Trajectories of Resilience-Related Traits and Their Impact on Health Outcomes in Schizophrenia: Results From a 4-Year Longitudinal Study

Background and hypothesis: For the rapidly growing population of older people living with schizophrenia (PLWS), psychological resilience, or the capacity to adapt to adversity, is an understudied target for improving health. Little is known about resilience and its longitudinal impact on outcomes among PLWS. This study assesses trajectories of resilience-related traits in PLWS and a nonpsychiatric comparison group (NCs) and longitudinal interactions between resilience and health.

Study design: This sample included 166 PLWS and 155 NCs (mean age 48 years, 52% women), with a 4.1-year mean follow-up time. The groups were comparable in age, sex, and follow-up time. We assessed resilience-related traits, physical well-being, obesity, hyperglycemia, positive symptoms, and negative symptoms. We conducted linear mixed-effects models to examine linear trends over time and continuous-time structural equation models (CTSEM) to assess the longitudinal relationships (cross-lagged effects between resilience and health).

Study results: People living with schizophrenia had lower resilience levels, compared with NCs. While resilience was stable over time for White individuals, younger non-White individuals with less education had increases in resilience over time. We found bidirectional 1-year cross-lagged effects of resilience with physical well-being and obesity, but not with hyperglycemia. Among PLWS, there were 1-year cross-lagged effects of resilience with both positive symptoms and negative symptoms.

Conclusions: These findings highlight the importance of resilience and its link to physical and mental health over time. Resilience may be a key protective factor in aging among PLWS, and the potential to improve resilience is an important and understudied approach for improving outcomes for older PLWS.