept ofresilience to the relevant domain outcome.

Conclusion

This theoretical exploration of the concept ofresilience highlights how interlaced with normal,everyday life resilience is, reflecting its multi-disciplinary roots. It would suggest that formany, providing the right resources are available,exposure to risks and adversity may not resultin a poor outcome. In relation to intervention,the context in which people live could be altered,the services and treatment received could beimproved and individual assets could be enhancedso as to enable a better chance for health andwell-being, even when faced with substantialrisk and adversity. Importantly, the complexinterplay between these layers should be recognizedand the underlying processes explored. Forthose experiencing persisting, chronic adversities,psychopathology could be averted providing thatthe individual is able to draw on a range ofresources within themselves and their immediateenvironment, and that the wider environment isalso supportive. The suggestion by Richardson51

that resilience may be the driving force thatcontrols the universe may be a little overstated,but the capacity for ‘ordinary magic’24 and theopportunity for positive adaptation should be anoption for everyone.

Conflicts of interest

The author has no conflicts of interest to declare.

Acknowledgements

This paper has been developed as part of thework of the Resilience and Healthy Ageing

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166 Gill Windle

Network, funded through the UK Lifelong Healthand Wellbeing Cross-Council Programme. TheLLHW Funding Partners are: Biotechnology andBiological Sciences Research Council, Engineeringand Physical Sciences Research Council, Economicand Social Research Council, Medical ResearchCouncil, Chief Scientist Office of the Scottish Gov-ernment Health Directorates, National Institute forHealth Research/The Department of Health, TheHealth and Social Care Research & Developmentof the Public Health Agency (Northern Ireland),and Wales Office of Research and Developmentfor Health and Social Care, Welsh AssemblyGovernment.

The author would like to thank the networkmembers for their inspiring discussions on thetopic: Dr Cherie McCraken (Liverpool University),Professors Jane Noyes and Jo-Rycroft Malone(Bangor University) for their helpful comments onthe paper, and Jenny Perry, Eryl Roberts and MartaCeisla (Bangor University) for their assistance withabstract screening and identification of papers.

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