The resilience framework as a strategy to combat stress-related disorders

Consistent failure over the past few decades to reduce the high prevalence of stress-related disorders has motivated a search for alternative research strategies. Resilience refers to the phenomenon of many people maintaining mental health despite exposure to psychological or physical adversity. Instead of aiming to understand the pathophysiology of stress-related disorders, resilience research focuses on protective mechanisms that shield people against the development of such disorders and tries to exploit its insights to improve treatment and, in particular, disease prevention. To fully harness the potential of resilience research, a critical appraisal of the current state of the art — in terms of basic concepts and key methods — is needed. We highlight challenges to resilience research and make concrete conceptual and methodological proposals to improve resilience research. Most importantly, we propose to focus research on the dynamic processes of successful adaptation to stressors in prospective longitudinal studies.In preparing this Perspective, U.B. was supported by the Deutsche Forschungsgemeinschaft (DFG CRC 1193, subproject C06); G.A.B. by the United States-Israel Binational Science Foundation (project 2013067), David and Maureen O’Connor, and the Rockefeller Foundation (2012-RLC 304); A.C. by DFG CRC 1193, subproject C04; E.B. by the European Union’s Horizon 2020 Programme (EU H2020/705217); C.J.F. by DFG CRC 1193, subprojects C03 and C06, DFG FI 848/5-1, and the European Research Council (ERC-CoG 617891); I.G.-L. by the National Institute of Mental Health (K01MH102415); S.G. by DFG CRC 1193, subproject B05; E.J.H. by the ERC (ERCCoG682591); R.K. by DFG CRC 1193, subprojects B01 and C01, and the State of Rhineland- Palatinate (project 1080, MARP); K.L. by DFG CRC 1193, subproject Z03, and the State of Rhineland-Palatinate (project 1080, MARP); B.L. by DFG CRC 1193, subprojects A02, B03, and Z02; M.B.M. by DFG CRC 1193, subprojects A03 and Z02; R.J.M. by the Swiss National Science Foundation (SNF 100014-143398; project no. un 8306); A.R. by DFG CRC 1193, subprojects C07 and Z03, and EU H2020/2014-2020 (643051 (MiND) and 667302 (CoCA)); K.R. by the ERC (ERC_StG2012_313749) and the NWO (NWO VICI no. 453-12-001); B.P.F.R. by the NWO (NWO VENI no. 916-11-086); D.S. by the SNF (SNF 100014-143398, project no. un 8306); O.T. by DFG CRC 1193, subproject C04, and the State of Rhineland-Palatinate (project 1080, MARP); A.-L.v.H. by the Royal Society (DH150176); C.H.V. by the Netherlands Brain Foundation (Fellowship F2013(1)-216) and the NWO (NWO VENI no. 451-13-001); T.D.W. by the National Institute of Health (NIH); M.We. by DFG CRC 1193, subprojects C05 and C07; and M.Wi. by DFG CRC 1193, subproject C04

Different age-specific incidence and remission rates in pre-school and primary school suggest need for targeted obesity prevention in childhood.

BACKGROUND: School entry marks a tremendous change in the children's life style, which might well be relevant for the emergence of overweight. Previous studies suggested a dramatic increase in the prevalence of overweight during this age. OBJECTIVE: To compare the age-specific balance between the incidence and remission of overweight between pre-school and primary school age children. DESIGN: We combined the data of three studies that had been conducted within the setting of the compulsory school entry health examination in different parts of Germany: one covering retrospective cohort data from age 2 to school entry (n=5045), one prospective data from school entry to fourth grade (n=1235) and one comprising both (n=1194). We assessed the rates of incidence and remission of overweight and obesity from age 2 to school entry and from school entry to fourth grade. RESULTS: In pre-school age, the pooled incidence for overweight was 8.2% (95% confidence interval: 7.5, 8.9) compared with a remission rate of 62.6% (58.4, 66.7), yielding a prevalence at school entry of 10.7% (9.9, 11.5). In primary school age, the pooled incidence for overweight increased to 14.6% (13.1, 16.1), whereas the remission rate was reduced to 17.7% (13.8, 22.3), yielding a prevalence of 23.7% (22.0, 25.4) in fourth grade. A similar pattern was observed for obesity. CONCLUSIONS: While high remission rates balance incident overweight in pre-school years, the dramatic increase in the prevalence of overweight and obesity in primary school years reflects a higher incidence and even more a lower remission rate. Obesity prevention programs in primary school age are mandatory and need to address primary and secondary prevention elements