Introduction

Resilience, the ability to “bounce back” from stress, as a construct has garnered increasing attention when looking at resistance to one’s risk of developing poor outcomes in the face of adversity [1]. As an adaptation process, across the lifespan, the experience of resilience will vary [2].

In the Arab World in general and in Lebanon, mental health research is focused on poor psychiatric outcomes, including rates of depression, anxiety, and post-traumatic stress syndromes. Resilience research is scarce, partly due to the lack of consensus on the scales used to measure it [2]. A recent methodological review identified three questionnaires with high ratings for their psychometric properties in capturing resilience in an adult population [2], among which is the Connor Davidson Resilience Scale (CD-RISC) [3]. No such scales have been found validated in the Arabic language. A study looking at resilience in Palestinian adolescents in Gaza [4], used ‘minimal to no anxiety and depression’ on the Arabic versions of the Beck Depression Inventory and the Beck Anxiety Inventory as a proxy to resilience.

Women’s mental health is particularly important to examine in current times. Women are more likely to develop post-traumatic stress disorder in their lifetime than men [5–8]. In light of this past year’s events in Lebanon, including the critical economic situation, due to both political turmoil and the COVID-19 pandemic, and a recently devastating atomic equivalent blast in the capital, resilience can no longer be avoided as an outcome when studying trauma in women.

Connor and Davidson (2003) developed a self-report tool to quantify resilience drawing participants from various settings. This 25-item tool is based on a five-factor structure of the resilience construct: personal competence, high standards, and tenacity; trust in one’s instincts, tolerance of negative affect, and strengthening effects of stress; positive acceptance of change and secure relationships with others; control; spiritual influences. It has been accurately translated into the Arabic language, the official language of Lebanon [9]. As such, we obtained the permission of the original authors to explore the psychometric properties of the Arabic version of the scale once applied to a Lebanese population of women. Thus, the reliability and validity of the scale in Lebanese women were assessed.

Materials and methods

Results

A total of 63 Lebanese women participated in this CD-RISC validation study. Participants had a mean age of 28.48 ± 4.98 years. The age distribution of the sample population is presented in Fig 1. Table 1summarizes the scores of the studied scales among our sample population.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Fig 1. The age distribution of our sample population.

https://doi.org/10.1371/journal.pone.0269700.g001

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Descriptive analyses of the studied scales among a sample of Lebanese women.

https://doi.org/10.1371/journal.pone.0269700.t001

Convergent validity

We present the Pearson correlation coefficients (r) for Arabic CD-RISC and the following scales measuring self-esteem (RSES), dispositional hope (DHS), optimism (LOT), and positive affect (PANAS) in Table 2.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 2. The Pearson correlation coefficients between Arabic CD-RISC with the other studied scales.

https://doi.org/10.1371/journal.pone.0269700.t002

The highest correlation was found between CD-RISC and positive affect of PANAS (r = 0.63, p <0.0001). Similarly, each of the scales RSES, LOT, DHS revealed a moderately strong correlation with CD-RISC (r = 0.56, 0.54 and 0.5 respectively).

Discussion

The objective of this study was to evaluate the psychometric properties of the Arabic version of the CD-RISC in a Lebanese sample of women. The results indicated that the reliability and validity of the Arabic version of the CD-RISC are adequate among our studied Lebanese women sample.

Establishing the internal consistency of the Arabic version in a Lebanese population is essential for future evaluation of resilience. The reliability of the used Arabic CD-RISC is comparable to the results of the original research that developed the adapted Arabic version of the CD-RISC resilience instrument [9]. In fact, Cronbach’s alpha is almost identical in both studies (0.89).

Convergent and discriminant validities of the used scale were computed to determine its validity among the studied sample. The convergent validity of Arabic CD-RISC was confirmed by the significant positive correlation with the positive affect of the PANAS scale. This comes in line with several studies revealing that highly resilient people cultivate their positive emotionality to overcome adverse events [22]. This makes positive affect an essential unit of the psychological resilience of an individual. Although moderate, the negative correlation between the negative affect of PANAS and CD-RISC establishes an extension of the findings where resilience is not considered a trait only but also a process based on myriad stressors and the negative affects coupled with it [23]. Similarly, a moderate correlation coefficient existed between CD-RISC and each of RSES, DHS, and LOT. Indeed, the latter are closely aligned constructs with resilience, as they all correlate with positive emotionality and optimistic outlook against hurdles [24–26].

The validation of the CD-RISC in the Arabic language has great implications on future resilience research in Lebanon and the region. Since its inception, Lebanon has been crippled by constant internal and external conflicts and instabilities. It has been repeatedly shaken by armed conflicts, unrest, and turmoil over the decade, leaving a notable mark on its people at both physical and psychological levels [27]. Nevertheless, the Lebanese people have never before experienced a more dreadful event than the recent August 4th, 2020 Beirut explosion [27]. The explosion was preceded by the October 17th, 2019 revolution and followed by an economic crisis, a global pandemic, and political violence [27].

However, despite the extensive history of economic and political grievances, studies conducted over the past 50 years have shown that Lebanese people tend to adapt fairly well to hardships [28]. This has been eminent in their ability to maintain functionality in academic, social, and occupational settings. It has been proposed that the Lebanese people’s ability to cope with distress has been part of the Lebanese identity transmitted through generations [29]. This might provide them with a sense of coherence and hope in their future. However, there hasn’t been any empirical studies that examined these claims on the Lebanese population, as these explanations were theorized by authors but were not backed up by neither quantitative nor qualitative data.

Literature suggests that childhood and adolescence are two critical developmental periods of heightened brain plasticity and increased sensitivity to environmental stressors [30, 31]. Exposure to adversities during these two developmental periods affect the stress response system and brain circuit that mediates emotional regulation [30, 32]. Studies in children who show features of resilience despite early trauma have identified crucial psychosocial factors that promote resilience, most prominently the formation of a solid bond with parents and family stability [33, 34]. The Lebanese culture is known to be collectivistic, with family support and values playing a salient role in the child’s life. This culture might be a reason for the resilient nature of the Lebanese people as they rely highly on psychosocial factors to promote coping with hardships. As evident from the above, the validated Arabic version of the CD-RISC is essential to further examine these claims on the Lebanese population after the cascade of devastating events that occurred over the past 2 years. Having an adequate instrument to measure resilience in the Lebanese population will prove to further advance empirical research examining the features and drivers of this apparent resilience.

Further, it is important to point out some limitations. The data was collected from a single center and the majority of our participants had high educational level and good socioeconomic status. Also, the sample size was limited. This may decrease the generalizability of the results.

Conclusion

This is the first study to validate the Arabic version of the Connor-Davidson Resilience Scale. We propose that the Arabic version of the CD-RISC has good psychometric properties. Although the study presents limitations, the Arabic version of the CD-RISC is a reliable and valid tool to evaluate resilience in Arabic-speaking women. Future studies should focus on empirically evaluating resilience, sense of coherence, and hope in the Lebanese population after the events of the last two years and consequently investigating the implications such events had on mental health. In addition, examining protective and moderating factors such as coping mechanisms is essential to fill in the gap in the trauma literature in the region.