title: Clinical and biological correlates of resilience in patients with schizophrenia and bipolar disorder: A cross-sectional study.
abstract: The concept of resilience is relevant in understanding the heterogeneous outcomes noted in schizophrenia and bipolar disorder. However, clinical and biological correlates of resilience in these populations have rarely been investigated. We aimed to identify key correlates of subjective resilience in such patients using comprehensive assessments and to explore associations between resilience levels and peripheral biomarkers.
  
  
  
  180 subjects with DSM-IV schizophrenia, bipolar disorder, and healthy controls (60 per group) were included. Demographic and clinical variables were assessed by means of interview and various psychometric scales. Furthermore, blood and saliva samples were obtained for the assessment of brain-derived neurotrophic factor, adrenocorticotropic hormone, cortisol, high sensitivity C-reactive protein, and alpha-amylase levels. Cross-sectional associations with resilience, as assessed by the 25-item Resilience Scale were sought.
  
  
  
  Resilience Scale total scores were significantly higher in healthy individuals (130.1, 95% confidence intervals (CI): 124.8-135.4) compared to subjects with schizophrenia (109.9, 95% CI: 104.6-115.2, p<0.001) and bipolar disorder (119.0, 95% CI: 113.8-124.3, p=0.012), while the difference between patient groups was non-significant (p=0.055). Self-esteem, spirituality, quality of life, and hopelessness were correlated with resilience in all three groups. In addition, internalized stigma and depression were relevant factors in the schizophrenia and bipolar disorder group, respectively. Correlations between resilience levels and peripheral biomarkers did not reach significance.
  
  
  
  Although causal relationships must be confirmed in prospective studies, our results have implications in developing psychological interventions to enhance resilience in patients with schizophrenia and bipolar disorder. The biological correlates of resilience in these populations warrant further investigations.
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Alex
authors.initials: A
authors.lastname: Hofer
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Frajo-Apor
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Wartelsteiner
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Kemmler
authors.affiliation: Division of Environmental Pathology, Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Kanagawa, Japan.
authors.forename: Juri
authors.initials: J
authors.lastname: Saruta
authors.affiliation: Division of Environmental Pathology, Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Kanagawa, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tsukinoki
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: W Wolfgang
authors.initials: WW
authors.lastname: Fleischhacker
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Electronic address: hiroyuki.uchida.hu@gmail.com.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uchida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001714:Bipolar Disorder / Q000378:metabolism* / Q000523:psychology* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055500:Resilience, Psychological; D012463:Saliva / Q000378:metabolism; D012559:Schizophrenia / Q000378:metabolism* / Q000628:therapy; D012565:Schizophrenic Psychology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Bipolar disorder; Recovery; Resilience; Schizophrenia