Anja Todorović

Purpose: The response shift effect occurs in Patient-reported outcome measures (PROMs) as a consequence of internal changes in perception of the measured concept. The purpose of this study was to assess the potential presence of the response shift effect within the French version of the Brief Resilience Scale (BRS) in a population of university students in the Lorraine region of France. Methods: To measure resilience, the French version of the BRS was used. To examine the potential presence of the response shift effect within this questionnaire, the Oort’s procedure and Rasch Measurement Theory based ROSALI-RMT algorithm was used. Results: The BRS demonstrated longitudinal measurement invariance across Time 0 and Time 1, as assessed using the ROSALI algorithm. A slight but significant increase in resilience was observed over time (time effect = 0.22, p < 0.0001), with no evidence of response shift effects, suggesting that the observed changes in resilience were genuine and not influenced by recalibration. Conclusion: These findings support the validity of the BRS in measuring resilience over time and highlight its utility in capturing genuine changes in resilience.

Objectives To identify the factors associated with low psychological resilience among university students in the Grand Est region of France at the end of the first national COVID-19 lockdown. Design A cross-sectional online survey was conducted (May 2020) among students at the University of Lorraine using the LimeSurvey platform and institutional mailing lists. Setting Higher education setting in north-eastern France, involving students from the University of Lorraine (multicampus public university) and Sciences Po Nancy, a political science institute in the same region. Participants A total of 3708 students fully completed the online questionnaire, including the Brief Resilience Scale (BRS), resulting in an estimated response rate of 7.1%. All students enrolled at the University of Lorraine and Sciences Po Nancy during the 2019–2020 academic year were eligible to participate. Primary and secondary outcome measures The primary outcome was psychological resilience, measured using the BRS. Secondary measures included perceived social support assessed with the Multidimensional Scale of Perceived Social Support, quality of interpersonal relationships evaluated using the Quality of Interpersonal Relationships Scale (Échelle de la Qualité des Relations Interpersonnelles, EQRI) and frequency of positive and negative thoughts measured with the Thermometer of Thoughts Tool. Factors associated with low resilience were analysed using bivariable and multivariable logistic regression. Results Among 3708 students included in the sample, corresponding to a response rate of approximately 7.1%, 50.6% had normal resilience, while 37.3% reported low resilience. Female gender (OR=2.1, 95% CI: 1.8 to 2.6) and low social support (OR=1.7, 95% CI: 1.1 to 2.6) were the factors associated most strongly with low resilience. Negative thoughts (OR=1.4, 95% CI: 1.4 to 1.5), lower quality of relationships with people in general (OR=1.5, 95% CI: 1.3 to 1.8) and studying arts, humanities or languages (OR=1.4, 95% CI: 1.0 to 1.8) were identified as factors associated with low resilience. Increased age (OR=0.9, 95% CI: 0.9 to 1.0) and flat sharing (OR=0.6, 95% CI: 0.4 to 0.9) were inversely associated with low resilience levels. Conclusions Resilience seems to be impacted primarily by internal and micro-environmental factors. Consolidating levels of individual resilience of at-risk populations by acting on these factors could be the key to improving their mental health.

Resilience has been associated with better outcomes. This study aimed to identify sociodemographic and psychological variables associated with a low level of resilience in parents in the context of the COVID-19 lockdown. A cross-sectional study including 698 French parents of school-aged children aged 8-18 years was conducted. Resilience was measured via the Brief Resilience Scale (BRS). The sociodemographic factors investigated included personal, family and community factors. Social support and the quality of interpersonal relationships were also collected. A logistic regression analysis was performed to explore significant associations between the participant characteristics and a low level of resilience. The mean BRS score was 3.5 (SD = 0.8), with 22.2% of parents classified as having a low level of resilience. The sociodemographic factors associated with having a low level of resilience included being female, living in an urban area, sharing a living space with fewer than four people, including oneself, and having individuals in the home or the family circle with confirmed COVID-19 who were not hospitalized. Older age was inversely associated with low resilience levels. In terms of psychological factors, parents with higher perceived social support and those with higher-quality interpersonal relationships with family members, colleagues at work and people in general were less likely to have a low level of resilience. Parents' resilience seems to be associated with sociodemographic and psychological factors. Identifying the factors related to a low level of resilience in parents may assist health caregivers in developing intervention approaches to improve parents' resilience.

This study aimed to confirm the psychometric validity of the French version of the Brief Resilience Scale (BRS-F), as well as to evaluate its psychometric properties for the first time using item response theory, more precisely the partial credit model (PCM). It also aimed to evaluate item invariance by exploring possible differential item functioning (DIF). The 3708 participants were recruited during a cross-sectional observational study among university students in the French region of Lorraine. The results of the classical test theory method demonstrated an overall good fit of the scale to the data, with SB-χ2 = 80.84, df = 9, χ²/df = 9.0, p < 0.001, and root mean square error of approximation (RMSEA) (90% CI) = 0.046 [0.039; 0.058], standardized root mean square residual (SRMR) = 0.018, and comparative fit index (CFI) = 0.991), and good internal consistency (Cronbach’s α = 0.86). The PCM also yielded a good fit, with a good internal consistency (PSR = 0.88) and overall good infit indices. A slight irregularity in response distribution was observed with the “Neutral” category, but was not a threat to the structural integrity of the scale. No statistically significant DIF was observed when tested for gender (male vs. female) or academic level (undergraduate vs. graduate). Overall, the BRS-F was a good fit for the population of university students in France in a cross-sectional design.

Background: COVID-19 and subsequent lockdowns had an impact on the mental health of students, who had already been identified as a vulnerable population prior to this pandemic. At the end of the first COVID-19 lockdown, 15% of students reported suffering from moderate to severe anxiety. Psychological resilience is defined as the ability to bounce back from a stressful event and has been shown to have a positive impact on mental health parameters. This study aimed to identify factors associated with low resilience in the student population of the Grand Est region of France, at the end of the first national containment related to COVID-19. Methods: The PIMS-CoV19 study: A cross-sectional online survey was conducted among students at the University of Lorraine to collect sociodemographic data, living and learning conditions, as well as levels of resilience and perceived health. Bivariable and multivariable logistic regression analyses were performed. Model robustness was assessed using bootstrap resampling. Results: Among 3708 students, 50.6% had normal resilience, while 37.3% reported low resilience. Female gender (OR = 2.1, 95% CI: 1.8-2.6) and low social support (OR = 1.7, 95% CI: 1.1-2.6) were the main risk factors for low resilience. Negative thoughts (OR = 1.4, 95% CI: 1.4-1.5), lower quality of relationships with people in general (OR = 1.5, 95% CI: 1.3-1.8), and studying arts, humanities, or languages (OR = 1.4, 95% CI: 1.0-1.8) were identified as risk factors. Increased age (OR = 0.9, 95% CI: 0.9-1.0) and flat sharing (OR = 0.6, 95% CI: 0.4-0.9) were protective factors against low resilience. Conclusions: Resilience seems to be impacted primarily by internal and micro-environmental factors. Consolidating levels of individual resilience of at-risk populations by acting on these factors could be the key to improving their mental health. Key messages: • Resilience seems to be impacted primarily by internal and micro-environmental factors. • Consolidating levels of individual resilience of at-risk populations by acting on these factors could be the key to improving their mental health.

Anxiety disorders remain underdiagnosed and undertreated, especially in child and adolescent populations. This study aimed to examine the construct validity of the Generalized Anxiety Disorder Scale 7 (GAD-7) in a sample of French adolescents by combining the Classical Test Theory (CTT) and the Item Response Theory (IRT) and to assess the invariance of items. A total of 284 adolescents enrolled in school in the Lorraine region were randomly selected to participate in a cross-sectional study. A psychometric evaluation was performed using a combination of CTT and IRT analyses. The study of psychometric properties of GAD-7 revealed poor adequation to the sample population, and engendered the deletion of one item (#7) and the merger of two response modalities (#2 and #3). These modifications generated the new GAD-6 scale, which had a good internal consistency reliability (Cronbach α = 0.85; PSI = 0.83), acceptable goodness-of-fit indices (χ2 = 28.89, df = 9, P = 0.001; RMSEA (90% CI) = 0.088 [0.054; 0.125]; SRMR = 0.063; CFI = 0.857), and an acceptable convergent validity (r = –0.62). Only one item (#5) had a consistent Differential Item Functioning (DIF) by gender. This study evaluated the structure of the GAD-7 scale, which was essentially intended at discriminating adolescent patients with high levels of anxiety, and adapted it to a population of adolescents from the general population. The GAD-6 scale presents better psychometric properties in this general population than the original GAD-7 version.

Billions of children/adolescents experienced unprecedented changes in their daily lives that impacted their health-related quality of life (HRQoL) during the first wave of the coronavirus disease 2019. The purpose of this study was to describe child-parent discrepancies in reporting on HRQoL and explore factors associated with such discrepancies at the end of the first lockdown in France. A cross-sectional study was conducted among French school-aged children from 8 to 18 years and their parents living in the Grand Est region in France during the first wave of the epidemic. The impact of individual, self-reported health status and environmental data on discrepant parent–child reports of HRQoL was assessed by multinomial multivariable logistic regression models. A total of 471 parent–child pairs were included. Among 50% of the discordant pairs, parents underestimated HRQoL more frequently than they overestimated it. Home location, social support score, children’s education level, parents’ education level, tensions and conflicts with neighbors reported by children, whether they had access to a garden, and parents’ professional activity were significantly associated with parental overestimation (_adjustedOR from 2.08 to 11.61; p < 0.05). Factors associated with parental underestimation were children’s education level, SF12 score, home location, the child’s gender, parent’s level of education, the presence of noise in the residence reported by children, whether a household member was infected with COVID-19, whether they had access to a garden, and family structure (_adjustedOR from 1.60 to 4.0; p < 0.05). This study revealed differences between child-reported and parent-reported HRQoL. The COVID-19 pandemic accentuated the discrepancies in observable dimensions and attenuated them in unobservable dimensions of HRQoL but did not impact the directional discrepancy; parents underestimated their child’s HRQoL more. These discrepancies appear to be explained by parent and child sociodemographic factors.