Decomposing Resilience and its Relationship With Mental Health during COVID-19 Pandemic Outbreak

Background: Resilience is key in maintaining mental health during stressful times Quantifying resilience factors and their relative contribution to outcomes may advance interventions COVID-19 pandemic is a major global stressor requiring individuals to recruit their resilience resources to endure We aimed to identify resilience factors and assess their contribution to mental health during COVID-19 Methods: Participants (N = 5,717, mean age 39, 70% females) were recruited through an online platform (covid19resilience org), April 6 - May 5, 2020 Resilience was assessed using a 21-item battery tapping 5 factors: self-reliance, emotion regulation, positive (confidence) and negative (hostility) aspects of close relationships and perception of neighborhood environment Current mental health screening included anxiety, depression and sleep Factor analyses were conducted on resilience items Resilience factors' effects on mental health were tested using structural equation modeling that included multiple distal risk factors and proximal COVID-19 related exposures, controlling for multiple covariates Results: Resilience factors correlated moderately among themselves (strongest r<0 50), suggesting that resilience is a multifaceted construct Bifactor modeling revealed a general resilience factor with robust 'buffering' effects on mental health outcomes during the pandemic (effect size∼0 60), greater than the risk-increasing effect of previous depression/anxiety (effect size∼0 35) Among resilience factors, emotion regulation showed the greatest buffering effect, moderating association between past and current depression Conclusions: Resilience factors can be quantified using a brief online tool that can inform on mental health trajectories Emotion regulation may be a modifiable target for enhancing resilience Interventional studies are warranted to translate findings for improving mental health following the pandemic