CD-risc Manual 08-19-18

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08-19-18
Connor-Davidson Resilience Scale (CD-RISC) ©

Manual
Further information about the scale can be obtained from the author at
[email protected] and at the www.cd-risc.com website.
Cite as: Davidson JRT. Connor-Davidson Resilience Scale (CD-

RISC) Manual. Unpublished. 08-19-2018, accessible at www.cd-
risc.com.
Contents
Introduction, Authorized and Unauthorized Versions of the CD-RISC .......................................................... 3
Directions for Scale Administration, Scoring and Interpretation of Score ...................................................... 5
Reading Ease and Reading Grade Level .......................................................................................................... 7
Demographic Features of the CD-RISC .......................................................................................................... 7
Mean Scores of CD-RISC in Different Populations ...................................................................................... 10
Table 1a. Mean (SD) CD-RISC 25-Item Scores in General Population Samples ..................................... 11
Table 1b. Mean (SD) CD-RISC 10-Item Scores in General Population Samples ..................................... 11
Table 1c Mean (SD) CD-RISC 2-Item Scores in General Population Samples ........................................ 12
Table 2a. Mean (SD) CD-RISC 25-Item Scores in Students and Young Adults ...................................... 15
Table 2b. Mean (SD) CD-RISC 10-Item Scores in Students and Young Adults ...................................... 17
Table 2c. Mean (SD) CD-RISC 2-Item Scores in Students and Young Adults ........................................ 17
Table 3a. Mean (SD) CD-RISC 25-Item Scores in Post-Traumatic Stress Disorder & Subjects Exposed to
Severe Trauma ........................................................................................................................................... 18
Table 3b. Mean (SD) CD-RISC 10-Item Scores in Post-Traumatic Stress Disorder & Subjects Exposed
to Severe Trauma ....................................................................................................................................... 20
Table 3c. Mean (SD) CD-RISC 2-Item Scores in Post-Traumatic Stress Disorder & Subjects Exposed to
Severe Trauma ........................................................................................................................................... 20
Table 4. Mean (SD) CD-RISC 25-Item Scores in Subjects with Depression, Suicide Attempts or
Suicidality .................................................................................................................................................. 21
Table 5a. Mean (SD) CD-RISC 25-Item Scores in Groups with Other Psychiatric Disorders ................. 23
Table 5b. Mean (SD) CD-RISC 10-Item Scores in Groups with Other Psychiatric Disorders ................. 24
Table 5c. Mean (SD) CD-RISC 2 Item Scores in Groups with Other Psychiatric Disorders .................... 24
Table 6a. Mean (SD) CD-RISC 25-Item Scores in Groups with Medical Problems ................................ 26
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Table 6b. Mean (SD) CD-RISC 10-Item Scores in Groups with Medical Problems ................................ 27
Table 6c. Mean (SD) CD-RISC 2-Item Scores in Groups with Medical Problems .................................. 28
Table 7a. Mean (SD) CD-RISC 25-Item Scores in Non-Treatment Seeking Trauma Survivors .............. 31
Table 7b. Mean (SD) CD-RISC 10-Item Scores in Non-treatment Seeking Trauma Survivors ............... 32
Table 7c. Mean (SD) CD-RISC 2-Item Scores in Non-treatment Seeking Trauma Survivors ................. 32
Table 8a. Mean (SD) CD-RISC 25-Item Scores in Other Groups, Those Under Stress and/or Mainly
Healthy Subjects ........................................................................................................................................ 34
Table 8b. Mean (SD) CD-RISC 10-Item Scores in Other Groups, Those Under Stress and/or Mainly
Table 8c. Mean (SD) CD-RISC 2-Item Scores in Other Groups, Those Under Stress and/or Mainly
Table 9. Mean (SD) CD-RISC 10-Item Summary Scores ......................................................................... 39
Table 10. Mean (SD) CD-RISC 2-Item Summary Scores ......................................................................... 43
Factor Analysis .............................................................................................................................................. 44
Culture, Nationality and Ethnicity: Studies with the CD-RISC .................................................................... 51
Validity .......................................................................................................................................................... 54
CD-RISC: Predictive Validity, Treatment and Change over Time ............................................................... 83
Table 11a. Changes in CD-RISC 25 Associated with Intervention or Treatment ..................................... 84
Table 11b. Changes in CD-RISC 10 and CD-RISC 2 Associated with an Intervention ........................... 86
Test Retest Reliability .................................................................................................................................... 94
Biological and Other Mechanistic Studies of the CD-RISC .......................................................................... 95
Translations of the CD-RISC ....................................................................................................................... 101
Citations that Mention the CD-RISC or Report Original Research ............................................................. 102
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Introduction
Our interest in resilience arose from long experience treating men and
women with posttraumatic stress disorder (PTSD), as well as from our
broad-range research into the disorder, which covered treatment assessment,
diagnosis, biological characterization, cross-cultural study, epidemiology,
risk factors and the development of measures for PTSD and other forms of
anxiety.
Among the measures that we felt needed a stronger presence in the field of
PTSD assessment was that of resilience. Although several scales addressing
aspects of resilience have existed for some time, they had largely failed to
penetrate into the world of clinical practice, treatment-outcome and
biological research. We were further stimulated after including a brief
single-item measure of stress vulnerability into one of our treatment
outcome studies in PTSD. The results showed that an active medication
allowed patients to deal better with stress than did a placebo. To the best of
our knowledge, this was the first demonstration of such an effect, i.e., that a
treatment for anxiety could boost stress coping/resilience more than a
placebo control.
Authorized Versions of the CD-RISC

After a search of the resilience literature, which at that time was heavily
influenced by contributions from the developmental psychology and child
psychiatry fields, but with some important work in adults as well, we
selected 17 domains, as outlined in Table 1 of our publication in 2003, and
developed a 25-item scale (Connor KM, Davidson JRT. Depression and
Anxiety 2003; 18: 71-82). This report presented psychometric data
establishing validity and reliability of the scale (known as the Connor-
Davidson Resilience Scale or CD-RISC), as well as briefly describing each
of the 25 items (see Table 2 of that citation), and giving general scoring
directions. However, the complete wording for each item and full directions
did not appear in the report and the scale cannot be adequately reconstructed
from the information given in this publication.
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In the original validation study, mean scores in specific populations were

reported as follows:
US general population 80.7
Primary care patients 71.8
Psychiatric outpatients 68.0
Generalized anxiety 62.4
PTSD samples 47.8/52.8
Many other studies have reported normative scores on the CD-RISC, the
results of which are given below and summarized in Tables 1a-c for the 25-,
10-, and 2-item scales respectively. The mean and median scores as given
for the US general population in Connor and Davidson (2003) are based on a
sample of those who furnished complete responses to all items of the CD-
RISC. In the entire sample (i.e., complete responses and those with
missing items), the mean score was 79.0 (12.9) and median (1,3 Q) was 81
(71, 89) (Davidson and Lee, unpublished data 2011).
Besides the full 25-item CD-RISC (or CD-RISC 25), there are two briefer
versions, the 10-item (CD-RISC 10) and 2-item (CD-RISC 2) scales. The
10-item version (score range 0-40) comprises items 1, 4, 6, 7, 8, 11, 14, 16,
17, and 19 from the original scale, and was developed by Drs. Campbell-
Sills and Stein, at the University of California, San Diego, on the basis of
factor analysis. In a community survey of 764 US adults, a mean score of
31.8 (SD = 5.4) was obtained for the CD-RISC 10 [Campbell-Sills L, Forde
DR, Stein MB. J Psychiatric Research (2009),
doi:10.1016/j.jpsychires.2009.01.013]. An almost identical mean score was
obtained by Davidson (unpublished) in the US general population sample
studied in the 2003 report above.
The CD-RISC 2 is based on items 1 and 8 (score range from 0-8), and was
developed as a measure of “bounce-back” and adaptability by the original
authors (Vaishnavi et al, 2007). In a general population survey of 458 US
adults, mean CD-RISC 2 score was 6.91, while lower scores were observed
in psychiatric groups with depression (5.12), GAD (4.96) and PTSD (4.70)
(Vaishnavi et al, 2007) and in survivors of the Southeast Asian Tsunami of
2004 (Irmansyah et al, 2010).
For a summary of all reports with the CD-RISC-10 and CD-RISC-2,

please refer to Tables 9 and 10 below.
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Unauthorized Versions of the CD-RISC

The above three versions of the CD-RISC are the only ones which are
authorized for use. Attention is drawn to the existence of unauthorized
versions, created without permission and/or in violation of copyright. These
altered versions of the CD-RISC have undergone significant modifications
either in item wording, addition or removal of items, change in the scoring
choices or blending with other items to create entirely new scales. They
include scales known as A Modified CD-RISC: Including Previously
Unaccounted Resilience Variables (27 items), CD-RISC Expanded
Kinyarwanda version (34 items), 6 items from the CD-RISC subsumed in
abbreviated form in the Positive Psychology Outcome Measure (PPOM), a
29-item Arabic translation of the scale, a 3-item version of the scale (2016),
a Ghanaian 18-item scale, and a 17-item Spanish scale (2012).
The CD-RISC literature continues to grow: the scale has now been translated
into many different languages and studied in a variety of populations,
including large community samples, survivors of various traumas,
Alzheimer’s caregivers, adolescents, elders, patients in treatment for PTSD,
members of different ethnic groups and cultures, and selected professional or
athletic groups (e.g., university students, nurses, social workers, physicians,
military medical personnel, medical students, missionaries, cricketers). The
CD-RISC has been included in studies of functional neuroimaging,
genotyping and treatment outcome. Psychometric properties of the RISC
hold up well, although its factor structure of the RISC-25 and mean score
varies with setting. For this reason, we do not recommend separate scoring
of the RISC-25 factor subscales that were originally reported by Connor and
Davidson, although we recognize that some interesting findings have been
reported when specific factors or items were analyzed (e.g., Laff, 2008;
Garcia-Izquierdo et al, 2009).
Directions for Scale Administration, Scoring and

Interpretation of Score
Directions: The CD-RISC is designed as a self-rating scale, although where

necessary, an assistant may read out each statement to the subject and record
the answer. The subject is directed to respond to each statement with
reference to the previous month, understanding that if a particular situation
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has not arisen in this time, then the response should be determined by how
the person thinks they would have reacted.
Scoring: Scoring of the scale is based on summing the total of all items, each
of which is scored from 0-4. For the CD-RISC-25, the full range is therefore
from 0 to 100, with higher scores reflecting greater resilience. We do not
recommend other methods of scoring such as the subscales defined by factor
analysis, any other derived subscales, item averaging, nor the adoption of a
1-5 scoring range for each item, as has been reported in some publications.
We also do not support use of “partial” scales, such as items which have
been determined by factor analysis or other statistical technique to produce a
seemingly “purer” version of the CD-RISC.
For the CD-RISC-10, the total score ranges from 0-40, and for the CD-
RISC-2, it ranges from 0-8.
Interpretation of Score: CD-RISC scores appear to be influenced by two

main factors: location/region where data was obtained and nature of the
sample. For the former, scores may vary according to country; for the latter,
scores are generally lower in those with psychiatric problems and who are
having difficulty coping with stress, as well as in younger adults, such as
students, who may score lower than older adults. With those considerations
in mind, we provide median and quartile scores obtained from the US and
Hong Kong general populations as follows. The median score describes the
midpoint of the frequency distribution. Quartiles describe four groups of
equal number taken from the observed distribution of scores, with the first
quartile (Q1) describing the score range for the lowest group (lowest 25% of
the population), i.e. the least resilient, the second (Q2) and third (Q3) the
intermediate scores, and the fourth (Q4) describing the highest or most
resilient, i.e. above 75% of the population.
For the CD-RISC-25 in the US general population (n = 577), median score is

82, with Q1, Q2, Q3 and Q4 being 0-73, 74-82, 83-90, 91-100 (Connor and
Davidson, 2003). Therefore, for example, a score of 55 would place the
subject in the lowest 25% of the general population, and a score of 89 would
fall in the 50-75% percentile, of third quartile: 25% would have a higher
score than this.
For the CD-RISC-10 (n = 764), median score was 32, with lowest to highest
quartiles being 0-29, 30-32, 33-36 and 37-40 (Campbell-Sills et al, 2009).
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Similar results were obtained in another US population (n=577) by Davidson

and Lee. A score of 26 would fall in the lowest 25% of the population, a
score of 36 would be the third quartile and 25% of the population would
score higher (i.e. 37-40).
For the CD-RISC-2 (n = 577), median score was 7, and quartiles were 0-5,
6, 7, 8 (Campbell-Sills, personal communication, 2015). (Groupings could
not be made into equal quartiles of 25, 50, 75 and 100%, and represent
respectively 15, 36, 54 and 100% of the sample).
Results from a general population survey in Hong Kong (n = 10,997)

showed a median CD-RISC-25 score of 62, and Q1, Q2, Q3 and Q4 ranges
being 0-53, 54-62, 63-71 and 72-100 (Ni et al, 2015 and personal
communication, 2016).
For the CD-RISC-2 (n = 10,997), Ni et al (2015 and personal

communication, 2016) found a median score of 5, with Q1, Q2, Q3 and Q4
ranges being 0-4, 5, 6, 7-8 respectively.
Reading Ease and Reading Grade Level
Flesch Reading Ease calculations indicate a range from 75-77 for the 2-, 10-,
and 25-item CD-RISC versions. Flesch-Kincaid Grade scores are 5.1 for all
three versions of the scale. Interpretation of the Flesch score indicates that
the scale should be easily understood by 12 year olds, although it has been
used successfully in younger populations. A Flesch-Kincaid score of 5
indicates that that the scale is expected to be understood by those with a fifth
grade level education.
A review is provided of the psychometric data on validity, reliability and

factor structure, obtained in the various studies worldwide.
Demographic Features of the CD-RISC
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AGE:
Mean CD-RISC scores vary across populations and may be affected by age,
in that some studies found weakly positive correlations (Gillespie et al,
2008; Campbell-Sills et al, 2009; Rosenberg et al, 2015; Terrill et al, 2016;
Boell, 2016; Lee et al, 2017; Seib et al, 2018), weakly negative correlations
in more narrowly defined age-specific adolescent and older cohorts
(Jorgensen and Seedat, 2008; Lamond et al, 2008; Yu et al, 2011; Wu et al,
2016), as well as in caregivers with a relative who had Alzheimer’s disease
(Wilks, 2006), or no relationship with age in cohorts spanning a broad age
range (Connor and Davidson, 2003; Huang, 2010; Gucciardi et al, 2011;
Derakhshanrad et al, 2014; Bozikas et al, 2016) or a narrow age range
(Ziaian et al, 2012; Ristevska-Dimitrovska et al, 2015a). Liu et al (2015) did
not find that age was a determinant of score.
ETHNICITY:
Ethnicity was a determining factor in two studies in South Africa and the
USA (Jorgensen and Seedat, 2008; Marwitz et al, 2017), but not in others
(Connor and Davidson, 2003; Wilks, 2006; Campbell-Sills et al, 2009).
However, in Chinese, Japanese, Korean, and Iranian samples, the mean
score was below those found in US populations (e.g., Yu and Zhang, 2007,
Khoshouei, 2009), although the samples were different in nature, i.e., they
were not representative of the general population. Ethnicity did not affect
resilience score in a multi-ethnic group of Australian adolescent refugees
(Ziaian et al, 2012). White and non-white surgeons did not differ in their
CD-RISC-10 scores (33.4 vs 33.6) (Warren et al, 2013).
GENDER & MARITAL STATUS:

The relationships between CD-RISC score and marital status and gender are
inconsistent. No relationship was found for either by Connor and Davidson
(2003), Wilks (2006), Lamond et al (2008), Jowkar et al (2010) or
Derakhshanrad et al (2014), but lower scores were obtained in the widowed
and in women by Campbell-Sills et al (2009), Yu et al (2011) and Levasseur
et al (2017). Wu et al (2016) found marital status unrelated to resilience, but
married subjects had higher resilience scores in one study of TBI (Marwitz
et al, 2017). In a post-earthquake sample in Turkey, Karairmak found no
difference in score between men and women (Karairmak, 2010), yet in a
Chinese post-earthquake sample, men scored higher than women (Ni et al,
2015), as was the case in Nepalese earthquake survivors (Bhattarai et al,
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2017). In Chinese medical students, Peng et al (2012) found significantly

higher CD-RISC scores in men than in women, as did Kang et al (2013) in
Korean college students (69.1 vs. 65.2): similar results were obtained in
Canadian medical students (Rahimi et al, 2014) and US medical students
(Houpy et al, 2017). In contrast, some studies have found higher scores in
women than men: an Australian study showed that adolescent girls
(median=70) scored higher than boys (median = 58) in a refugee sample
(Ziaian et al, 2012). Male Nigerian nursing students had significantly higher
scores on the CD-RISC-10 than did women (30.1 vs 27.3) (Aloba et al,
2016), and young male adults with diabetes had significantly higher scores
on the CD-RISC-2 than did females (6.5 vs 5.8) (D’Emden et al, 2017).
Bozikas et al (2016) found that women with schizophrenia-spectrum
disorder had higher resilience than men. Female Air Force recruits had
higher scores than did males (Bezdjian et al, 2016). Boell (2016) noted that
in Brazilians with chronic medical disease women had higher scores than
men. Ameen (2018) noted higher scores in traumatized Iraqi adolescent girls
(64.7) than in boys (51.7).
A study of 100 university students in Iran failed to show a difference in

score between men (58.9) and women (57.4) (Ebrahimi et al, 2012), as was
also the case in 60 patients with spinal cord injury (Kilic et al, 2013). No
differences were found comparing men and women surgeons (33.6 vs 32.7)
in a US sample (Warren et al, 2013). No differences were found between
men and women, and married vs. unmarried Korean psychiatric outpatients
(Min et al, 2013). Notario-Pacheco et al found no differences between men
and women with fibromyalgia in a Spanish sample (Notario-Pacheco et al,
2014). Male and female university freshmen had similar scores in an English
sample (Allan et al, 2014), although RISC predicted academic success in
females but not clearly in males. A study of government employee
earthquake survivors in Japan found no difference in scores for men and
women (Tsuno et al, 2014). Likewise, Liu et al (2015) and Zhong et al
(2016) failed to show differences between men and women in large Chinese
community samples. No differences between men and women were found
in a sample with physical disability (Terrill et al, 2016), in healthy US
volunteers participating in an MRI study (Gupta et al, 2016) or in US
veterans of Afghanistan and Iraq (Brancu et al, 2017).
OTHER DEMOGRAPHIC VARIABLES:

A relationship has been found with level of education by Campbell-Sills et
al (2009), Wu et al (2016), Marwitz et al (2017), and Brown et al (2018), but
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not by Lamond et al (2008) or Boell (2016). Higher income was related to

higher levels of resilience (Wu et al, 2016; Lee et al, 2017). Unemployed
survivors of an earthquake had lower levels of resilience than did employed
survivors (Bhattarai et al, 2017).
In one large (n=764) community study of the CD-RISC 10, demographic

factors were found to account for no more than 10% of the variance in score
(Campbell-Sills et al, 2009).
Mean Scores of CD-RISC in Different Populations
Community populations: In their original report, Connor and Davidson

(2003) reported a mean (sd) of 80.4 (12.8), from a random digit dial
telephone survey of a national sample of US adults. This score was based on
the inclusion of only subjects who provided complete responses to the scale.
When all subjects were included, the mean score was 79.0 (12.9). In a
smaller study of non-psychiatric US combat veterans, a similar score of 83.4
(9.9) was obtained by Morey et al (2008). In a general community sample
(n=764) from Memphis, the mean CD-RISC 10 score was 31.77 (5.47),
which is almost identical with that obtained by Davidson et al (unpublished)
in a US community population (n=458) of 32.1 (5.8). In a Chinese
community cohort, the mean CD-RISC-25 score was 65.4 (13.9) (Yu,
personal communication, 5/18/09), pointing to population or cultural
determinants of the total CD-RISC score. In a non-randomly selected
Portuguese general population sample (n=421), the mean scores for the 25-,
10-, and 2-item versions of the CD-RISC were 73.4 (12.0), 29.3 (5.7) and
6.50 (1.23) (Faria, personal communication 7/22/2010). In a study of factors
that determined successful aging, Jeste et al (2013) reported mean scores on
the CD-RISC 10 that ranged from 30.8-32.1 according to age decile (50-59
up to 90-99). An Australian community sample showed mean scores for the
CD-RISC-25 ranging from 71.5-73.5 in different age groups (Liu et al
2015). (In the Liu study, reported scores were 25 points higher due to use of
a 1-5 scoring algorithm, and have been corrected here). These and other
scores are summarized in Tables 1a-c.
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Table 1a. Mean (SD) CD-RISC 25-Item Scores in General Population Samples
Authors Scale Number Mean (SD) Location Comments
Connor et al (2003) 25 458 80.4 (12.8) USA National random digit dial sample
Lamond et al (2008) 25 1,395 75.7 (13.0) USA Community sample over age 60
Sutherland et al 25 64 82.7 (8.0) USA Women in university community; healthy controls
(2009) in study of chemical dependency
Kavirajan et al 25 1,151 76.1 USA Postmenopausal women in community
(2011) (12.6)
Goins et al (2012) 25 160 83.0 (13.4) USA Federally recognized Native American tribe
Yu et al (2009) 25 560 65. 4 (13.9) China Community sample

Yu et al (2009) 25 326 71.0 (11.3) China Parents (healthy controls in a study of autism)
Peng et al (2012) 25 1,998 61.7 (10.6) China Medical Students

Ni et al (2015) 25 10,997 60.0(13.9) China Hong Kong general population
Zhong et al (2016) 25 214 64.8(13.8) China Elderly (>60 years) community sample no mental
215 62.3(15.0) illness or cognitive problems
Wu et al (2017) 25 3960 63.4(13.1) China New employees in Chinese communities
Ha et al (2009) 25 143 66.8 (12.7) Korea Healthy volunteers
Faria et al (2010) 25 421 73.4 (12.0) Portugal Community sample Lisbon
Solano & Neto 25 103 75.4 Brazil Family member normative controls of subjects
(2012) (72.6,78.3, with chronic pain
95% CI)
Alemi et al (2018) 25 232 60.5 (13.9) Afghanist Community sample of young adults 18-35
an
Ziaian et al (2012) 25 53 60 Australia Refugees from Africa,
35 69 Yugoslavia, Middle East
82 67
Liu et al (2015) 25 1,892 71.5 (12.5) Australia Australian community cohort - three age groups
2,062 71.4 (13.4) 28-32, 48-52 and 68-72
1,826 73.4 (13.6)
Law et al (2014) 25 79 71.3 (10.8) Australia Centenarians
Table 1b. Mean (SD) CD-RISC 10-Item Scores in General Population Samples
Davidson (2003) 10 458 32.1 (5.8) USA National random digit dial sample
Campbell-Sills et al 10 764 31.8 (5.4) USA Community random digit dial sample in Memphis
(2008)
Goins et al (2012) 10 160 33.5 (6.2) USA Federally recognized Native American tribe
Jeste et al (2013) 10 1,006 30.8(7.0) to USA Community sample of older people ages 50-99
32.1(6.2)
range by
age group
Levasseur et al 10 4541 31,0 (0.1) Canada Older age community sample
(2017) 32.0 (0.1)
Lopes and Martins 10 463 29.1 (5.5) Brazil Adult sample
(2011)
Antunez et al (2015)` 10` 1,922 29.0 (0.1) Spain Adult sample
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Table 1c Mean (SD) CD-RISC 2-Item Scores in General Population Samples

Vaishnavi et al 2 458 6.91(1.5) USA National random digit dial sample
(2008)
Lee et al (2008) 2 1,969 6.47 (1.37) USA National RDD violent trauma sample different
from above
Campbell-Sills et al 2 764 6.62(1.33) USA Community random digit dial in Memphis
(2008)
Rapacciuolo et al 2 571 5.87(1,69) Italy Community sample of over 60 years age in Naples
(2016)
Adolescents, Students and Young Adults: There have been a number of

reports from children, adolescents, university students and young adults,
summarized in Table 2. Scores ranged in one South African study from 56.3
(19.4) - 71.1 (15.8) according to ethnic group (Jorgensen and Seedat, 2006),
and were 65.9 (18.5) in another South African study (Bruwer et al, 2008). In
a third South African study, Fyncham et al (2009) reported the mean score to
be 63.7 (15.9) in over 700 students of mean age 16.7 years. An Iranian study
of undergraduates revealed a mean score of 68.3 (17.5) (Khoshouei, 2009).
In young Australian adults and undergraduates (Benetti & Kambouropoulos,
2008), the mean score was 68.3 (12.3). Clauss-Ehlers and Wibrowski (2007)
studied a group of high school graduates transitioning to college, and
reported a mean (sd) CD-RISC score of 73.1 (14.1) before a preparation
course.
Russian schoolchildren (mean age 13 years) who survived a terrorist attack

had a mean score of 70.1 (14.0) (Vetter et al, 2010). Dutch undergraduate
students (mean age 19.6 years) showed a mean score of 66.4 (10.8).
Incoming college students in Texas had a mean score of 67.7 (10.0) before a
four-week resiliency program (Steinhardt and Dolbier, 2008).
Ito et al (2009) have reported a mean (sd) CD-RISC score of 55.8 (14.8) in
Japanese university students (mean age 20.1), and 64.3 (16.7) in adults
(mean age 38.9) who took a university course.
In 79 Dutch undergraduate volunteers (mean age 19.6 years), the mean CD-
RISC score was 66.4 (10.8) (Giesbrecht et al, 2009), while in a later study
from the same country, the mean score was 63.9 (14.2) (Markovitz et al,
2014).
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Otto and colleagues (2010) studied 856 college students in Arizona, average
age 18.9, and found the mean CD-RISC score to be 72.9 (13.5).
A cohort of 220 first year psychology students yielded a mean score of 28.0
(5.7) on the CD-RISC 10 (Shlomi, 2010).
A somewhat older college population (n=51, mean age 31.2 years) was
studied 19 months following a major earthquake in Pakistan. The mean CD-
RISC score was 81.2 (12.3) (Ahmad et al, 2010).
A group of 401 Australian university students, mean age 23.6, demonstrated

a mean CD-RISC score of 69.1 (13.4) (Bitsika et al, 2010).
Among 2,914 Chinese adolescents (mean age 14.4, range 13-17) sampled in
Chengdu following a major earthquake, the total score mean was 69.6 (13.2
sd) (Yu et al, 2011).
In a Canadian study of homeless youth (mean age 18.2, range 15-21),

resilience was higher in those with the longest period of homelessness, and
was a significant protector against suicidal ideation (Cleverley and Kidd,
2011).
In a group of 190 Singaporean adolescents, the mean scores were 71.1, 27.9
and 5.76 for the 25-, 10- and 2-item scales (Lim et al, 2011).
Brown and Tylka (2011) observed a mean score of 76.0 (13.2) in 290
African American students.
Notario-Pacheco et al (2011) reported good psychometric properties for the

CD-RISC 10 in Spanish university students. The mean score was 27.4.
Stephens (2012) evaluated 70 adolescent nursing students, grouped by

whether they were randomized to a treatment or non-treatment cohort. Their
mean baseline scores were 75.2 and 74.5.
Hartley (2012) assessed a student counseling clinic sample of college

students with a history of mental illness (n=121) and a group of classroom
subjects (n=605). Significantly lower RISC-10 scores were noted in the
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former group: 19.6 (8.2) vs. 30.1 (5.2). The 10-item scale performed better
than the 25-item scale in this study.
Ziaian et al (2012) studied 170 refugees from Bosnia, Serbia, Iran, Iraq,
Afghanistan, Sudan and Liberia, and found a low mean CD-RISC score
(62.2). Significantly lower scores were observed in males, recent arrivals
and those with depression or behavior disturbance. Exposure to trauma and
area of origin were not factors that affected level of resilience.
These and other scores are summarized in Tables 2a-c.
14
15
Table 2a. Mean (SD) CD-RISC 25-Item Scores in Students and Young Adults
Authors Scale Number Mean (SD) Location Diagnostic group
Clauss-Ehlers and 25 95 73.1 (14.1) USA High school graduates
Wibrowski (2007)
Steinhardt and Dolbier 25 27 70.6 (12.3) USA College freshmen undergoing either
(2008) 30 67.7 (10.0) treatment or control group
Otto et al (2010) 25 856 72.9 (13.5) USA College students
Johnson et al (2011) 25 45 M 77.8(10.3) USA College students in a study of alcohol
43 F 73.6(11.0) use habits
Hartley (2011) 25 605 75.7(11.9) USA Undergraduate students
Brown and Tylka 25 290 76.0(13.2) USA African American students
(2011)
Stephens (2012) 25 70 74.5 USA Nursing students control group
75.2 Nursing students pre treatment
Bezdjian et al (2016) 25 53,672 83.6(11.0) USA Air Force recruits (mean age 20.1 yrs)
Wamser-Nanney et al 25 429 69.8 (17.6) USA Trauma-exposed college students
(2017) mean age 19
Benetti and 25 240 64.3 (12.3) Australia Adult undergraduates
Kambouropoulos
(2008)
Bitsika et al (2010) 25 401 69.1 (13.4) Australia University students
Gucciardi et al (2011) 25 199 73.0 (10.9) Australia Teenage cricketers
Ziaian et al (2012) 25 170 62.2 (20.40) Australia Adolescent refugees
Pidgeon and Keye 25 141 90.7 (12.6) Australia University students
(2014)
Innes (2016) 25 194 65.0(12.9) Australia Chiropractic students
Jorgensen and Seedat 25 701 64.8 (18.9) South Africa School sample adolescents
(2006)
Bruwer et al (2008) 25 502 65.9 (18.6) South Africa Convenience sample of high school
students mean age 16.2
Rogers (2016) 25 62 77.4 South Africa Clinical associate students
Fyncham et al (2009) 25 787 63.7 (17.9) South Africa Secondary school sample
Yu et al (2011) 25 2,914 69.6 (13.2) China Adolescent earthquake survivors
Peng et al (2012) 25 1,998 61.7 (10.6) China Medical students
Fu et al (2013) 25 2,132 50.5 (19.9) China Adolescent and child survivors of
1,988 50.2 (19.5) earthquake
Chen et al (2014) 25 32 49.3 (6.5) China Adolescent earthquake survivors who
52.7 (17.9) lost a parent: pre-treatment scores
Shi et al (2016) 25 2,968 68.2 (14.3) China College freshmen “left behind”
70.4 (14.4) College freshmen controls
Lü et al (2016) 25 82 63.5 (18.7) China Healthy college students
Lu et al (2017) 25 474 57.9 (13.2) China Community sample of elderly adults
Chen et al (2018) 25 310 64.3 (13.2) China College students
Khoshouei et al (2008) 25 323 68.3 (17.5) Iran Undergraduates
Ebrahimi et al (2012) 25 100 58.1 (7.4) Iran University students
Zakiei et al (2017) 25 260 80.9 Iran University students
Ameen & Cinkara 25 223 63.7 (12.0) Iraq Adolescent refugees Syria and Iraq
(2018)
Ameen (2018) 25 143 54.7 (10.3) Iraq Displaced adolescents Iraq
Ito et al (2009) 25 220 55.8 (14.8) Japan Undergraduates mean age 20

434 64.3 (16.7)
Undergraduates mean age 39
Sidheek et al (2017) 25 606 61.6 (13.5) India Low income girls ages 16-18
Allan et al (2014) 25 1,534 75.1 (12.8) England University freshmen
Giesbrecht et al (2009) 25 79 66.4 (10.8) Netherlands Undergraduates
Markovitz et al (2014) 25 254 63.9 (14.1) Netherlands Dutch students
15
16
Vetter et al (2010) 25 94 70.1 (14.0) Russia Schoolchildren ages 10-16 who

survived a terrorist attack in Ossetia,
some of whom had PTSD
Cleverley and Kidd 25 47 60.9 (18.9) Canada Homeless youth (male)
(2011) 53.1 (19.0) Homeless youth (female)
Lim et al (2011) 25 190 71.13 Singapore Adolescents mean age 12.8 (range 12-
16)
Kang et al (2013) 25 321 67.2 (12.7) Korea College students
16
17
Table 2b. Mean (SD) CD-RISC 10-Item Scores in Students and Young Adults

Campbell-Sills et al 10 131 27.2 (5.8) USA College undergraduates
(2007)
Hartley (2012) 10 605 30.1 (5.3) USA Normative student sample
Jones et al (2017) 10 39 33.5(18.4) USA Juvenile male healthy controls
24.1(6.3) Juvenile sexual offenders
26.4(18.3) Juvenile child sexual abuse offenders
Reyes et al (2017) 10 20 31.8 (5.3) USA Student veterans
Shlomi (2010) 10 220 28.0 (5.7) Canada Psychology students
Rahimi et al (2014) 10 155 28.8 (4.4) Canada Medical students – female < male scores
31.2 (5.2)
16)
Lee et al (2016) 10 1094 25.8 (8.0) Korea All students (n=1094)
30.8 (9.2) Morning type (n=52)
26.3 (8.0) Intermediate type (n=656)
24.2 (7.3) Evening type (n=350)
Skrzypiec et al (2018) 10 2050 29.3 (7.3) China School pupils aged 10-15
Chow et al (2018) 10 678 24.0 (5.7) China/Hong Student nurses
Kong
Notario-Pacheco et al 10 681 27.4 (6.4) Spain University first year students mean age
(2011) 20.1 (18-30)
Markovitz et al (2014) 10 254 25.7 (6.8) Netherlands Dutch students
Leventhal et al (2015) 10 1,730 20.8 India Rural schoolgirl population mean age
737 22.2 12.9 years
Mathad et al (2017) 10 194 26.3(6.3) India Nursing students
Montero-Marin et al 10 314 27.8 (6.7) Spain Dental students
(2014)
Farkas & Orosz (2015) 10 465 28.0 (0.6) Hungary Students
Orosz et al (2018) 10 343 28.2 Hungary High school and university students
DiFabio & Saklofske 10 164 24.8 (6.2) Italy High school students
(2014)
Aloba et al (2016) 10 449 26.7 Nigeria Student nurses

Chamberlain et al 10 240 32.0 (5.7) Australia Third year student nurses
(2016)
Table 2c. Mean (SD) CD-RISC 2-Item Scores in Students and Young Adults

Lim et al (2011) 2 190 5.76 Singapore Adolescents mean age 12.8 (range 12-16)
Markovitz et al 2 254 5.61 (1.44) Netherlands Dutch students
(2014)
Lu et al (2016) 2 218 6.46 (1.72) Taiwan Student athletes
Heo et al (2018) 2 1866 5.6 (1.7) Korea Adolescents in school system
Psychiatric Groups: Mean (SD) scores in a range of psychiatric groups are

listed in Tables 3, 4, and 5. These have been grouped into PTSD/Severe
trauma, depression/suicide, and other diagnoses.
Several studies have examined the CD-RISC in populations with

posttraumatic stress disorder (PTSD) (see Tables 3a-c). It is evident that
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scores in those with PTSD are much below the normative population scores.
One study in China assessed cutoff scores using ROC curves in 115
rehabilitation patients, and found that scores of 45.5 and 19.5 for the CD-
RISC-25 and CD-RISC-10 respectively provided best discrimination at
AUC values of 0.76 and 0.78. The CD-RISC-2 failed to separate (Peng et al,
2014), but did discriminate between groups in a Korean study of firefighters
(Jeong et al, 2015).
Table 3a. Mean (SD) CD-RISC 25-Item Scores in Post-Traumatic Stress Disorder &
Subjects Exposed to Severe Trauma

Connor et al (2003) 25 22 47.8 (19.5) USA Treatment seeking cases
Connor et al (2003) 25 22 52.8 (20.4) USA Treatment seeking cases
Davidson et al (2007) 25 100 57.0 (16.0) USA Tiagabine group pre-treatment
94 54.2 (16.2) Placebo group pre-treatment
Morey et al (2009) 25 20 66.7 (15.8) USA OIE/OEF veterans
Mansfield et al (2011) 25 1,843 76.2 (16.0) USA Navy personnel
1,226 72.8 (16.6) Marines
All were mandatory pre-separation
assessments
Tsai et al (2012) 25 86 59.6 (19.1) USA OEF/OIF Veterans with PTSD
76 72.0 (14.3) Other Rx seeking OEF/OIF veterans
Anderson and Bang 25 52 74.2 (15.0) USA Asymptomatic abuse survivors
(2012) 16 61.1 (14.7) Abuse survivors with PTSD
Krystal et al (2014) 25 20 62.0 (19.8) USA PTSD civilian clinical trial sample
Green et al (2014) 25 1,981 72.7 (18.4) USA Post 9/11 US veterans
Asnaani et al (2015) 25 118 68.4 (20.7) USA PTSD clinical sample with nicotine
withdrawal
Elliott et al (2015) 25 127 80.9(14.0 USA Resilient cluster – OEF/OIF veterans
61.8(21.5) Overcontrolled cluster
61.9(18.9) Undercontrolled cluster
Davidson et al (2006) 25 161 55.7 (18.4) International Prior to receiving drug
Davidson et al (2006) 25 168 53.0 (17.2) International Prior to receiving placebo
Thabet et al (2011) 25 99 81.9 (18.0) Gaza Women survivors of domestic abuse:
not all had PTSD
Mehta et al (2018) 25 48 68.2 (1.2) Australia Non-PTSD combat veterans
48 79.1 (0.9) PTSD combat veterans
Connell et al (2013) 25 54 72.1 (12.2) South Combat veterans, 33% with PTSD
Africa
Marx et al (2017) 25 22 60.8 (15.4) South PTSD – psychiatric patients
31 80.7 (11.1) Africa Healthy controls
Blanc et al (2016) 25 167 66.4 (18.4) Haiti Earthquake survivors
Tsuno et al (2014) 25 825 48.5 (16.1) Japan Government employees exposed to East
Japan Earthquake
He et al (2013) 25 410 67.8 (11.7) China Burn injury patients
Ying et al (2014) 25 788 55.0 China Adolescent (12-19 years) earthquake
survivors
Chen et al (2014) 25 32 51.8 (13.2) China Bereaved adolescent earthquake
49.3 (6.5) survivors assigned to three treatment
52.7 (17.9) groups
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19
Ni et al (2015) 25 495 China Sichuan earthquake survivors five years

follow-up
Zhang et al (2017) 25 222 56.9(16.0) China Parents bereaved of their only child.
Randomized stratified community
sample Changsha
Ssenyonga et al 25 426 51.9 (15.0) Uganda Congolese refugees with and without
(2013) PTSD PTSD
51.5 (17.8)
No PTSD
Ameen 25 143 54.7 (17.1) Iraq Adolescents displaced and/or loss of
home and family
Ghisi et al (2013) 25 76 61.3 (17.3) Italy Industrial accident victims (39% with
74.2 (10.0) PTSD) and matched controls
Brunetti et al (2017) 25 19 66.7 (8.9) Italy PTSD
19 72.2(13.9) Trauma +ve/No PTSD
Fu et al (2013) 25 2,132 50.5 (19.9) China Child and adolescent survivors of
1,988 50.2 (19.5) Sichuan earthquake. Mean age 11.7
years (range 6-16). Control and
intervention groups were studied.
Bhattarai et al (2017) 25 82 64.8(14.0) Nepal Earthquake survivors with spinal cord
injury
Kukihara et al (2014) 25 241 50.8 (19.6) Japan Older adult survivors of Fukushima
earthquake, tsunami and nuclear
accident; 53% PTSD and 67%
depression
Jeon et al (2017) 25 10 50.0 (15.8) Korea Ferry sinking survivors before and after
57.6 (18.3) treatment
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20
Table 3b. Mean (SD) CD-RISC 10-Item Scores in Post-Traumatic Stress Disorder &
Grattan et al (2011) 10 71 29.1 (6.1) USA Deepwater Horizon Oil Spill
10 23 29.9 (5.9) USA
10 47 30.0 (6.5) USA
10 47 28.5 (5.5) USA
Melvin et al (2012) 10 60 31.0 (6.5) USA Combat veteran couples
McCanlies et al 10 114 29.9 (6.3) USA Police officers post Hurricane Katrina
(2014)
Rainey et al (2014) 10 110 31.3 USA Traumatic injury; hospitalized patients
Pietrzak et al (2014) 10 1,686 30.3 (6.6) USA National sample of older veterans age
60-96
Wingo et al (2017) 10 246 23.6(7.9) USA Veterans with PTSD and depression
Davidson et al (2008) 10 329 20.1 International Prior to drug treatment
19.9 International Prior to receiving placebo
Klasen et al (2010) 10 330 22.7 (8.3) Uganda Former child soldiers aged 11-17
Tran et al (2013) 10 84 25.9 (6.7) Austria WW II survivors with PTSD
31.1 (6.1) WW II survivors without PTSD
Wang et al (2010) 10 341 24.8 (7.4) China Earthquake survivors – whole group
20.8 (6.3) PTSD group
26.8 (6.3) Non-PTSD controls
Wu et al (2015) 10 318 24.8 (7.5) China Earthquake survivors (Results given in
paper based on 1-5 scoring algorithm,
and are corrected here)
Duan et al (2015) 10 95 25.5 (4.9) China University students with PTSD and
posttraumatic growth
Okuyama et al (2014) 10 1,973 20.5 (0.7) Japan Adolescent survivors of Great East
Japan Earthquake
Table 3c. Mean (SD) CD-RISC 2-Item Scores in Post-Traumatic Stress Disorder &

Davidson et al (2008) 2 329 4.53 International Prior to receiving drug
4.56 International Prior to receiving placebo
Jeong et al (2015) 2 222 6.0 (1.2) Korean Control group
5.1 (1.5) firefighters PTSD or depression alone
4.4 (1.5) PTSD with depression
Langhinrichsen- 2 120 3.94 USA primary PTSD

Rohling et al (2017) 5.66 care/behavioral PTSD possible
6.03 health PTSD unlikely
Eight studies looked at depression and five studies have examined resilience
scores in relation to a history of suicide attempts or ideation. In depression,
the scores have ranged from 39-63, perhaps affected by the sample, phase of
illness and level of recovery at the time of assessment. Minor depression was
associated with scores intermediate between wellness and major depression.
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21
Those who went on to respond poorly to treatment had lower scores than did
those who responded well (Camardese et al, 2007). A small study of 9
outpatients with depression and/or anxiety prior to group therapy showed a
very low mean CD-RISC score of 39.0 (12.2) (Dodding et al, 2008). Their
non-symptomatic significant other partners (n=11) scored 62.8 (11.7).
In a sample of abstinent substance abusers who either had, or had not,

attempted suicide, the mean scores were 49.8 and 62.7 respectively (Roy et
al, 2006). Subsequent studies comparing suicide-attempters (SA) with non-
attempters have consistently found lower CD-RISC scores in the former
group. Nrugham et al (2010) found Norwegian schoolchildren with
depression and a history of SA showed lower resilience (55.4 (13.4) than
depressed adolescents with no SA (62.4 (13.6). In veterans of OIF and OEF,
Pietrzak et al (2009b) reported scores of 60.9 (2.8 s.e.) in those with SA and
75.5 (1.0 s.e.) in those without such history. In 903 Italian prisoners, the CD-
RISC score was lower among those with a history of SA (56.4 (16.0)) than
in those without (65.1(13.1)) (Sarchiapone et al, 2009). Liu et al (2014)
found that low CD-RISC scores predicted suicide attempts in a large
community sample.
These scores are summarized in Table 4.
Table 4a. Mean (SD) CD-RISC 25 Scores in Subjects with Depression, Suicide Attempts
or Suicidality
Authors Scale N Mean (SD) Location Comments

Davidson et al 25 41 57.1 (13.3) USA Major depression outpatient sample
(2005)
Pietrzak et al 25 34 60.9 USA Suicide attempting OIF/OEF veterans
(2009b) (2.8 se)
Vahia et al (2010) 25 401 71.7 (12.5) USA Community sample post-menopausal women
63.4 (14.7) with sub threshold depression
137 Community sample post-menopausal women
with major depression
Lavretsky et al 25 20 60.2 (16.7) USA Alzheimer’s Caregivers
(2010) 66.6 (17.7)
20 USA Alzheimer’s Caregivers
Lavretsky et al 25 36 60.5 (14.0) USA Depressed older subjects to receive tai chi or
(2011) 56.9 (13.4) health education
37
Laird et al (2018) 25 337 58.2 (16.0) USA MDD in older subjects mean age = 70.4
Soczynska et al 25 29 43.3 (15.3) Canada Depressed bipolar
(2017) 46 57.1 (19.1) Euthymic bipolar
Singh et al (2014) 25 90 77.4 CT India Psychogeriatric and medical geriatric OP
55.5 RA sample. Depression < Rheumatoid arthritis <
47.7 DP Healthy controls
Roy et al (2006) 25 41 49.8 Italy Suicide attempting substance abusers
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22
Camardese et al 25 102 53.3 (15.2) Italy Major depression which responded to

(2007) 41.2 treatment
(19.5)
Depression which failed to respond.
Roy et al (2007) 25 30 39.7 Italy Suicide attempting substance abusers, some
(3.7 se) with history of depression
Sarchiapone et al 25 131 56.4 (16.0) Italy Prisoners with history of suicide attempt
(2009)
Bauriedl-Schmidt 25 45 71.7(13.9) Germany/ Healthy controls > Chronic and episodic
et al (2017) 48.5(20.3) Austria depression; chronic = episodic depression
44.3(17.1)
Min et al (2012) 25 80 46.1 Korea Major depression, dysthymia or depression
(18.7) NOS
Seok et al (2012) 25 52 43.9 Korea Major depressive disorder
64.9 Healthy controls
Min et al (2013) 25 230 47.4(20.2) Korea Outpatients with depression and/or anxiety
disorder
Um et al (2014) 25 254 46.0 (20.8) Korea Depressed outpatients
Choi et al (2015) 25 62 60.5 Korea Euthymic bipolar disorder patients

62 72.8 Healthy controls
You & Park 25 2034 50.2(15.9) Korea Community sample of elders: in men high
(2017) CD-RISC score protected against suicidal
behavior
Ristevska- 25 218 79.1 Macedonia Not depressed breast cancer
Dimitrovska et al 68.2 Subthreshold depression breast cancer
(2015a) 56.4 Major depression breast cancer
Dodding et al 25 9 39.0 (12.2) Australia Major depression
(2008)
Nrugham et al 25 76 55.4 (13.4) Norway Depressed teenagers with history of suicide
(2010) 176 62.4 (13.6) attempt
Depressed subjects without suicide history
Lewis et al (2017) 2 697 5.8(1.7) England Subthreshold depression in primary care
Table 4b. Mean (SD) CD-RISC-10 and CD-RISC-2 Scores in Subjects with Depression, Suicide Attempts
or Suicidality
Authors Scale n Mean (SD) Location Comments
Poole et al (2017a) 10 277 22.3(7.6) Dep Canada Primary care
3413 31.0 Non-dep
Lewis et al (2017) 2 697 5.8(1.7) Subthr England Primary care
depression
CD-RISC scores have been reported in subjects with other psychiatric

disorders or pathology, including generalized anxiety, generalized social
anxiety, substance use problems, bipolar disorder, pain, insomnia and
schizophrenia, as shown in Tables 5a and 5b.
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Table 5a. Mean (SD) CD-RISC 25-Item Scores in Groups with Other Psychiatric
Disorders

Connor et al 25 24 62.4 (10.7) USA Generalized anxiety disorder
(2003)
Simon et al (2009) 25 103 48.7 (15.6) USA Generalized social anxiety disorder
Sutherland et al 25 64 63.8 (17.7) USA Chemical dependency
(2009)
Elliott et al (2016) 25 127 81.0(14.0) USA Resilient personality
61.9(18.6) Undercontrolled personality
61.8(21.4) Overcontrolled personality
Baslet et al (2017) 25 46 55.9 (18.1) USA Psychogenic seizures & altered responsiveness
67.8 (17.3) Psychogenic seizures & no altered
responsiveness
Roy et al (2006) 25 59 62.7 Italy Abstinent substance abusers
Roy et al (2007) 25 70 62.9 Italy Abstinent substance abusers
(2.5 se)
Carli et al (2011) 25 1,420 64.3 (14.7) Italy 1,427 prisoners, 568 with insomnia – RISC
was lower in the insomnia group (data not
given).
Carli et al (2013) 25 1,356 65.1 (14.1) Italy Male prisoners – 51% with Axis I disorder
(Substance use disorder in 39%)
Callegari et al 25 91 66.2(1.3se) Italy Older adults in community
(2016) 56 62.4(1.6) In nursing home
50 56.4(1.7) Psychiatric nursing home group – mainly
depressed or psychotic
Deane and 25 24 60.3 (18.5) Australia Schizophrenia
Andresen (2006)
Deane and 25 119 63.0 (18.3) Australia Schizophrenia
Andresen (2006)
Hansen and 25 15 57.1 Norway Schizophrenia
Thomassen (2010) (14.4)
Torgalsbøen 25 15 61.3 (13.3) Norway Schizophrenia in recovery or remission
(2012)
Bozikas et al 25 48 61.6(21.0) Greece Schizophrenia spectrum
(2016) 81 71.2(10.4) Healthy controls
Jafari et al (2010) 25 27 53 (10) Iran Males with substance dependence
52 (5)
Zakiei et al (2017) 25 260 80.9 Iran University students assessed for obsessive-
compulsive personality disorder
Min et al (2012) 25 41 53.6 (21.0) Korea GAD, panic, OCD, SAD mostly
Solano & Neto 25 108 57.7 Brazil Anxiety
(2012) 41 52.1 Borderline Personality Disorder
Schibalski et al 25 676 61.1(12.7) Germany Elevated psychiatric symptoms in
(2017) representative population survey
Obbarius et al 25 521 56.1 (17.2) Germany Psychosomatic disorder patients
(2018)
Jiao et al (2016) 25 208 57.6 (15.9) China Methadone maintenance treatment patients
Lee et al (2016) 25 68 60.5 (18.4) China Euthymic bipolar disorder patients
68 69.3 (11.1) Healthy controls
Hoseiny et al 25 30 38.1 (2.2) Iran Opiate dependence
(2015) 30 37.1 (3.3)
Marulanda and 25 40 59.2 (15.0) Canada High risk for psychosis
Addington (2014) 40 70.6 (11.5) College student controls
Marx et al (2017) 25 40 58.2 (17.2) South Social anxiety disorder psychiatric patients
31 80.7 (11.1) Africa Healthy controls
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Table 5b. Mean (SD) CD-RISC 10-Item Scores in Groups with Other Psychiatric
Disorders

Hartley (2012) 10 121 19.6 (8.2) USA Student counseling clinic sample
Lee et al (2018) 10 110 23.4 (8.2) USA Schizophrenia
92 33.1 (5.7) Healthy controls
Solano et al (2016) 10 575 25.8(9.1) Brazil Psychiatric outpatients
Poole et al (2017b) 10 606 24.7(7.3) Canada High vs not high anxiety on GAD-7 in
3100 31.4(6.4) primary care patients
Table 5c. Mean (SD) CD-RISC 2 Item Scores in Groups with Other Psychiatric Disorders

Draper et al (2014) 2 210 5.9 (2.0) Australia Geriatric in- and outpatients; 36% depressed
Mean CD-RISC scores have been reported as follows: generalized anxiety

disorder 62.4 (10.7) (Connor and Davidson, 2003); PTSD 47.8 (19.5), 52.8
(20.4) (Connor and Davidson, 2003), 55.7 (18.4), 53.0 (17.2) (Davidson et
al, 2006) and 66.7 (15.8) (Morey et al, 2008).
In a group of Korean patients with GAD or panic mostly, the mean CD-
RISC was 53.6 (21.0) (Min et al, 2012). A later study by that group found
lower scores in depression and/or anxiety (Min et al, 2013).
Bipolar patients with depression scored lower than euthymic bipolar patients
(Soczynska et al, 2017).
In a geriatric group, community subjects had higher resilience scores than

did a nursing home cohort, and the lowest scores were found in a third group
of psychogeriatric nursing home patients, with depression, psychosis,
personality disorder or dementia (Callegari et al, 2016).
In two groups of Australian patients with schizophrenia (mainly), corrected

mean scores were 60.3 (18.4) and 63.0 (18.3) (Deane and Andresen, 2006;
Andresen et al, 2006). (Note comment on required scoring corrections in
these two publications in citations section below). A small cohort of
recovered or remitted patients with schizophrenia was studied by
Torgalsbøen in Norway, and found to have a mean CD-RISC score of 61.3.
Their scores correlated significantly with global function and global
relational function. Another study from the same group found a mean score
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25
of 57.1 in a small group of patients with schizophrenia (Hansen and

Thomassen, 2010). A group of subjects at high risk for developing psychosis
scored lower (59.2 (15.0)) than student controls (70.6 (11.5)), and lower
RISC scores were associated with more negative symptoms and poorer role
function (Mirulanda and Addington (2014). In Greece, Bozikas et al (2016)
observed a score of 61.6 in schizophrenia-spectrum patients, which was
lower than healthy controls (71.2). A study in the US, using the CD-RISC-
10, found lower scores in schizophrenia than in healthy controls (Lee et al,
2018).
In Texas, women with chemical dependency (n=64) have lower CD-RISC

scores (63.8 (17.7)) than those without (82.7 (9.0)) (n=64) (Sutherland et al,
2009).
Simon and associates (2009) reported on a cohort of 103 US patients with

generalized social anxiety disorder (GSAD), and found the mean CD-RISC
to be 48.7 (15.6). Lower scores on SAD (58.2) were also observed by Marx
et al (2017), relative to healthy controls (80.7) in a South African cohort.
In 1,265 incarcerated Italian males, Carli et al (2010) noted the mean CD-
RISC score to be 65.3 (14.1). In another cohort (n=1,420) of Italian
prisoners with significant insomnia, the mean score was 64.3(14.7) (Carli et
al, 2011). It is unclear whether these are two separate groups or whether
there was some overlap between them. A third report by the group (Carli et
al, 2013) evaluated the relationship between resilience (mean score =
65.1(14.1), aggression and impulsivity.
Treatment seeking veterans from OIF and OEF were found to have mean
CD-RISC scores of 70.0 (16.5) and 50.9 (15.2) when divided into those
without and those with suicidal ideation respectively (Pietrzak et al, 2010).
Green and colleagues (2010) found a mean CD-RISC score of 72.0 (17.5) in
497 veterans who had served since 9/11/2001.
Jafari et al (2010) noted low scores in Iranian males with substance

dependence (medians of 53 and 52 in two groups entering treatment).
Brazilian subjects with anxiety and borderline personality disorder had mean
(95% CI) scores of 57.7 (53.8-61.5) and 52.1 (44.6-59.6) (Solano and Neto,
2012).
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26
Medical groups: Studies have been carried out in patients with a variety of
medical problems, as shown in Tables 6a-c.
Table 6a. Mean (SD) CD-RISC 25-Item Scores in Groups with Medical Problems

Connor et al 25 139 71.8 (18.4) USA Primary care patients
(2003)
Sexton et al 25 40 68.1 (14.3) USA Women with infertility
(2009)
Steinhardt et al 25 16 83.1 (8.5) USA Patients with diabetes
(2009)
White et al (2010) 25 42 82.2 (9.4) USA Spinal cord injury
Loprinzi et al 25 12 73.6(10.1) USA Breast cancer survivors in controlled
(2011) 8 78.2(10.5) trial
McCauley et al 25 46 81.1(21.1) USA Mild TBI
(2013) 29 82.5(16.7) Orthopedic non-head injuries
Graham et al 25 41 60.6(24.3) USA OIF/OEF Veterans with TBI
(2013) 26 77.7(18.8) Controls without TBI
Senders et al 25 117 73.4 (15.8) USA Multiple sclerosis
(2014)
Cohen et al (2014) 25 14 93 (82-93) USA Pre lung transplant
42 87 (76-95) Post lung transplant
Sexton et al 25 214 76.6(13.6) USA Postpartum women
(2015)
Fernandez et al 25 120 72.8 (16.0) USA End stage liver disease – transplant
(2015) candidates
Kreutzer et al 25 160 76.8(17.3) USA Mild TBI
(2016)
Elliott et al (2016) 25 127 67.5(20.1) USA TBI +ve OEF/OIF Veterans
70.8(19.6) TBI –ve OIF/OEF Veterans
Hanks et al (2016) 25 67 75.9 (16.9) USA Mild TBI
Marwitz et al 25 192 76.8 (17.2) USA TBI
(2017)
Park et al (2017) 25 154 72.2(15.0) USA IBS
102 77.3(12.7) Healthy controls
Jalilianhasanpour 25 50 63.2 (16.5) USA Functional neurological d/o
et al (2018) 45 78.7 (12.1) Healthy controls
Reid et al (2018) 25 165 75.4 (16.4) USA DoD/VA with mTBI
Arbour et al 25 8 70 (15) Canada Young with mod/severe TBI
(2017) 5 80 (4) Mid-age with TBI
McKillop et al 25 70 65.1 (16.7) Canada Chronic back pain patients
(2017)
Shin et al (2012) 25 24 89.9(15.8) Korea Spinal cord injury males
12 89.4(11.9) SCI females
Min et al (2013) 25 83 64.5(13.1) Korea Metastatic cancer with distress
69 77.1(12.6) Cancer without emotional distress
Singh et al (2014) 25 90 77.4 HC India Geriatric sample
55.5 RA RA < HC; RA > DEP
47.7 DEP
Huang et al 25 345 74.9 (14.8) Taiwan Diabetes
(2010)
26
27
De Robert et al 25 37 77.9 (11.5) Argentina Hypertension (HT)

(2010) 71 68.8 (12.7) Non-HT control
Low resilience with chronic stress
increased odds for hypertension
O’Hanlon et al 25 27 72.0 (13.5) UK Parents with cleft lip/palate
(2011) 25 27 70.1 (13.5) Control parents
West et al (2012) 25 31 64.9(15.4) Australia Chronic pain
36 69.8(16.3) Family controls
Guest et al (2016) 25 88 75.6 (14.8) Australia Spinal cord injury
Kohler & Loh 25 29 73.7(12.9) Australia Geriatric orthopaedic fracture patients
(2016)
Solano & Neto 25 132 76.3 Brazil Surgical OP pre-anesthesia workup
(2012) 100 77.3 Chronic pain
103 75.4 Chronic pain group family controls
Solano et al 25 20 74.0 Brazil Colorectal cancer with depression
(2016a) 24 88.5 Cancer without depression
Boell et al (2016) 25 412 79.8 (78.5-81.0) Brazil Type 2 diabetes
191 67.5 (64.8-70.2) Chronic kidney disease
Bodde et al (2013) 25 26 73.3(11.7) Netherlands Amputees with complex regional pain

syndrome type 1.
He et al (2013) 25 410 67.8 (11.7) China Burn injury patients
Jiao et al (2016) 25 208 57.6 (15.9) China Methadone maintenance patients
Wu et al (2016) 25 213 61.0 (12.3) China Women with breast cancer
Bhattarai et al 25 82 64.8(14.0) Nepal Earthquake survivors with spinal cord
(2017) injury
Abolghasemi et al 25 40 82.1 (13.0) Iran Fertility clinic male population – fertile
(2013) 40 59.3 (14.2) Fertility clinic – infertile males
Derakhshanrad et 25 63 58.4(15.5) Iran Stroke survivors
al (2014)
Derakhshanrad & 25 25 74.7 (15.8) Iran Cognitively oriented stroke survivors
Piven (2017)
Setareh et al 25 100 65.1 (13.0) Iran Multiple sclerosis < resilient than
(2017) 100 57.5 (17.9) healthy controls
Markovitz et al 25 253 68.8 (14.6) Belgium Breast cancer patients
(2015) 25 211 68.0 (11.9) Healthy control women
Ristevska- 25 218 74.7(17.0) Macedonia Breast cancer patients. (see table 4
Dimitrovska et al also)
(2015a)
Fradelos et al 25 144 65.3(17.9) Greece Breast cancer patients
(2017)
Crosta et al (2018) 25 153 66.8 (12.1) Italy Psoriasis patients
72.2 (9.8) Healthy controls
Dubey et al 25 68 74.4 (12.6) Switzerland Cancer patients
(2015)
Spies and Seedat 25 95 81.7 South Women with HIV
(2014) Africa
Roos et al (2014) 25 142 69.5 (17.2) South Pregnant women at antenatal clinic
Africa
Table 6b. Mean (SD) CD-RISC 10-Item Scores in Groups with Medical Problems
Authors Scale Numbe Mean (SD) Location Diagnostic group

r
Wingo et al (2010) 10 792 34.0 (median) USA Primary care/gynecology groups
(0-40 range)
Dodd (2010) 10 102 32.4(5.4) USA Inpatients in rehabilitation post injury
27
28
Wrenn et al (2011) 10 233 30 (12) median USA PTSD primary care patients
534 35 (8) median Non-PTSD primary care patients
Mascolini (2012) 10 42 27.0 USA HIV positive older subjects
20 31.0 HIV negative older subjects
Bradley et al 10 971 31.6(7.7) USA African-American OB/GYN
(2013) outpatients
Lukow et al 10 96 22.0 (8.8) USA Mild to severe TBI
(2015)
Rosenberg et al 10 1,782 31.4(6.6) USA Hematopoetic cell transplantation
(2015) survivors
Dale et al (2014a) 10
138 28.3(7.8) USA HIV+ve women
Dale et al (2014b) 10 85 29.3(7.8) USA HIV+ve women
Terrill et al (2016) 10 1862 28.0(7.1) USA Long term physical disabilities
Battalio et al 10 1574 29.0(7.0) USA Neurological disabilities – internet
(2016) sample
Carlsen et al 10 73 30.4(5.5) USA Adolescents with IBD
(2017)
Koelmel et al 10 163 26.8(6.2) USA Multiple sclerosis
(2016)
Scali et al (2012) 10 238 27 (22-32 1,3Q) France Mammography subjects with and
without breast cancer
Matzka et al 10 343 29.3(7.0) Austria Cancer patients
(2016)
Kilic et al (2013) 10 60 29.5(7.2) Australia Spinal cord injury
Li et al (2016) 10 231 26.9 (6.6) China Pregnant women
Hayter & Dorstyn 10 97 25.6(8.1) Australia Spina bifida
(2013)
Black & Dorstyn 10 196 27.0(7.1) Australia Multiple sclerosis
(2013)
Lyons et al (2016) 10 357 27.0(7.7) Australia HIV+ve men
Seib et al (2018) 10 278 30 median Australia Women with cancer
Markovitz et al 10 101 27.6 (5.9) Belgium Breast cancer patients
(2014) 10 107 27.4 (6.8) Belgium Control women
Notario-Pacheco 10 191 24.7(10.8) Spain Fibromyalgia

et al (2014)
McGlone (2010) 10 27 29.3(6.2) Canada Epilepsy

Poole et al (2016) 10 3836 30.3(7.1) Canada Primary care population
Walsh et al (2018) 10 241 29.0 (7.5) Ireland Post treatment for prostate cancer
Sharma et al 10 131 27.0 (7.0) Nepal Chronic pain
(2018)
Table 6c. Mean (SD) CD-RISC 2-Item Scores in Groups with Medical Problems

Vinaccia and 2 40 6.8 (1.8) Colombia COPD
Quiceno (2011)
Vinaccia et al 2 40 7.5 (1.0) Colombia Chronic kidney disease
(2012) 41 7.0 (1.4) Rheumatoid arthritis
d.Emden et al 2 151 6.1(1,5) Australia Type 1 diabetes
(2017)
Markovitz et al 2 101 6.2 (1.2) Belgium Cancer patients
(2014) 110 5.9 (1.5) Belgium Control women
28
29
A primary care sample in North Carolina was found to have a mean (sd)
CD-RISC score of 71.8 (18.4) (Davidson and Connor, 2003). Seven hundred
ninety two mainly African American gynecological or primary care
outpatients were studied by Wingo et al (2010) in the US. Using the CD-
RISC 10, the authors found a median score of 34 (range 0-40). The same
group reported a median score of 30 in 233 PTSD cases among inner city
primary care patients who had been exposed to trauma, compared to a
median score of 35 in the non-PTSD group, a significant difference
(p<0.0001) (Wrenn et al, 2011).
Sexton et al (2009) studied infertility in 40 women, and reported a mean

score of 68.1 (14.3), with the scale proving to be reliable and valid, showing
convergent validity against other measures, and correlating positively with
active coping.
In African American diabetics, the mean resiliency score was 83.1 (8.5)
(Steinhardt et al, 2009). Huang (2010) studied 345 diabetic patients in
Taiwan, and found the mean CD-RISC score to be 74.9 (14.8).
Forty-two patients with spinal cord injury showed a mean CD-RISC 25

score of 82.2 (9.4) (White et al, 2010).
Inpatients in rehabilitation after injury reported a mean score of 32.4 (5.4) on

the CD-RISC 10 (Dodd, 2010).
Shin (2010) studied resilience in Korean patients with cardiovascular

disease, validating their new cardiovascular resilience scale against the CD-
RISC, with which it correlated.
Twenty-seven subjects with epilepsy had a mean (sd) score of 29.26 (6.23)
on the CD-RISC 10 (Jeanette McGlone et al, personal communication,
4/5/10).
Parents with cleft lip or palate did not differ from a matched control group in
respect of CD-RISC 25 scores, which were 72.0 and 70.1 respectively
(O’Hanlon et al, 2011).
In an Australian sample, patients with chronic pain showed low resilience

(64.9) compared to healthy controls (West et al, 2011).
29
30
Mascolini (2012) showed that older subjects who were HIV +ve (n=42) had
lower RISC-10 scores than those who were HIV –ve (n=20) (p=0.06) and
that resilience was lowest in the HIV +ve group with impaired activities of
daily living.
West et al (2012) found that chronic pain (n=31) was associated with
reduced RISC-25 scores, which were lower than a comparison group (n=36)
of relatives without pain. Although the authors state that the RISC scores
were “above average,” in point of fact both groups (64.9 and 69.8) scored
well below the US general population mean. A Brazilian group with chronic
pain and their normal control family members scored 77.3 and 75.4
respectively (Solano and Neto, 2012), which were higher than their
Australian counterparts. In Nepalese earthquake survivors with spinal cord
injury (SCI), those with severe pain had lower resilience than those without
(Bhattarai et al, 2017).
A Korean study found high levels of resilience in 36 patients 6 months post

SCI (Shin et al, 2012). Paraplegics had higher resilience than quadriplegics
in a group of Nepalese earthquake survivors with SCI (Bhattarai et al, 2017).
In a US study of 75 subjects with mild TBI or other orthopedic injuries,

mean CD-RISC scores were normal (81 and 82 respectively) (McCauley et
al, 2013). However, in a group of veterans with mild TBI, the CD-RISC
score was significantly lower than that of controls (60.6 vs. 77.7) (Graham et
al, 2013), although it was affected by the 5HTTLPR genotype. A study of
those with mild to severe TBI found the mean CD-RISC-10 to be
substantially lower (22.0) than that of the US population (Lukow et al,
2015).
Eighty three Korean patients with metastatic cancer who were depressed and
anxious according to the HADS scale, showed lower levels of resilience
(64.5) compared to those (n=69) without emotional distress (77.1) (Min et
al, 2013).
Studies by Dorstyn and colleagues (Hayter & Dorstyn, 2013; Black &
Dorstyn, 2013), showed respectively lower scores on the CD-RISC-10 in
spina bifida and multiple sclerosis respectively.
A study of amputees with complex regional pain syndrome type 1 showed

that those with continuing symptoms were less resilient (median 71, IQR:
30
31
64,87) than those who were symptom free (median 81, IQR: 76,83). The
authors believed that resilience might be a key factor helping amputees
patient to accept and adapt to their new situation (Bodde et al, 2013).
Other studies have investigated subjects with burn injury (He et al, 2013),
multiple sclerosis (Senders et al, 2014; Setareh et al, 2017), HIV+ve status
(Dale et al, 2014; Spies and Seedat, 2014), and a group of patients assessed
before or after lung transplantation (Cohen et al, 2014). In the last
mentioned, the unusually high CD-RISC scores indicated a highly resilient
group, perhaps due to the stringent selection criteria for transplant eligibility.
The authors noted that resilience appeared to protect against psychological
distress post-operatively.
Patients with breast cancer in a Macedonian sample were least resilient

(56.4) if they had major depression, intermediate with mild depression (68.2)
and highest with no depression (79.1) (Ristevska-Dimitrovska et al, 2015a).
Solano et al (2016a) found higher scores in a sample of non-depressed

Brazilian patients with colorectal cancer (88.5) as compared to a depressed
sample (74.0), and that resilience correlated inversely with depression and
positively with measures of hope and independence. In another study from
Brazil, Boell (2016) noted that patients with type 2 diabetes scored within a
normal range (79.8), whereas those with chronic kidney disease were lower
in resilience (67.5).
Ristevska-Dimitrovska et al (2016b) found that resilience was negatively

related to severity of symptoms, side-effects of treatment, and to body
image, in Macedonian breast cancer survivors; positive correlations were
found relative to quality of life and functioning.
Non-treatment Seeking Trauma Survivors:
Tables 7a-c display these scores.
Table 7a. Mean (SD) CD-RISC 25-Item Scores in Non-Treatment Seeking Trauma
Survivors

Morey et al (2009) 25 20 83.4 (9.9) USA Combat trauma veterans without
PTSD
31
32
Pietrzak et al 25 272 73.8 (16.1) USA National Guard soldiers from

(2009a) OIF/OEF
Pietrzak et al (2009b) 25 233 75.5 (1.0 se) USA OIF/OEF combat veterans
McTighe (2009) 25 139 75.7 (10.9) USA Social workers in the vicinity of
terrorist attacks in NYC 9/11/01
New et al (2009) 25 42 80.4 (9.5) USA Healthy controls
82.0 (17.7) Trauma exposed non-PTSD
62.3 (23.1) PTSD
Johnson et al (2011) 25 225 71.6 (16.2) USA Active duty Marines
Anderson et al (2012a 25 37 75.0 USA Women who survived intimate
and b) partner abuse
Nugent et al (2012) 25 2,915 80.8 (17.1) USA Traumatized low income African
American sample from primary
care and OB-GYN clinics
Elbogen et al (2012) 25 1,388 75.1 (18.3) USA Iraq and Afghanistan War
veterans
Youssef et al (2013b) 25 178 76.7(15.7) USA Iraq/Afghanistan War veterans
followed for three years
Wamser-Nanney et al 25 429 69.8 (17.6) USA Students who experienced trauma
(2017)
Brancu et al (2017) 25 3247 72.6 (18.4) USA Afghanistan and Iraq veterans
Daniels et al (2012) 25 70 68.9 (15.3) Canada Acute trauma survivors (mainly
traffic accidents) seen in hospital
ED
Goldstein et al (2013) 25 93 66.9 (16.1) Canada Young adults transitioning from
welfare
Karairmak et al (2010) 25 246 70.1 (14.1) Turkey Earthquake survivors
Bensimon (2012) 25 500 67.7 (11.0) Israel College students exposed to
76 trauma
Fu et al (2013) 25 2,132 51.9 China Children ages 6-16 (mean 11.7)
who survived earthquake
Table 7b. Mean (SD) CD-RISC 10-Item Scores in Non-treatment Seeking Trauma
Survivors

Wang et al (2010) 10 341 26.8 (6.3) China Schoolteachers affected by
earthquake
Kang et al (2018) 10 227 28.9 (6.7) China Ambulance personnel: MD, RN,
EMT
Hammermeister et al 10 351 28.1 (0.8 SE) USA Stryker Battalion combat troops
(2012)
Table 7c. Mean (SD) CD-RISC 2-Item Scores in Non-treatment Seeking Trauma
Survivors

Nicholls et al (2006) 2 770 5.6 (2.6) USA Trauma survivors who contacted
Anxiety Disorders Association of
America
Irmansyah et al (2010) 2 1,466 4.67 Indonesia Tsunami survivors
32
33
Osofsy et al (2011) 2 452 6.87(2.04) USA Deepwater Horizon Oil Spill area
residents
Davidson & Lee (2015) 2 240 6.42(1.39)All USA Violent trauma survivors in US
106 6.69(1.26) F general population. Random digit
134 6.20(7.0) NF dial sample. Forgivers (F) > Non-
forgivers (NF).
A cohort of National Guard returnees from Iraq and Afghanistan was found
to have a mean score of 73.8 (16.1) (Pietrzak et al, 2009a).
The mean CD-RISC scores in 139 clinical social workers living and working
in New York City on 9/11/2001 were reported as 75.7 by McTighe (2009).
In 341 primary and secondary school teachers of mean age 39.0, who were
assessed after the Wenchuan earthquake, the mean CD-RISC 10 score in
those without PTSD was 26.8 (6.3 sd) (Wang et al, 2010).
246 survivors of the Marmara and Bolu earthquakes in Turkey were studied
by Karairmak (2010). Their mean CD-RISC 25 score was 70.1 (14.1).
Irmansyah and colleagues used the CD-RISC 2, translated into Bahasa

Indonesian, to assess resilience in a group of 1,466 earthquake/tsunami
survivors (2010). The mean and SD scores were given for each item as 2.29
(1.22) and 2.38 (1.31), making the grand mean 4.67 in the displaced persons
group.
Anderson et al (2012a and b) found that women survivors of intimate partner

abuse demonstrated a mean score of 75.0 but that higher scores were
associated with lower risk of PTSD, and this applied to four of the five scale
factors (i.e., all except for the spirituality factor).
Hammermeister and colleagues (2012) studied 351 Stryker Battalion combat

troops, some of whom had PTSD, and noted a mean CD-RISC 10 score of
28.1, which is below the population mean. (Score is corrected here – authors
had used a 1-5 range instead of 0-4).
Elbogen et al (2012) reported a mean score of 75.1(18.3) in a national

sample of over 1,000 OEF/OIF veterans.
Thus, in summary, scores on the CD-RISC 25 and CD-RISC 10 in this

group fall in between those for people with PTSD and those in the general
population. The CD-RISC 2 score falls below that of the general population.
33
34
Other Populations: Further studies of the CD-RISC have been conducted in

a range of populations, some of which have been drawn from psychiatric
settings (e.g., VA centers, or from special populations in the community,
e.g., ambulance officers, missionaries, etc.). These have been grouped
together since they are not defined by psychopathology, trauma type or
developmental phase. The mean scores are summarized in Tables 8a-c.
Table 8a. Mean (SD) CD-RISC 25-Item Scores in Other Groups, Those Under Stress
and/or Mainly Healthy Subjects

Wilks (2006) 25 205 73.4 (13.30 USA Alzheimer’s Caregivers
Laff et al (2008) 25 241 76.0 (11.0) USA Medical interns
Schaeffer et al 25 48 76.5 (12.8) USA Missionaries
(2009) 203 73.0 (11.9) USA Missionaries
Green et al (2010) 25 497 71.2.(17.5) USA Veteran population
Sen et al (2010) 25 740 75.3 (11.9) USA Medical interns
Gabriel et al (2011) 25 57 66.5 (13.4) USA Nurses
Phillips (2011) 25 79 72.4(13.0) USA Unemployed men
Coates (2012) 25 110 80.5 USA Single low income Black fathers
Kjellstrand & Harper 25 128 76.0(14.8) USA Single mothers
(2012)
Cox (2012) 25 144 76.8 (12.5) USA Military couples pre, during and post
71.7 (11.7) deployment
73.6 (14.3)
Calcote et al (2013) 25 176 76.3 USA Hazardous waste and emergency
response workers
Knows-His-Gun et al 25 161 78.3(15.4) USA Native American
(2013) 77.5(10.3) Caucasian
Rudow et al (2014) 25 151 83(11.6) USA Kidney and liver donors
Gonzalez et al (2016) 25 409 78.1 (10.9) USA Distance runners
Lutz et al (2016) 25 656 78 (13) USA Air Force and Army recruits
Bezdjian et al (2016) 25 53,672 83.6(11.0) USA Air Force recruits
McFarland & Roth 25 56 68.5(9.4) USA Resident MDs on oncology rotation
(2016)
Baron Nelson et al 25 19 81.6 (13.0) USA Parents of children with brain tumor:
(2018) 87.0 (8.3) non-intervention and intervention gps
Gupta et al (2017) 25 48 78.0(11.7) USA Healthy volunteers for MRI study
Gillespie et al (2007) 25 735 75.9 (11.0) Australia Operating theatre surgical nurses
Gucciardi and 25 433 73.4 (11.0) Australia Adult cricketers
Gordon (2008)
Gucciardi et al 25 321 73.2 (10.7) Australia Adult cricketers
(2011)
Gucciardi et al 25 199 73.0 (10.9) Australia Teenage cricketers
(2011)
Loh and Klug (2012) 25 108 75.0 Australia Women immigrants
Devilly & Varker 25 281 77.28(10.4) Australia Victorian police officers
(2015)
Hegney et al (2015) 25 1,743 69.6 – 70.3 Australia Four groups of nurses, many with mild
depression or anxiety
Baek et al (2010) 25 576 61.0 (13.0) Korea Students, nurses, firefighters
Lee et al (2014) 25 552 64.5 (17.0) Korea Firefighters
Jeon et al (2017) 25 1794 61.2(13.3) Korea Hospital employees sleep survey
34
35
Jung et al (2017) 25 42 54.5(12.8) Korea Hospital employees, mainly nurses.

45 54.0(11.5) Means given here after correcting for
use of 1-5 scoring system
Lee and Williams 25 206 70.6(14.0) Koreans in Adults whose parents had alcoholism
(2013) the US
Kim et al (2016) 25 169 71.6 (15.6) Korea Conscripted Marines
Carli et al (2010) 25 1,265 65.3 (14.1) Italy Prisoners
Hosseini and 25 139 73.8 (16.0) Iran Athletes
Besharat (2010)
Azadmarzabadi et al 25 100 67 (7) Iran Acute stress syndrome from daily stress
(2018) 100 63 (4) Acute stress reaction from major trauma
100 76 (13) No symptoms post daily stress
100 73 (9) No symptoms after major trauma
Stephenson (2012) 25 50 82.0 (11.2) US Virgin Graduates of the Temporary Assistance
Islands to Needy Families Program
Hemmings et al 25 150 73(58,84) South Africa Non-TB contacts of family members
(2013) with TB
Van Breda et al 25 55 77.3(1.7SE) South Africa Ironman athletes
(2015) 32 72.6(2.0) Recreational athletes
Manzano-Garcia & 25 783 79.8(9.8) Spain Business owners and entrepreneurs
Calvo (2013)
Yu et al (2009) 25 76 65.4(11.9) China Healthy parents
Yu et al (2013a) 25 1,205 60.7(15.6) China Refugees
Yu et al (2014) 25 183 57.7 – 59.3 China Refugees to Hong Kong
Chi et al (2015) 25 645 49.9(15.8) China Children (mean age 10.8 – range 8-15)
of parents with HIV
Tan et al (2016) 25 3960 63.4 (13.1) China New factory employees
Zhang et al (2016) 25 222 56.9(16.9) China Parents bereaved of their only child
Lu et al (2017) 25 474 57.9(13.2) China Older adults
Du et al (2017) 25 518 66.0 China Children with HIV+ve parents – mean
age 12.0(2.5) years
Zhang et al (2016) 25 516 61.6 (13.0) China Older couples – men and women’s
60.7 (12.8) scores given
Herbert et al (2013) 25 45 69.4(15.7) India Adult offspring of a parent with
schizophrenia
Rajan and John 25 121 65.0(15.9) India Parents of children with intellectual
(2016) disability
Bhat (2017) 25 30 60.2 (18.5) India Male and female residents in elderly
30 60.4 (16.6) care homes
Petros et al (2013) 25 196 67.0 (15.8) England Healthy adults in a university
community
Horvath & Massey 25 116 75.6 (14.3) England Forensic medicine faculty who
(2018) witnessed trauma to others
Tajanlangit (2014) 25 103 81.8 Philippines Mental health nurses
Cole (2016) 25 47 84.8 Nine Leaders of faith-based schools
countries
Lim et al (2015) 25 365 84.9(11.2) Singapore Older community sample Chinese
women, average age 72
Ong et al (2018) 25 285 70.8 (15.1) Singapore Caregivers to older adults with mental
or physical illness
Sarubin et al (2015a) 25 201 73.9(12.0) Germany Healthy older women, non-clinical
population
Table 8b. Mean (SD) CD-RISC 10-Item Scores in Other Groups, Those Under Stress
Authors Scale Numbe Mean (SD) Location Diagnostic group
r
35
36
Li et al (2012) 10 113 22.6(7.6) China Parents under stress: children receiving

surgery for congenital disease
Tian et al (2015) 10 575 26.5(6.1) China Telephone operators
Ye et al (2017) 10 500 23.0 (5.7) China Parents of children with cancer
Blanco et al (2017) 10 294 26.9(8.3) Spain Non-professional caregivers
Paulus et al (2012) 10 10 30.6(12.3) USA Elite athletes
11 31.4(10.0) Healthy adult controls
Prabhakaran et al 10 63,290 31.9 USA Active duty air force personnel
(2012)
Rosenberg et al 10 96 30.0(6.0) USA Parents of children with cancer
(2013)
Warren et al (2013) 10 133 33.4(4.0) USA Surgeons
Turner (2015) 10 10 36.7 USA Nurses in hospital following tornado
Gonzalez et al (2016) 10 409 31.1 (5.0) USA Distance runners
Houpy et al (2017) 10 117 28.2 (6.4) USA Third and fourth year medical students
Richards et al (2017) 10 419 32.3 USA Physical educators
Brown et al (2018) 10 521 30.7 (5.0) USA Nurses
Lauridsen et al 10 272 30.3 (5.2) Denmark Hospital employees
(2017)
Gayton and Lovell 10 146 30.1-31.2 Australia Experienced paramedics
(2012) 73 27.4 Student paramedics
Slatyer et al (2017) 10 65 28.3 (6.0) Australia Nurses enrolled in mindfulness based
26 27.5 (5.1) stress reduction course
Avrech Bar et al 10 184 29 Israel Nurses, OT and PT staff
(2017)
Ang et al (2018) 10 1338 25.9 (6.0) Singapore Nurses
Table 8c. Mean (SD) CD-RISC 2-Item Scores in Other Groups, Those Under Stress
Eisenach et al (2014) 2 13 6.9 (1.0) USA New anesthesiology
residents
Langhinrichsen-Rohling 2 120 4.97(2.59) USA Highly stressed, primary
et al (2017) care sample referred to
behavioral health
Stevens et al (2010) 2 633 6.84 (3.82) Australia Ambulance officers
Gianesini (2012) 2 324 6.25 (1.63) Switzerland Parents of young
schoolchildren
Two hundred and five Alzheimer’s disease caregivers were studied by Wilks
(2006), and their mean CD-RISC was 73.4 (13.3). A second study of
dementia caregivers by Lavretsky et al (2010) gave lower scores ranging
between 60 and 66.
In a study of African Americans, Brown (2008) reported a mean score of

78.1 (12.1). Another population of African American diabetics scored a
mean of 83.8 (8.5) (Steinhardt et al, 2009). In a third study of African
Americans, Coates (2012) reported a mean score of 80.5 and mean (sd) item
score of 3.22 (0.56) in 110 single, low-income fathers.
36
37
A study of Australian surgical nurses reported the mean CD-RISC to be 75.9

(11.0) (Gillespie et al, 2007). In a large population cohort of Americans over
age 60, the mean score was 75.7 (13.0) (Lamond et al, 2008). Two Chinese
cohorts of parents of autistic children (PAC, n=76) and of non-autistic
children (PNC, n=329) resulted in mean (sd) scores of 65.4 (11.9) and 71.0
(11.3) (Chen Yu, personal communication, 5/26/09). 143 healthy Korean
volunteers were studied by Ha et al (2009) and a mean score of 66.8 (12.7)
was noted.
US missionaries in Europe (n=48) and Africa (n=203) yielded mean (sd)

scores of 76.5 (12.8) and 73.0 (11.9) respectively (Frauke Schaefer, personal
communication, 5/22/09).
Gucciardi and colleagues (2008, 2011) examined three populations of adult

or teenaged Australian cricketers and reported the mean CD-RISC as 73 in
all cases. In one report (Gucciardi et al 2011), mean scores for the CD-RISC
25 were 73.2 (10.7) and 73.0 (10.9) in 321 adult and 199 adolescent
Australian cricketers respectively. For the CD-RISC 10, the mean score in
adults was 29.51 (4.88). An Iranian study of athletes from different sports
(volleyball, basketball and football being most common) showed a similar
mean CD-RISC score (73.8 (16.0)) to that of the cricketers (Hosseini and
Besharat, 2010).
A study of medical interns at Yale found a mean RISC score of 76.0 (11.0).
Although total CD-RISC score and the factor scales failed to predict
depression among interns, two items relating to challenge were associated
with risk (Laff, 2008). A subsequent study in another group of interns by
Sen et al (2010) found a mean CD-RISC score of 75.3 (11.9) in a US cohort
of 740 medical interns.
Baek et al (2010) studied the CD-RISC in a non-randomly selected young

(average age = 27.4) Korean population of 576 students, nurses and
firefighters. The mean score was 61.2 (13.0). A subsequent study of Korean
firefighters found a mean score of 64.5 (17.0) (Lee et al, 2014).
In two military samples of active duty Marines and veterans of OIF/OEF, the
mean CD-RISC scores were respectively 71.6 (16.2) and 67.0 (17.6)
(Johnson et al, 2011). The mean scores in military couples before, during
and after deployment were comparable (71.7 to 76.8) (Cox, 2012).
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In 57 US nurses, Gabriel et al (2011) reported mean score of 66.5 (13.4).

[Note that in their paper, the authors reported a mean score of 91.5, due to
scoring each item on a 1-5 scale, rather than the 0-4 metric].
A group of 128 upper- or middle-income single mothers was found to score

76.0 (14.8) (Kjellstrand and Harper 2012). The five highest scoring items
reflected qualities of personal competence and tenacity.
113 parents whose children were undergoing surgery scored 22.2(7.6) on the
CD-RISC 10 in a Chinese sample (Li et al, 2012).
Gayton and Lovell (2012) observed a higher CD-RISC score in paramedics

with several years’ experience compared to student paramedics.
Lee and Williams (2013) studied 206 Koreans living in the US, most of
whom were students; 89% were born in Korea and 11% in the US. Mean
CD-RISC score was 70.6 (14.0).
Parents of children with cancer in the USA were found to score close to the
population mean, but those with lower scores were more at risk for
unfavorable outcomes (Rosenberg et al, 2013).
A group of surgeons was found to score 33.4 (4.0) on the CD-RISC-10,

which is no different from the score of post-college educated subjects in a
US community sample (Warren et al, 2013). US medical students scored
slightly lower on the CD-RISC-10 than national norms, but fourth year
students, men and those not burned-out scored higher than their counterparts
(Houpy et al, 2017).
Summary: These results lead to the conclusion that psychiatrically healthy

subjects score higher on the CD-RISC than do those with a range of
psychiatric illnesses, or even than a general sample of primary care patients.
In the US, two population surveys of the 25- and/or 10-item scales suggest
that the mean item score ranges from 3.17-3.21, which translates into a 25
item score around 79-81, or 31-32 for the CD-RISC 10. Studies of healthy
Chinese, Japanese and Korean and other non-US adults showed substantially
lower scores, suggesting that ethno-cultural factors need to be taken into
account when measuring resiliency. It is also possible that response-set bias
may exist, leading some populations to under- or over-report symptoms.
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Interpretation of mean population scores is confounded also by such

considerations as the age of subjects, and whether or not the sample has been
enriched by special features, e.g., medical clinic samples, exposure to severe
trauma (Bitsika et al, 2010). In a varied group of adolescents, students and
young adults, the CD-RISC 25 scores cluster between the mid-50s to low
70s. Studies in the US have tended to report higher scores than in other
countries.
For the CD-RISC 2, two US population studies have yielded mean scores of
6.94 in the general population (Vaishnavi et al, 2007) and 5.6 (2.6) in a non-
PTSD sample who had contacted the Anxiety Disorders Association of
America (ADAA), a major national anxiety disorders advocacy
organization, and a significantly lower score of 4.6 (2.6) in those with PTSD
who contacted the ADAA. As a self-selected sample of enquirers to a
support organization, it is likely that the level of resilience in this group may
have been lower. In a Portuguese general community convenience sample,
the mean score was 6.50 (1.23) (Joana Faria, personal communication,
7/22/2010). A representative state sample of Australian ambulance officers
resulted in a CD-RISC 2 score of 6.84 (3.82) (Stevens et al, 2010).
The material in Tables 1-8 is presented according to the nature of the sample
and sub-grouped for the three versions of the CD-RISC. For those who wish
to see the entire scores from all studies with the 10- and 2-item versions of
the scale, these follow in Tables 9 and 10 respectively.
Summary Scores: CD-RISC-10
Table 9. Mean (SD) CD-RISC 10-Item Summary Scores
Authors Scale Numbe Mean (SD) Location Comments

r
Davidson 10 458 32.1 (5.8) USA National random digit dial sample
(2003)
Campbell-Sills 10 131 27.2 (5.8) USA College undergraduates
et al (2007)
Campbell-Sills 10 764 31.8 (5.4) USA Community random digit dial sample
et al (2008) in Memphis
Wingo et al 10 792 34.0 (median) USA Primary care/gynecology groups
(2010) (0-40 range)
Dodd (2010) 10 102 32.4(5.4) USA Inpatients in rehabilitation post injury
Grattan et al 10 71 29.1(6.1) USA Deepwater Horizon Oil Spill
(2011) 10 23 29.9(5.9) USA
10 47 30.0(6.5) USA
10 47 28.5(5.5) USA
Wrenn et al 10 233 30 (12) median USA PTSD primary care patients
(2011) 534 35 (8) median Non-PTSD primary care patients
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Christensen 10 41 31.4(5.8) USA Inpatients with traumatic injury

(2011)
Hartley (2012) 10 605 30.1(5.3) USA Normative student sample
Melvin et al 10 60 31.0 (6.5) USA Combat veteran couples
(2012)
Goins et al 10 160 33.5 (6.2) USA Federally recognized Native
(2012) American tribe
Hartley (2012) 10 121 19.6(8.2) USA Student counseling clinic sample
Mascolini 10 42 27.0 USA HIV positive older subjects
(2012) 20 31.0 HIV negative older subjects
Paulus et al 10 10 30.6(12.3) USA Elite athletes
(2012) 11 31.4(10.0) Healthy adult controls
Hammermeiste 10 351 28.1 USA Stryker Battalion combat troops
r et al (2012) (0.88)
Prabhakaran et 10 63,290 31.9 USA Active duty Air Force personnel
al (2012)
Rosenberg et al 10 96 30.0(6.0) USA Parents of children with cancer
(2013)
Bradley et al 10 971 31.6(7.7) USA African-American OB-GYN
(2013) outpatients
Warren et al 10 133 33.4(4.0) USA Surgeons
(2013)
Dale et al 10 138 28.8(7.8) USA HIV+ve women
(2014a)
Dale et al 10 85 29.3(7.8) USA HIV +ve women
(2014b)
McCanlies et 10 114 29.9 (6.3) USA Police officers post Hurricane Katrina
al (2014)
Rainey et al 10 110 31.3 (not given) USA Hospitalized subjects with traumatic
(2014) injury
Green et al 10 1,090 30.5 (6.6) USA Community sample of military
(2014) veterans
Lukow et al 10 96 22.0 (8.8) USA Mild to severe TBI
(2015)
Rosenberg et al 10 1,782 31.4(6.6) USA Hematopoietic cell transplantation
(2015) patients
Turner (2015) 10 10 36.7 USA Nurses responding to tornado
casualties
Gonzalez et al 10 409 31.1 (5.0) USA Distance runners
(2016)
Battalio et al 10 1574 29.0(7.0) USA Neurological disability
(2016)
Terrill et al 10 1862 28.0(7.1) USA Long term physical disabilities
(2016)
Wingo et al 10 246 23.6(7.8) USA Veterans with PTSD and depression
(2017)
Carlsen et al 10 73 30.4(5.5) USA Adolescents with IBD
(2017)
Jones et al 10 39 33.5(18.4) USA Juvenile male controls
(2017) 24.1 and 26.4 Juvenile male sexual offenders
Koelmel et al 10 163 26,8(6.2) USA Multiple sclerosis
(2016)
Richards et al 10 419 32.3 USA Physical educators
(2017)
Lee et al 10 110 23.4 (8.2) USA Schizophrenia
(2018) 92 33.1 (5.7) Healthy controls
Brown et al 10 521 30.7 (5.0) USA Nurses
(2018)
Shlomi (2010) 10 220 28.0 (5.7) Canada Psychology students
McGlone 10 27 29.3 (6.2) Canada Epilepsy
(2010)
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Rahimi et al 10 155 28.8(4.4) Female Canada Medical students

(2014) 31.2(5.2) Male
Poole et al 10 3413 31.0 Canada Prim care non-depressed
(2017a) 277 22.3(7.6) Prim care depressed
Poole et al 10 3802 30.3(7.0) Canada 11 primary care practices Calgary
(2017b)
Levasseur et al 10 4541 31.0 Women Canada Community sample of elders 60+
(2017) 32.0 Men years of age
Wang et al 10 341 24.8(7.4) China Earthquake survivors – whole group
(2010) 20.8(6.3) PTSD group
26.8(6.3) Non-PTSD controls
Wang et al 10 341 26.8 (6.3) China Schoolteachers affected by earthquake
(2010)
Li et al (2012) 10 113 22.6(7.6) China Parents under stress: children
receiving surgery for congenital
disease
Duan et al 10 95 25,.5 (4.9) China University students with PTSD and
(2015) PT growth
Tian et al 10 575 26.5(6.1) China Telephone operators
(2015)
Wu et al 10 318 24.8(7.5) China Earthquake survivors – corrected
(2015) values given here
Li et al (2016) 10 231 26.9 (6.6) China Pregnant women
Ye at al (2017) 10 460 23.2 China Parents of children with cancer
Kang et al 10 227 28.9 (6.7) China Ambulance personnel: MDs, RNs and
(2018) EMTs
Skrzypiec et al 10 2050 29.3 (7.3) China Schoolchildren ages 10-15
(2018)
Chow et al 10 678 24.0 (5.7) China/Hong Student nurses
(2018) Kong
Matzka et al 10 343 29.3(7.0) Austria Cancer patients
(2016)
Kilic et al 10 60 29.5(7.2) Australia Spinal cord injury
(2013)
Gayton and 10 146 30.1-31.2 Australia Experienced paramedics
Lovell (2012) 73 27.4 Student paramedics
Black & 10 196 27.0(7.1) Australia Multiple sclerosis
Dorstyn (2013)
Hayter & 10 97 25.6(8.0) Australia Spina bifida
Dorstyn (2013)
Lyons et al 10 357 27.0 (7.7) Australia HIV+ve gay men
(2016)
Chamberlain et 10 240 32.0 (5.7) Australia Third year nursing students
al (2016)
Slatyer et al 10 65 28.3 (6.0) Australia Nurses in clinical trial
(2017) 26 27.5 (5.1)
Seib et al 10 278 30 median Australia Women with cancer
(2018)
Skrzypiec et al 10 2050 29.3 (7.3) Australia/Ch Chinese schoolchildren ages 10-15
(2018) ina
Davidson et al 10 329 20.1 International PTSD before drug treatment
(2008) 19.9 International PTSD before receiving placebo
Klasen et al 10 330 22.7 (8.3) Uganda Former child soldiers aged 11-17
(2010)
Aloba et al 10 449 26.7 Nigeria Student nurses
(2016)
Lopes and 10 463 29.1 (5.5) Brazil Adult sample
Martins (2011)
Solano et al 10 575 25.8 (9.1) Brazil Medical and psychiatric patients
(2016)
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Lim et al 10 190 27.88 Singapore Adolescents mean age 12.8 (range 12-
(2011) 16)
Ang et al 10 1338 25.9 (6.0) Singapore Nurses
(2018)
Deen et al 10 5 16.8 and 22.4 Malaysia Elite squash players tested before and
(2017) after therapy
Notario- 10 681 27.4 (6.4) Spain University first year students mean
Pacheco et al age 20.1 (18-30)
(2011)
Montero-Marin 10 314 27.8 (6.7) Spain Dental students
et al (2014)
Notario- 10 191 24.7(10.8) Spain Fibromyalgia patients
Pacheco et al
(2014)
Rodriguez-Rey 10 620 28.4 (6.8) Spain Mixed sample of medical patients,
et al (2015) parents of children with
medical/psych problems and general
population
Scali et al 10 238 27 (22-32 1,3Q) France Mammography subjects with and
(2012) without breast cancer
Glück et al 10 84 25.9 (6.7) PTSD Austria World War II survivors
(2013) 31.1 (6.1) Control
Markovitz et al 10 254 25.7 (6.8) Netherlands Students
(2014) 101 27.6 (5.9) Belgium Breast cancer patients
107 27.4 (6.8) Belgium Control women
DiFabio & 10 164 24.8(6.2) Italy High school students
Saklofske
(2014)
Okuyama et al 10 1,973 20.5(0.2 SE) Japan Adolescent survivors of Great East
(2014) Japan Earthquake
Lee et al 10 1094 25.8 (8.0) Korea College students
(2016)
Antunez et al 10 1,922 29.0 (0.1) Spain Adults in the community
(2015)
Blanco et al 10 294 26.9(8.3) Spain Non-professional caregivers
(2017)
Farkas & 10 465 28.0 (0.6) Hungary Students
Orosz (2015)
Gabor et al 10 343 28.2 Hungary High school and university students
(2018)
Schäfer et al 10 191 31.3 (4.8) Germany Male soldiers
(2015)
Mathad et al 10 194 26.3(6.3) India Nursing students
(2017)
Lauridsen et al 10 272 30.3 (5.2) Denmark Hospital employees
(2017)
Moffett & 10 105 27 England First year veterinary students
Bartram (2017)
Avrech Bar et 10 184 29 [median] Israel Nurses, OT and PT staff
al (2017)
Walsh et al 10 241 29.0 (7.5) Ireland Men 1 year post treatment for prostate
(2018) cancer
Sharma et al 10 131 27.0 (7.0) Nepal Chronic pain
(2018)
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Summary Scores of All Studies: CD-RISC-2
Table 10. Mean (SD) CD-RISC 2-Item Summary Scores

Nicholls et al (2006) 2 770 5.6 (2.6) USA Trauma survivors who contacted
Anxiety Disorders Association of
America
Vaishnavi et al 2 458 6.91(1.5) USA National random digit dial sample
(2008)
Campbell-Sills et al 2 764 6.82(1.33) USA Community sample random digit dial
(2008) in Memphis
Davidson and Lee 2 106 6.7 (1.3) USA National RDD trauma survivor
(2015) 134 6.2 (1.5) sample. Those who forgave
perpetrators of violent trauma vs
those who did not.
Osofsy et al (2011) 2 452 6.87(2.04) USA Deepwater Horizon Oil Spill area
residents
Eisenach et al (2014) 2 13 6.9 (1.0) USA New anesthesiology residents
Langhinrichsen- 2 120 4.97(2.59) USA Primary care scmaple referred to
Rohling et al (2017) behavioral health. Highly stressed.
Davidson et al 2 329 4.53 International PTSD before receiving drug
(2008) 4.56 International PTSD before receiving placebo
Irmansyah et al 2 1,466 4.67 Indonesia Tsunami survivors
(2010)
Gianesini (2012) 2 324 6.25(1.63) Switzerland Parents of schoolchildren aged 3-10
Stevens et al (2010) 2 633 6.84 (3.82) Australia Ambulance officers
Draper et al (2014) 2 210 5.9 (2.0) Australia Geriatric psychiatry in- and
outpatients
D’Emden et al 2 151 6.1(1.5) Australia Type 1 diabetes
(2017)
16)
Vinaccia and 2 40 6.8 (1.8) Colombia COPD
Quiceno (2011)
Vinaccia et al (2012) 2 40 7.5 (1.0) Colombia Chronic renal disease
41 7.0 (1.4) Rheumatoid arthritis
Markovitz et al 2 254 5.6 (1.4) Netherlands Dutch students
(2014) 101 6.2 (1.2) Belgium Breast cancer patients
110 5.9 (1.5) Belgium Control women
Lu et al (2016) 2 218 6.46(1.72) Taiwan Student athletes
Jeong et al (2015) 2 222 Korea Firefighters and rescue workers
6.0 (1.2) Controls
5.1 (1.5) PTSD or MDD alone
4.4 (1.5) PTSD and MDD
Harrer et al (2018) 2 75 4.80 (1.72) Germany Students pre-treatment
76 4.79 (1.87) Student controls
Heo et al (2018) 2 1866 5.6 (1.7) Korea School system adolescent sample
Rapacciuolo et al 2 571 5.87(1.7) Italy Older community sample in Naples
(2016)
Lewis et al (2017) 2 697 5.8 (1.7) England Subthreshold depression primary care
Sharma et al (2018) 2 131 5.2 (1.7) Nepal Chronic pain i
140 5.4 (1.9) Chronic pain ii
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Factor Analysis
Factor analysis Reports will be presented for the RISC-25 and RISC-10 as
follows.
CD-RISC-25
In the first report describing the scale in an adult cohort (n =577)
representative of the US population, Connor and Davidson (2003) derived
five factors, the strongest of which captured aspects of persistence/tenacity
and strong sense of self-efficacy. Other factors with lower eigenvalues
(ranging from 1.563 to 1.073), corresponded to emotional and cognitive
control under pressure (factor 2); adaptability/ability to bounce back (factor
3); control/meaning (factor 4); meaning (factor 5). Factors 4 and 5 are
composed of only 3 and 2 items respectively and may be less robust.
Lamond and colleagues (2008) examined a cohort of 1,395 older Americans,

and derived four factors from the data: personal control/goal orientation;
adaptation and tolerance of negative affect; leadership and trust in instincts;
spiritual coping.
In a study of 787 South African adolescents, Jørgensen and Seedat (2008)

were unable to confirm the original five-factor solution, and proposed a two-
or three-factor solution, wherein tenacity was quite robust. Ethnicity
appeared to influence their findings, and it may be of importance that the
English language version of the CD-RISC was given to subjects for whom
English was often a second language.
A report in 323 Iranian university students who completed the CD-RISC

generated four factors, which the author considered to be relatively similar
to those derived by Connor and Davidson (2003), termed as achievement
motivation, self-confidence, tenacity and adaptability (Khoshouei, 2009).
A Chinese study of the CD-RISC by Yu and Zhang (2007) in 560 residents

of Guangdong and Beijing, found three factors to best account for their
findings: tenacity, strength and optimism. Of these, tenacity (hardiness)
explained the greatest variance, similar to Connor and Davidson’s original
findings. Yu and Zhang also make some important observations on the
different valence that is given to personal competence/control and
spirituality in the United States, compared to their lesser salience in Chinese
culture, while harmony was seen as being of greater importance. The ability
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to get along well with others and to empathize with their needs, feelings etc.,
may deserve more attention with respect to resilience. In this context,
perhaps altruism is an important missing element in current measures of
resilience.
Gillespie et al (2007) assessed 735 Australian operating room surgical

nurses, and largely replicated the Connor and Davidson 5 factor structure,
albeit with differences in item loadings.
Catalano et al (2008) found a five-factor solution to be the most satisfactory

interpretation of their results in a Canadian sample of 274 spinal cord injury
patients.
A Japanese study extracted five factors by exploratory factor analysis, which

differed somewhat from the five factors reported by Connor and Davidson,
and then in a confirmatory factor analysis to test a one-dimensional
structure, the authors confirmed goodness of fit to the data (Ito et al, 2009).
A contrary finding has been reported by Burns and Anstey (2010) in a
sample of 1,775 Australian community members. The authors were unable
to establish goodness of fit in a confirmatory factor analysis of the original
Connor and Davidson model, leading them to conclude that the CD-RISC
reflected a multidimensional measure of resilience. They therefore
undertook parallel analysis to guide a further exploratory factor analysis, and
ultimately retained 22 items that they regarded as a one-dimensional
measure. They also found that their derived measure was in some ways
superior to the CD-RISC 10, which was also tested. Slightly different
findings emerged, however, in a later study by Gucciardi et al (2011).
In veterans of OIF/OEF (n=272), exploratory factor analysis found five

factors, which the authors labeled as hardiness, purpose/control, leadership,
effort and spiritual (Pietrzak et al, 2009). Higher scores on the
purpose/control factor were associated with lower risk of suicidal ideation.
In a study of 40 women with infertility problems, Sexton et al (2009)

reported five factors, labeled emotional/interpersonal stability, self-efficacy,
adaptability, spirituality and confident decision-making. Her view is that the
factor analysis obtained most closely resembled the factor structure reported
by Lamond. However, the numbers here are on the small side for a factor
analysis.
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Garzia-Izquierdo et al (2009) observed that the original CD-RISC factors of

personal competence and positive acceptance of change negatively predicted
emotional exhaustion in a group of 311 Spanish workers. (The other three
factors were not examined).
Varying levels of homogeneity for each factor-generated subscale of the

CD-RISC was reported by McTighe (2009), with Cronbach’s α ranging from
0.67-0.85.
Singh and Yu (2010) examined 256 Indian students (mean age 22.7, range
17-27), and found a four-factor solution by exploratory factor analysis:
hardiness, optimism, resourcefulness and purpose. Scale homogeneity was
established with Cronbach’s α being 0.89 for the total scale and 0.80, 0.75,
0.74 and 0.69 for factors 1 through 4.
Jowkar et al (2010) compared Iranian versions of the CD-RISC and the

Resilience Scale for Adults (RSA) in a student population. A factor analysis
upheld the original structure of the RSA, but not of the CD-RISC, for which
the authors failed to show a clear pattern. However, the Cronbach α was
high for the full CD-RISC and for factor 1, but lower for factors 2-4.
Four factors were obtained by Bitsika et al (2010), which represented

challenge-seeking/purpose, decisiveness, spirituality and self-
confidence/optimism. Factors 1, 2 and 4 showed inverse relationships with
depression and anxiety, with factor 4 (self-confidence) bearing the strongest
relationship to both depression and anxiety, and factor 2
(decisiveness/solution-focused) being also relevant to anxiety risk.
A three-factor solution was generated by Karairmak (2010) in her sample of

Turkish earthquake survivors, these being labeled as tenacity/personal
competence, tolerance of negative affect and spirituality. Cronbach’s α was
0.89 for the full scale and 0.93, 0.79 and 0.50 for the three factors, the last
factor consisting of only three items.
In their study of adolescents, Yu et al (2011) replicated by confirmatory

factor analysis the original five factors of Connor and Davidson (2003), and
showed a Cronbach’s α coefficient of 0.89 for the full scale, and 0.83, 0.66,
0.66, 0.58 and 0.50 for factors 1 through 5 respectively.
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In a Korean population, the authors (Baek et al, 2010) obtained five factors,
which differed to some degree from those obtained by Connor and
Davidson. These factors were termed hardiness, tolerance of negative affect,
optimism, social support and spirituality. As with others (Yu and Zhang,
2007), the authors suggested that the original CD-RISC spirituality factor
may be heavily influenced by Western beliefs, and apply less to other belief
systems. Baek et al found high Cronbach α’s for the item-subtotal analysis
(0.93), but varying levels for each factor (0.87, 0.87, 0.58, 0.59 and 0.25 for
factors 1-5). Another study from Korea found a Cronbach’s α = 0.82 (Jung
et al, 2017).
Among 520 Australian cricketers (Gucciardi et al, 2011), confirmatory

factor analysis and item level analyses confirmed superiority of the 10-item
over the original five factor 25-item CD-RISC. Using measurement
invariance analysis, the authors demonstrated configural, metric and partial
scalar invariance for the 10-item scale when comparing adolescent (mean
age 16.9) and adult (mean age 26.1) cricketers.
In two samples of Spanish business owners, three factors were derived and
confirmed, corresponding to hardiness, resourcefulness and optimism
(Manzano-Garcia and Calvo, 2012).
Young children between ages 6 and 16 who survived an earthquake in China

were assessed with the CD-RISC, for which two factors emerged:
rational/positive thinking and self-awareness (Fu et al, 2013).
Among Canadian subjects with spinal cord injury (SCI), the original 5-
factors were tested and found to fit the data reasonably well, with good
reliability of the five scales. The authors concluded that the 5-factor
structure observed in the general population was replicated in the SCI
sample (Fujikawa et al, 2013).
A study of 1,981 veterans of OIF and OEF in Iraq and Afghanistan was
studied by Green et al (2014), who found that a two-factor model provided
best fit to the data, these factors being labeled adaptability and self-efficacy.
The adaptability factor emerged as the factor which most closely
corresponded to the usual notion of resilience, being associated with
protection against psychopathology following exposure to trauma, unlike the
other factor. The authors noted that 6 of the 8 adaptability items appear in
the CD-RISC-10, and the two items in the CD-RISC-2 also contain items
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from this factor. A later report (Mehta et al, 2018) in Australian and US
subjects with PTSD found a two-factor solution of self-efficacy and
adaptability, similar to the Green et al report above.
When the original five-factors were applied as predictors of suicidal

tendencies, Youssef et al (2013b) found that factor 3 (close relations and
positive acceptance of change) was the strongest predictor.
Confirmatory factor analysis was used to assess three competing models in a

sample of Mexican-American adolescents with substance use disorders. A
single 7-item factor emerged, comprising items which were indicative of
how one copes with difficult circumstances (Burrow-Sanchez et al, 2014).
Sarubin et al (2015b) has found that a single factor component accounted for
the scale structure, using exploratory principal axis analysis.
Factor analysis of the CD-RISC in 120 patients awaiting liver transplant

showed a single factor solution after removing five poorly loading items,
which related mainly to meaning/purpose and coping (Fernandez et al,
2015).
A study conducted in 2357 Chinese military personnel found three factors

which the authors named competency, toughness and adaptability (Xie et al.
2016). Four items (3, 15, 18 and 20) did not load on these factors. The
authors made the interesting comment that “all religious beliefs and
activities are banned by the Chinese military”, which would essentially
invalidate the items that tap into that construct, or at least be confusing to
respondents. Although Xie et al obtained three factors, these were quite
different from the three factors obtained by Yu and Zhang (2007) in their
study of Chinese subjects.
A study of the CD-RISC in Spanish university students applied Rasch

analysis to examine the structure and psychometrics of the CD-RISC
(Gonzalez et al, 2015). Unlike most studies of scale structure and
dimensionality, which rely on classical test theory and measures such as
Cronbach’s alpha, the Rasch analysis is based on item response theory,
which has some advantages. The authors obtained unidimensionality for 22
items, after removing items 3, 9, and 20. The concluded that overall the
instrument has good psychometric properties and serves as a satisfactory
measure of overall resilience. Their study did find that the items are
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appropriate for detecting different levels of impaired resilience, e.g., in

clinical samples, but that a ceiling effect at the high end might mean the
scale would not be optimal in situations where the task was to differentiate
between groups who had strong resilience to start with.
Perera and Ganguly (2016) used confirmatory factor analysis (CFA) and
exploratory structural equation modeling (ESEM) in a sample of 274
university students with disability. They identified general (G) and specific
(S) factors of competence, control and spirituality and recommended ESEM
as an approach that successfully accounts for the multidimensional structure
of the CD-RISC due to (i) coexistence of general and specific constructs and
(ii) fallibility of items as purely unidimensional indicators of the constructs
they are designed to measure. The G and S factors were then found to relate
to career optimism and wellbeing.
Exploratory factor analysis with oblique rotation resulted in the emergence

of four factors in a sample of 575 Brazilian psychiatric and medical
outpatients (Solano et al, 2016b), named tenacity (40% of the total variance),
adaptability, social support and intuition. The internal coherence was high
with a Cronbach alpha = 0.93.
Wu et al (2017) found four factors, labeled stress tolerance; tenacity/goal

direction; adaptability/acceptance; optimism in a large community sample of
new employees in Chinese cities.
The original five-factor structure was replicated by Sharma and Sharma

(2016) in 160 employees of Indian IT companies. Another study in India
found a four-factor solution, using exploratory factor analysis – hardiness,
optimism, resourcefulness and purpose in adolescent low-income girls
(Sidheek et al 2017).
A report by Laird et al (2018) found four factors in a sample of US adults

over age 60 with depression, these factors being labelled as grit, active
coping self-efficacy, accommodative coping self-efficacy and spirituality.
Chen reported a Cronbach alpha = 0.92 in a sample of Chinese students

(2018).
CD-RISC 10 and Factor Structure:
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Campbell-Sills et al (2007) assessed a group of 1,743 undergraduates, 75%

of whom were women, finding that the CD-RISC possessed an unstable
four-factor structure in two identical cohorts. The authors removed those
items that had inconsistent or non-salient loadings and those that
corresponded to poorly defined factors. A 10-item scale emerged, and
performed well in exploratory and confirmatory factor analyses: the items in
this derivative scale came from the hardiness (items 1, 4, 6, 7, 8, 11, 14, 16,
17, 19) and persistence (item 11) factors of their previous analyses. The CD-
RISC 10, according to the authors, is best seen as reflecting one latent factor
of ‘resilience.’ The one-factor structure of the CD-RISC 10 has since been
replicated in Chinese teachers (Wang et al, 2010), Chinese parents of
children with cancer (Ye et al, 2017), Spanish students and Spanish patients
with fibromyalgia (Notario-Pacheco et al, 2011; 2014), Spanish caregivers
(Blanco et al, 2017), Brazilian adults (Lopes and Martins, 2011), low-
income African-American men (Coates et al, 2013) a German community
(Sarubin et al, 2015b), US competitive athletes (Gonzalez et al, 2016) and
Danish hospital employees (Lauridsen et al, 2017). In the Danish study, the
authors reported a Cronbach’s alpha of 0.87. One exploratory factor analysis
in Nigerian student nurses demonstrated two factors, named toughness and
motivation (Aloba et al, 2016). In that same study, the scale showed strong
internal consistency with a Cronbach’s alpha = 0.81. A study of the Khmer
translation of the CD-RISC-10 for adolescents found a single factor, and a
Cronbach’s alpha of 0.82 (Duong & Hurst, 2016). A unifactorial structure
was obtained using CFA and allowing for correlation of residues in a sample
of 1862 patients with long-term physical disabilities (Terrill et al, 2016).A
unifactorial structure was also obtained by Madewell and Ponce-Garcia
(2016) in over 400 US college students. Munevar et al (2016) found a one-
factor solution in 52 Colombian patients with chronic illness, and regarded
the scale as being suitable for the Colombian culture. In this sample, the
Cronbach alpha was 0.81. Cronbach’s alpha was 0.92 in a Chinese sample of
ambulance and medical personnel (n = 227, Kang et al, 2018)
CD-RISC-2 and Factor Structure
With only two items, it makes little sense to perform factor analysis, but one
report found a Cronbach’s α = 0.84 in 120 primary care patients
(Langhinrichsen-Rohling et al, 2017).
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Summary: In over 10,000 subjects, covering many different populations,

studies have variously found 1,2, 3, 4, and 5 factor solutions to best explain
the structure of the 25-item scale. The observed differences across the
studies are hardly surprising, and may reflect variations in methodology and
sample, as well as underlying assumptions (e.g., pre-determining the number
of factors, or items in a factor). For the 10-item scale, almost all studies have
replicated its unifactorial structure, in keeping with the original purpose
behind the development of this shorter scale.
Culture, Nationality and Ethnicity: Studies with the CD-RISC
Yu and Zhang (2007) noted the CD-RISC to show strong psychometric

properties in a Chinese adult population, almost 75% of whom were between
ages 20-49. Good internal consistency was obtained (Cronbach α coefficient
= 0.91), and significant correlations were obtained between the CD-RISC
and the Rosenberg Self-Esteem Scale, Life Satisfaction Index and the five
scales of the NEO Inventory. As noted, a factor analysis produced somewhat
different, yet still overlapping findings.
A second study in China examined the characteristics of parents of autistic

children (PAC), as compared to parents of normal children (PNC). The PAC
group showed lower levels of resilience on the CD-RISC, and this measure
was inversely associated with levels of somatization, interpersonal
sensitivity and phobic anxiety (Chen Yu, personal communication
2/29/2008).
In one South African study, the CD-RISC demonstrated validity in

adolescents and the authors considered the scale to be a useful measure in
their population, although in need of further validation. As in some other
studies, Jørgensen and Seedat found that increasing age was associated with
lower resilience (i.e., younger adolescents were more resilient than older
ones), and that Black ethnicity was associated with lower scores.
An Iranian study (Khoshouei, 2009) showed good internal consistency for

the CD-RISC (alpha coefficients ranging from 0.78-0.91), and good test-
retest reliability (r=0.78-0.88).
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Brown (2008) evaluated the CD-RISC in 153 African Americans. The scale
correlated significantly with racial socialization messages as measured by
the Teenage Experience of Racial Socialization Scale (TERS), Cultural
Pride Reinforcement Scale (CPR) and the Multidimensional Scale of
Perceived Social Support (MSPSS), particularly the special person and
family support subscales of the MSPSS. A hierarchical regression analysis
showed that, of all the variables studied, CPR and MSPSS-Special Person
were the significant predictors of resilience, supporting Brown’s main
hypothesis that social support and racial socialization would predict
resiliency in young African American adults. In a later report, Brown and
Tylka (2011) found that the CD-RISC was related to racial socialization and
related messages, but not to racial discrimination.
An Italian study assessed the relation between resilience and aggression in

903 prisoners with or without substance abuse. Inmates with substance abuse
scored lower on the CD-RISC than did the controls (Cuomo et al, 2008).
In a South African sample of 502 young people, Bruwer et al (2008)

demonstrated convergent validity between the MSPSS and the CD-RISC,
similar to the Brown study.
A study in Japanese students by Ito et al (2009) found good internal

consistency (Cronbach’s α = 0.94 and 0.90 for two samples), and good test-
retest reliability of 0.94 and 0.83.
Acceptable psychometric properties of the CD-RISC were obtained in a

Turkish sample (Karairmak, 2010).
In Korean adults, the scale showed good internal homogeneity (0.93 for two
samples) and acceptable test-retest reliability (r=0.70) (Baek et al, 2011). In
depressed or anxious Korean outpatients, resilience was predicted by use of
positive reappraisal, focus on planning and less use of rumination, according
to the Cognitive Emotion Regulation Questionnaire (CERQ) (Min et al,
2013).
A community sample of older Native Americans from the southeastern US,

part of the Native Elder Study, was studied and found to show resilience
scores comparable to other US community samples (mean 83.0 (13.4) for the
25-item scale and 33.5 (6.2) for the 10-item scale) (Goins et al, 2012).
Convergent validity was shown relative to measures of depression (r=0.51
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both scales), self-efficacy (r=0.47 and 0.45 for the 25 and 10 item scales),
self-mastery (r=0.29 and r=0.31) and social support (r=0.27 and r=0.21).
Divergent validity was shown relative to handgrip strength and body mass
index (non-significant or weakly significant correlations). A study of Native-
Americans found a similar score on the CD-RISC-25 to a comparative group
of Caucasians (78.3 vs 77.5)(Knows-His-Gun et al, 2013).
Iranian athletes were studied by Nezhad and Besharat (2010), who found
that the RISC predicted athletic achievement, correlated positively with
psychological wellbeing, and negatively with psychological distress.
A cultural form of validity was shown by Wu et al (2011) who found that in

a culture that emphasized collective values more than individual ones, the
RISC score was predicted by level of collectivist well-being, but not by
individualistic well-being, in Chinese earthquake survivors. A similar
finding has been reported by Yu and colleagues (2013a), who noted that
family resilience (measured by the Zubrick scale) served as an additional
predictor of depression beyond individual resilience, which was measured
by the CD-RISC, in mainland Chinese refugees in Hong Kong.
In a community sample of 365 older Chinese women, Lim et al (2015)

observed that stressful life events (SLE) and resilience moderated the impact
of SLE in producing depression, and that optimism and sense of competence
were two major aspects of resilience in this regard. In another study from
China, Zhong et al (2016) found that in elderly patients, an authoritative
parenting style was associated with higher resilience, compared to an
authoritarian style.
Loh and Klug (2012) studied 108 Australian women who had immigrated
after the age of 15, and found that the RISC was sole predictor of
psychological distress (as measured by the General Health Questionnaire) in
a multiple regression analysis, as well as correlating significantly with
measures of acculturation (+ve), length of residence (+ve) and distress (-ve).
Resilience was an important mediator of the acculturation process and
helped to minimize distress.
Suarez (2012) studied 75 Quechua women in Peru, who had survived

extreme violence (torture, sexual violence, combat, death of family members
and forced displacement). While CD-RISC score did not contribute to
variance in PTSD symptoms, it did contribute to post-traumatic distress
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when this was measured by local (idiomatic) symptoms. This interesting

study speaks to the benefit of measuring distress according to common
symptoms in a culture.
Resilience was found to increase in Australian teenage refugees the longer

they had been in the country, which speaks to the possibility that as people
successfully adapt to new environments, their resilience increases (Ziaian et
al, 2012).
Coates et al (2013) have reported a unifactorial structure of the CD-RISC-10

in low income African-American males, as well as correlations with
spirituality and well-being.
Burrow-Sanchez et al (2014) studied Mexican-American adolescents with

substance use disorders, and noted that a single factor of hardiness taken
from the scale held a direct relationship with ethnic identity as measured by
the Multigroup Ethnic Identity Measure (MEIM) (r = 0.285, p<0.01), and
that ethnic identity mediated the indirect relation between hardiness and
depressive symptoms.
In survivors of a Haitian earthquake, spiritual belief and religious practice

related to level of resilience. Those who believed that God was responsible
for the event had higher CD-RISC score (77.3) than did those without such
belief (65.3), and those who practiced the Voodoo religion also had higher
scores (72.5) compared to non-practitioners (64.6) (Blanc et al, 2016).
A study of young adults in Afghanistan revealed no correlation between the

CD-RISC and a measure of hope and optimism, or with mental and physical
distress. The authors opined that in collectivist cultures the RISC score
might be lower and also not as sensitive as local culturally relevant measures
such as the one-item scale they used to assess hope and optimism (Alemi et
al, 2018). The authors make the interesting suggestion that there is perhaps
need to shift thinking away from “I” and “self-image” to “Us” when
conceptualizing resilience in “non-western” societies.
Validity
The CD-RISC has been compared to numerous other measures that in one
way or another are related to aspects of resilience, such as hardiness, social
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support, stress-coping ability, self-esteem, life satisfaction, successful aging,

positive and negative affect. The results of many investigations assessing the
scale’s validity will be described.
Construct: The construct of resilience would postulate that those who suffer
from depression, PTSD, substance abuse, psychosocial problems and
suicidal behavior would be less resilient than their counterparts, and this is
indeed the case, as noted above in the presentation of mean scores across
different populations (Tables 1-8). Moderating or mediating effects of
resilience have been predicted and demonstrated with respect to associations
between early adversity and outcomes like depression and suicide attempt,
both with the CD-RISC 10 (Wingo et al, 2010; Campbell-Sills et al, 2007)
and the CD-RISC 25 (Campbell-Sills et al, 2007). Wingo et al concluded
that, using the CD-RISC 10, resilience moderated depression in those who
had been exposed to childhood trauma both as a main effect and an
interaction with trauma exposure. An increase of 5 points on the CD-RISC
10 was associated with a decrease of 2.5 points on the Beck Depression
Inventory (BDI). The nature of the CD-RISC x trauma interaction was such
that, for a given level of trauma, the high CD-RISC group (>75th percentile)
had lower BDI scores than the less resilient groups.
Construct validity comes from a study by Roberts et al (2007), which

showed that among 252 veterans of Iraq or Afghanistan, those with higher
resilience were less likely to develop PTSD (OR = 0.11, 95% CI = 0.06-
0.21), and of those who did have PTSD, resiliency was uniquely associated
with decreased PTSD severity after accounting for demographic variables
and combat severity (β = -.0.37, p<0.001). Roy et al (2007) showed that the
CD-RISC score was lower in substance abusers with a history of attempted
suicide than in those with no such history, and that in a logistic regression,
the risk of suicide attempt was predicted by the CD-RISC but not the
Childhood Trauma Questionnaire (CTQ) score for either emotional or
physical abuse. In a second report by the same group, the authors found that
CD-RISC score, but not Beck Depression Inventory, predicted suicide
attempt (Roy et al, 2007). Likewise, Nrugham et al (2010) reported that
resilience moderated the association between a lifetime history of violence
and attempted suicide even in the presence of antecedent depression. A later
report by Roy et al (2011) found a protective effect for resilience against
suicide in those who had experienced childhood trauma in two separate
samples: prisoners (n=332) and substance abuse patients (n=40). Similar
results were found by Youssef et al (2013a, 2013b) in two samples of
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OIF/OEF veterans. Baseline CD-RISC score predicted suicidality at three-

year follow-up to a greater extent than did PTSD or alcohol use, and opined
that the assessment of resilience and childhood trauma can contribute to their
clinical status regarding depression and suicidal ideation..
Breno and Paz Galupo (2007) assessed 82 adult women who had been on the
Child Welfare rolls as teenagers, and found that trauma-related beliefs of
powerlessness and self-blame correlated negatively (r=-0.54, p<0.01) with
resilience.
One study assessed the relationship between resiliency and scores on an

anatomy test in 79 Mexican medical students (Elizondo-Omaña et al, 2007).
A significant correlation was obtained between grade and CD-RISC (r=0.55,
p<0.05).
In South African adolescents, Fyncham et al (2009) showed that resilience

moderated the relationship between childhood abuse and PTSD symptoms,
reducing its impact on PTSD in the presence of high resilience.
Simon et al (2009) showed that childhood abuse, particularly of the

emotional neglect type, was associated with lower levels of resilience in
generalized social anxiety disorder.
McTighe (2009) failed to demonstrate any relationship between meaning-

making and resilience score in social workers who had experienced the
attacks on 9/11, although some relationships emerged between certain CD-
RISC factors (spirituality and stress) and personal witnessing of 9/11,
experience of major loss and length in practice.
Burns et al (2010) evaluated a large Australian general population cohort

(n=3,989) and demonstrated that the effects of resiliency upon depression
and anxiety were fully moderated by positive and/or negative affect.
In a study of college students, Otto et al (2010) reported that a small group

of “flourishers” (14% of their sample) showed greater resilience than did
“non-flourishers” (mean scores circa 83 and 72 respectively).
In a post-earthquake population, the CD-RISC was the only psychological

variable to predict (lower) symptoms on measures of PTSD and depression
(Ahmad et al, 2010).
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Following the 2004 earthquake and tsunami in Aceh and Nias, Irmansyah
(2010) observed that resilience as measured by the CD-RISC 2 served as an
independent predictor of outcome, according to the Self Report
Questionnaire (SRQ-20).
Huang (2010) found that social support and better coping strategies were
associated with greater resilience in diabetics, and that resilience was
significantly and positively associated with health-related quality of life and
diabetic self-care (e.g., diet and exercise).
Pietrzak et al (2010) noted that veterans with suicidal ideation had

significantly lower scores on the CD-RISC, and that CD-RISC score were
negatively related to suicidal ideation.
A relationship was found between insomnia and suicidality in 1,420 male

Italian prisoners, with resilience emerging as one of the variables that
independently predicted insomnia (Carli et al, 2011). In another report by the
same group, the CD-RISC score was lower among the low-impulsive group
than in the high-impulsive group, and CD-RISC was one of a number of
independent predictors of suicidality, in that greater resilience was
associated with lower risk of suicidality (Carli et al, 2010). A third report by
Carli et al (2013) found that CD-RISC score predicted impulsivity on the
Barrett Impulsivity Scale but not aggressiveness as measured by the Brown-
Goodwin scale. The authors concluded that impulsivity and aggression were
two different personality traits.
Response readiness to chemical and other threats was studied in a

representative sample of paramedics in New South Wales, Australia. Using
the CD-RISC 2, the authors found that personal resilience emerged as one of
the strongest predictors of response readiness (Stevens et al, 2010).
A study of medical interns failed to demonstrate an association between

resilience, as measured by the CD-RISC, and depression during internship
(Sen et al, 2010).
In 120 Iranian university students, the CD-RISC score was a negative

predictor of risk for developing substance abuse (Fadardi et al, 2010). A
later study in 260 Iranian university students showed a negative correlation
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between CD-RISC-25 and severity of obsessive-compulsive personality

disorder (Zakiei et al, 2017).
CD-RISC scores were lower in those with PTSD compared to those without
(62.9 vs. 77.6, p<0.001) (Green et al, 2010) and, in the same sample, lack of
resilience uniquely predicted risk for PTSD, suicidality, alcohol problems,
depression and poor health. The authors concluded that resilience may be a
construct that plays a unique role in the occurrence of PTSD and severity of
other correlates among deployed veterans.
Higher couple functioning was associated with greater resilience, regardless

of level of PTSD, in couples where either one or both members had
experienced combat (Melvin et al, 2012).
Repressor type coping and trait anxiety, but not resilience, were predictive of
post-deployment PTSD in a sample of US Air Force medical personnel
(McNally et al, 2011).
Gabriel et al (2011) found that high resilience (HR) was associated with
positive affect regardless of task accomplishment in nurses, i.e., they
concluded that HR subjects were able to sustain positive affect under any
circumstance, but for those with LR, positive affect was dependent on task
accomplishment. No such interactive effect was found for negative affect,
suggesting that resilience may be more crucial for maintaining positive
emotion at times of daily stress rather than preventing negative affect.
Phillips (2011) found that unemployed men with the highest cognitive
flexibility as measured by the Short Category Test were those with the
highest score on the CD-RISC.
Pietrzak et al (2011) used cluster analysis to derive three groups of OIF/OEF

veterans: low combat/low PTSD (n=134), high combat/high PTSD (n=72),
and high combat/low PTSD (n=61). CD-RISC scores in the groups were
76.0 (1.9), 66.3 (2.6) and 80.1 (2.2). The authors reported that membership
in the highly resilient group was characterized by the following: being in a
relationship, having few psychosocial difficulties, reporting greater sense of
purpose and control, and the presence of family support. They made
suggestions as to the implications of these findings for the development of
therapeutic interventions. In a later study of a large national cohort of older
veterans, these authors found that resilience (CD-RISC-10) was a predictor
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for successful aging, along with gratitude and purpose in life (Pietrzak et al,
2014).
A weak but significantly negative correlation (r=-0.19, p<0.05) was found

between extent of alcohol intake and resilience in 88 college students at the
University of Nebraska (Johnson et al, 2011).
In spinal cord injury (SCI) patients, resilience buffered the effects of SCI-
related stressors on depression, and that the resilience model may be useful
in guiding interventions designed to improve mental health in SCI patients
(Catalano et al, 2011).
Dodd (2010) found that greater resilience was associated with secure
attachment over fear-based attachment, as well as with social support in
disabled in-patients undergoing post-injury rehabilitation.
In a national survey of 744 nurses, Mealer et al (2011) found that higher

resilience was associated with lower rates of PTSD and burnout. A later
qualitative study by this group showed that highly resilient nurses (n=13)
differed from nurses with PTSD (n=27) in having greater spirituality,
supportive social network, optimism and a resilient role model in coping
with adversity. Differences were found in worldview, cognitive flexibility,
social network and self-care (Mealer et al, 2012).
In depression and anxiety, those with lowest CD-RISC scores were found to
be less spiritual in their orientation, to have less purpose in life and to take
less exercise; they also showed more trait anxiety (Min et al, 2012).
In a sample of female outpatients who had received mammography, lower

resilience levels were associated with current anxiety (but not depression)
and previous trauma (Scali et al, 2012).
Posttraumatic growth mediated posttraumatic growth in parents of children

undergoing surgery to correct congenital disease, and as positively
associated with CD-RISC score (r=0.432, p<0.01) (Li et al, 2012).
Volunteering in the community and number of chronic health problems were

associated (positively and negatively respectively) with resilience, while the
two variables also interacted in predicting resilience, such that greatest RISC
score was found in volunteers who had the highest number of chronic health
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problems. A limitation of this study was the authors’ use of an unvalidated

six-item variant of the RISC, the structure of which differed substantially
from the validated forms of the CD-RISC (Okun et al, 2011).
Among a national sample of 1,100 war veterans, resilience was found to be

lower in those who had demonstrated severe violence or other aggression,
and the CD-RISC score emerged as an independent predictor of other
physical aggression, but not of severe violence, in the sample (Elbogen et al,
2012).
In 351 combat-exposed Stryker Brigade troops, resilience fully mediated the

relationship between psychological skills (goal setting, stress management,
cognitive skills) and PTSD (Hammermeister et al, 2012).
A large cohort of over 63,000 Air Force personnel was studied by

Prabahakaran et al (2012), who showed that CD-RISC-10 score was related
to all four pillars of fitness (i.e., physical, emotional, social and spiritual) in
the Air Force Comprehensive Fitness program, with the key drivers of
resilience being personal coping and symptoms of depression.
Hourani et al (2012) studied 475 active duty marines who were transitioning
into civilian life. They found that pre-separation CD-RISC score predicted
risk (i.e., higher scores protected against) of mental health problems and
functional impairment on follow-up, with strongest influence being noted on
the latter.
Kramer (2012) observed that resilient individuals were more likely to use
accommodative coping to maintain their assumptions following stress, and
that being resilient was predictive of using accommodative focused coping
and of positive growth after a stressful event.
Following mild traumatic brain injury (mTBI), resilience (along with

depression) was found to predict post-injury anxiety and post-concussion
symptoms after accounting for other factors (McCauley et al, 2013). In
another study of TBI, the CD-RISC-10 was lower in those with cases as
defined on the Brief Symptom Inventory (BSI) compared to non-cases (18.7
vs 26.4), and the score correlated significantly with degree of adaptation to
brain injury, and to BSI depression (Lukow et al, 2015).
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The ability to switch flexibly back and forth between processing affective
and non-affective stimuli has been regarded as central to trait resilience.
Genet and Siemer (2013) showed that resilience, as measured by a combined
score of the CD-RISC and Block’s Ego Resiliency Scale, was predicted by
greater flexibility on an affective task-switching test.
Successful aging was predicted by resilience to the same extent as it was

predicted by physical health and depression in a large cohort of older
community members (Jeste et al, 2013).
In a sample of Korean psychiatric outpatients, the RISC was positively

correlated with CERQ measures of positive refocusing and reappraisal,
focus on planning and putting things into perspective, while CD-RISC
scores were negatively correlated with Beck depression score, State-Trait
anxiety, self-blame, catastrophizing and rumination (CERQ) (Min et al,
2013).
CD-RISC was the only variable to predict level of PTSD symptoms in a

group of 38 Italian industrial accident survivors (Ghisi et al, 2013), and
scores were lower (61.3) in the trauma group than in the controls (74.2).
Resilience mediated the effect of dispositional optimism on subjective well-

being in a group of burn-injury patients, as well as having in independent
effect on well-being (He et al, 2013).
Resilience predicted risk of psychological vulnerability to a greater exent

than did positive affect in Iran men attending a fertility clinic (Abolghasemi
et al, 2013).
Senders and colleagues (2014) observed a strongly positive correlation

between CD-RISC score and a measure of trait mindfulness, the Five Facet
Mindfulness Questionnaire (FFMQ)(r=0.67), and noted that mindfulness
accounted for 44% of the variation in CD-RISC score in a group of patients
with multiple sclerosis.
In their community study of the CD-RISC 10 in Memphis, Campbell-Sills et

al (2009) demonstrated that the CTQ measure of early sexual abuse
predicted CD-RISC in a multiple regression model (β=-0.10, p<0.05), but no
such relationships were observed for the emotional and physical neglect
measures.
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Wingo and colleagues (2014) found that higher CD-RISC-10 scores

mitigated against the risk of harmful alcohol and illicit drug use in a large
cohort (n=2024, mean CD-RISC-10 score = 31.8) of inner city residents,
most of whom were African-American, all recruited from hospital clinics.
Resilience had a buffering interaction effect in those who had experienced
childhood abuse, affording greater protection against harmful drug and
alcohol use. A later report by the same group obtained a significant
correlation between the RISC-10 and social function (beta = 1.11, p<0.0001)
in veterans with PTSD and depression (Wingo et al, 2017).
Adolescent survivors of the Wenchuan earthquake were less likely to

develop depression and PTSD if they showed greater resilience (Ying et al,
2014).
Paramedic students in South Africa who had PTSD showed lower resilience
scores than those without (Fjeldheim et al, 2014), and the CD-RISC served
as a predictor of PTSD status in a multivariate logistic regression.
CD-RISC score moderated the relationship between traumatic experience

and PTSD symptoms in Korean firefighters, and for equal exposure to
trauma, it was found that those with CD-RISC scores in the upper 25th
percentile were protected from the direct and indirect effects of trauma
relative to those in the lower percentiles (Lee et al, 2014).
In postpartum women who had been exposed to childhood trauma, the RISC
score predicted postpartum depression and PTSD, and sense of competence
and overall functioning. The CD-RISC moderated the effect of high degree
early trauma on outcome; in those with scores above 53, the rate of
postpartum PTSD was 8%, while in those with scores below 29, the rate was
58% (Sexton et al, 2015).
In sixty-eight Swiss cancer patients, low resilience was associated with

greater unmet psychological needs concerning their cancer. Age, metastasis,
living alone and recurrence were predictive factors of resilience (Dubey et
al, 2015).
The CD-RISC-10 score was negatively correlated with the Silencing of the
Self Scale (STSS) score in a sample of US women who were HIV +ve (Dale
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et al, 2014b). STSS contributed to resilience over and above the contribution
of other variables.
Daily alcohol consumption correlated negatively with CD-RISC-10 score in

police officers exposed to trauma. The mean score was 31.5 in those
consuming 2 daily drinks or less, versus 25.3 in those who had 7 or more
daily drinks (McCanlies et al, 2014).
The severity of traumatic injury as measured on the Glasgow Coma Scale

(GCS) correlated significantly with the CD-RISC-10 score at baseline (r =
0.257) and 12 months (r = 0.338) in 110 traumatically injured inpatients
(Rainey et al, 2014).
Nicotine withdrawal symptoms are associated with more severe PTSD.

Resilience protected patients against severe PTSD when nicotine withdrawal
was mild, but not when severe, suggesting a protective function for
resilience against PTSD in those with mild (but not severe) nicotine
withdrawal (Asnaani et al, 2015).
The CD-RISC-2 score was lowest in those with PTSD and depression,
compared to those with PTSD or depression alone, and controls, in a sample
of Korean firefighters (Jeong et al, 2015).
A large community study of the Hong Kong general population

demonstrated significant correlation between the CD-RISC-25 and CD-
RISC-2 with depression (negative), family harmony and functioning
(positive) and no significant relation to alcohol intake (Ni et al, 2015).
A study of 161 Native American Indians and Caucasians at the St. Labre
Community showed positive relationship between resilience and length of
time employed and between resilience and existential wellbeing, and a
negative relationship with years of unemployment (Knows-His-Gun et al,
2013).
The CD-RISC-10 correlated negatively with Maslach’s Burnout scale

(emotional exhaustion, cynicism and reduced personal accomplishment) and
positively with a measure of psychological empowerment in a group of
Chinese telephone operators (Tian et al, 2015).
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Ultra-endurance Ironman athletes scored significantly higher than

recreational athletes on the CD-RISC-25, and also the resilience scores of
the combined group correlated negatively with the personality dimension of
harm avoidance; there was no correlation versus reward dependency or
novelty seeking (Van Breda et al, 2015).
Two studies showed that the CD-RISC correlated with or predicted

psychological wellbeing in Australian university students (Pidgeon and
Keye, 2014) and Indian geriatric subjects with depression, rheumatoid
arthritis or accompanying persons of these patients (Singh et al, 2014).
Functional status was the sole variable to predict resilience in a group of

Iranian stroke survivors (Derakhshanrad et al, 2014). A later study by this
group obtained positive correlations between the CD-RISC-25 and measures
of motivation (the AAMQ), occupational performance and satisfaction on
the Canadian Occupational Performance Measure (r = 0.67, 0.45 and 0.48
respectively) (Derakhshanrad & Piven, 2017).
The CD-RISC correlated with measures of self-concept and social support in

1,250 Spanish adolescents (Rodriguez-Fernandez et al, 2015).
Among parents of children with intellectual disability, the CD-RISC
correlated negatively (-0.224) with a measure of impact of disability, while a
positive (0.479) correlation was obtained relative to positive impact of
disability on the parent in an Indian sample (Rajan and John, 2016).
In 115 Chinese patients, cut off scores of 45.5 and 19.5 were found to
distinguish best between those with and without PTSD for the CD-RISC-25
and CD-RISC-10 respectively (Peng et al, 2016).
In a large study of over 50,000 Air Force recruits, CD-RISC score was lower
(76.9) in those who were eventually separated from service as being
unsuitable, compared to the remainder (84.0), and similarly for those who
developed mental illness (76.1) compared to those without (83.9) (Bezdjian
et al, 2016). AUC cutoff scores to discriminate between groups showed
moderate sensitivity (64-65%).
Healthy eating index (HEI) scores according to US dietary guidelines were

associated with higher CD-RISC scores and for every 10-point increase in
the HEI, the likelihood of being in the high resilience group increased by
22% (Lutz et al, 2016).
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In older members of the Naples, Italy, metropolitan area, correlation was

observed between CD-RISC-2 score and Psychological General Wellbeing
Short Scale (r=0.22, p<0.0001) (Rapacciuolo et al, 2016).
A US study of subjects with physical disability found that CD-RISC-10 was

correlated with social role satisfaction (beta =0.17, p<0.001) and Older
Person Quality of Life (OPQOL) scale (beta = 0.39, p<0.001). but bot with
physical role (Battalio et al, 2016).
Among 377 Chinese nurses, the CD-RISC-10 correlated (r=0.40 – r=0.46,

p<0.01) with measures of achieving rapport, listening receptively and
communicating effectively, and the scale moderated the effect of emotional
intelligence on clinical communicative ability (Kong et al, 2016).
Dispositional mindfulness and optimistic expectations of achieving success

predicted resilience on the CD-RISC-10 in Australian student nurses
(Chamberlain et al, 2016).
The presence of personality disorder traits was associated with CD-RISC-25

score in almost 4000 Chinese factory employees, with lower RISC scores
associated with greater chance of personality pathology (Tan et al, 2016).
Another study of the relationship between resilience and personality in US
war veterans showed that those with over-controlled and under-controlled
personalities were less resilient than those categorized as having resilient
personalities (Elliott et al, 2016).
Resilience correlated positively with physical self-concept in 148 Chilean

judo practitioners (Zurita-Ortega et al, 2016).
In 430 Spanish adults, the CD-RISC-25 correlated negatively with two

dimensions of coping on the SCQA (Alonso-Tapia et al, 2016): rumination,
emotional expression, and positively with three: help seeking, positive
thinking and problem solving.
CD-RISC scores were lower in bipolar disorder and also correlated with
quality of life in a group of 136 Chinese subjects with bipolar disorder and
in healthy controls (Lee et al, 2016).
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The CD-RISC-10 correlated positively with empathy (r=0.23) and

mindfulness (r=0.47), and negatively with perseverative thinking (r=-0.23)
in Indian nursing students (Mathad et al, 2017).
You and Park (2017) found that higher score on the CD-RISC-25 protected
men, but not women, against suicidal behavior in a large community sample
of Korean elders.
Poole et al (2017a) noted that resilience moderated the relationship between

adverse childhood experiences and depression, as well as independently
predicting depression in primary care patients. She also observed a
correlation between the RISC-10 and anxiety on the GAD-7 (r=-0.48),
Adverse Childhood Experiences (r=-0.19) and emotional dysregulation on
the DERS (r=-.062, all p<0.001). Resilience moderated the effect of ACEs
on emotional dysregulation, with ACEs having stronger influence on
dysregulation in those with low resilience than in those with high resilience
(Poole et al, 2017b).
In a sample of Swiss parents, the CD-RISC-2 was found to correlate

positively (r = 0.17) with an emotional coach type of parenting, and
negatively with dismissing and disapproving styles of parenting (r = -0.12
and -0.14) (Gianesini, 2012).
Older Chinese married couples were studied as to the relationship between

sense of community and life satisfaction, and the moderating influence of
personal and partner resilience. Both of the latter, along with sense of
community predicted life satisfaction, and in cases where resilience was low,
the effect of sense of community on life satisfaction was weaker (Zhang et
al, 2017).
Resilience was related to perceptions of mattering, isolation and

marginalization in physical educators (Richards et al, 2017).
The control factor of the CD-RISC was associated with psychological

wellbeing and the personal competence subscale factor with physical
wellbeing in 986 community and university subjects: each of these β values
was greater than the values for other resilience measures in a regression
analysis (Maltby et al, 2017).
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Resilience correlated positively with satisfaction with life (r = 0.43),

gratitude (r = 0.35), social support (r = 0.42) and negatively with PTSD
symptoms (r = -0.39) in a sample of 113 New Orelans police officers dealing
with the aftermath of Hurricane Katrina (McCanlies et al, 2017).
The CD-RISC was associated with capacity to learn from one’s mistakes
(“self-regulation”). Unfortunately, the authors extracted an unofficial 15-
item scale to demonstrate this interesting finding, making it impossible to
interpret and of uncertain relevance to the available and validated forms of
the CD-RISC (Artuch-Garde et al, 2017).
McKillop et al (2017) found the CD-RISC to correlate negatively (r = - 0.28,

p < 0.05) with scores on the Pain Disability Index (PDI) in 70 Canadian
patients with chronic back pain. Other correlations between the CD-RISC-10
and CD-RISC-2 and measures of pain were reported by Sharma et al (2018).
In their study of Nepali patients with chronic pain, the RISC-10 correlated at
r = -0.35 for pain catastrophizing (PCS) and r = -0.27 for pain intensity
(PROMIS). Correlations for the CD-RISC-2 were -0.30 and -0.27.
A new scale to measure wisdom was developed by Jeste’s group (Thomas et

al, 2017). This scale, the SD-WISE, shares a number of features in common
with resilience and the CD-RISC-10 was used to demonstrate construct
validity. Of nine measures of mental health and wellbeing, the correlation of
the SD-WISE to the CD-RISC-10 (r = 0.33) was highest of all scales.
In 606 Indian adolescent girls, the Kannada version of the CD-RISC

correlated negatively (p<0.001) with psychological distress on the Kessler-
10 scale, and scores were lower (58.2) in those below the K-10 cutoff of 20
(Sidheek et al, 2017).
The percentage of subjects with CD-RISC scores below the median was
higher in US veterans with suicidal ideation (76%), and violent impulses
(82%) than in those with neither (49%) (Elbogen et al, 2017).
Chen, Chen and Bonanno (2018) reported that enhancement and suppression
ability, as measures of flexibility in emotional regulation, correlated
significantly with the CD-RISC score (r = 0.26 and 0.33) in 310 Chinese
college subjects.
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Brown et al (2018) reported a positive correlation (p < 0.001) between CD-

RISC-10 score and job satisfaction among US nurses.
Crosta et al (2018) reported a negative correlation between the CD-RISC-25

and Childhood Trauma Questionnaire (CTQ) score an Italian sample (r = -
0.42, p < 0.01).
In 343 Hungarian subjects, the CD-RISC-10 correlated significantly with

measures of competitive qualities: lack of competitive interest, anxiety-
driven avoidance of competition and competitive orientation (r = 0.12. r =
0.23 and r = 0.24) (Gabor et al, 2018).
Convergent Validity:
CD-RISC-25:
Concurrent (convergent) validity is demonstrated by showing that the scale
correlates with like measures, either of resilience itself or related measures
such as stress coping, self-esteem, optimism, symptoms of depression or
anxiety, etc. Three Chinese studies have assessed the convergent validity of
the CD-RISC. In one (Yu and Zhang, 2007a), the CD-RISC correlated with
the Rosenberg Self-Esteem Scale (r=0.49, p<0.01), the Life Satisfaction
Index A (r=0.48, p<0.01), and all five factors if the NEO-FFI (i.e.,
neuroticism, r=-0.47; extraversion, r=0.43; openness, r=0.27; agreeableness,
r=0.36; conscientiousness, r=0.64 – all p<001). In another study (Yu and
Zhang, 2007b), the CD-RISC and Ego Resiliency Scale (ERS) were
evaluated and the CD-RISC proved superior in comparison to the ERS in
respect of correlations against the NEO, self-esteem and life satisfaction
scales, 6 out of 7 of which were significant for the CD-RISC (ranges r=-0.39
to 0.54), and only one of which was significant for the ERS (ranges r=-0.13
to 0.19). In a third report of adolescents, the CD-RISC and nearly all of its
five factors correlated significantly in expected directions with the
Children’s Depression Inventory, the Screen for Child Anxiety Related
Emotional Disorders and the Multidimensional Scale of Perceived Social
Support. Only in factor 5, which contains 2 items, were correlations non-
significant for depression and anxiety (Yu et al, 2011).
Positive correlations have been shown against the Kobasa Hardiness scale
(r=0.83, p<0.001), the Sheehan Social Support Scale (r=0.36, p<0.0001).
Negative correlations were found for the Perceived Stress Scale (r=-0.76,
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p<0.001), the Sheehan Stress Vulnerability Scale (r=-0.32, p<0.0001), and

the Sheehan Disability Scale (r=-0.62, p<0.0001) (Connor and Davidson,
2003).
Maguen and colleagues (2008) found that in 328 military medical personnel
preparing for deployment, the CD-RISC score correlated with the PTSD
Checklist-Military (PCL-M) measure of PTSD (r=-0.22, p<0.01), negative
(r=-0.32, p<0.01) and positive (r=0.62, p<0.01) effect on the Positive and
Negative Affectivity Schedule (PANAS). In subsequent hierarchical linear
regression analyses of predictors for positive and negative affect, the CD-
RISC remained as a significant predictor, but not in the model to predict
PTSD symptoms. The authors stressed the important association between
resilience and positive affect.
In a study of the Brief Resilience Scale (BRS), Smith and colleagues found
that the BRS correlated with the CD-RISC (r=0.59, p<0.01) (Smith et al,
2008). Significant correlations were also found between the CD-RISC and
the PSS (r=-0.53, p<0.01), positive and negative affect on the PANAS
(r=0.68 and r=-0.25, p<0.01), as well as anxiety and depression on the
Hospital Anxiety and Depression Scale (HADS) (r=-0.40 and r=-0.35,
p<0.01). Two of these correlations held up when partialling out for the effect
of other measures in the model.
In an epidemiological survey of older community members in California,

Lamond et al (2008) observed a significant predictive relationship between
the following variables and CD-RISC score: emotional wellbeing (r2=0.237,
p<0.001), cognitive functioning (r2 =0.303, p<0.001), self-reported
successful aging (r2 =0.353, p<0.001), optimism (r2 =0.386, p<0.001) and
days spent with family and friends (r2 =0.386, p<0.001).
Campbell-Sills et al (2006) demonstrated a number of convergent

relationships between the CD-RISC and other measures, in keeping with
their hypotheses. In 132 undergraduates, the investigators assessed the
degree to which the CD-RISC served as a satisfactory measure of adult
resilience. They predicted that coping style would relate to resilience and
that, secondly, the CD-RISC would show convergent validity with related
measures, and divergent validity against less closely related ones. Lastly,
they assessed the degree to which the scale served as measure of buffering
(i.e., showed a ‘moderator’ effect) on the relationship between recalled
childhood abuse and current psychiatric symptoms as measured by the Brief
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Symptom Inventory (BSI). Their findings showed that strong correlations

existed with three of the five NEO dimensions (neuroticism, r=-0.65;
extraversion, r=0.61 and conscientiousness, r=0.46). Lesser but still
significant correlations were found relative to the openness (r=0.20) and
agreeableness (r=0.15) scales. Except for one comparison, gender and
ethnicity did not influence these findings. As to coping, in a regression
model, task-oriented coping (‘active’ coping) and emotion-oriented coping
showed positive and negative relationships with CD-RISC respectively
(β=0.39, t=6.06, p<0.001 and β=-0.18, t=-2.39, p<0.05). With regard to their
last hypothesis that resilience would moderate the relationship between early
trauma and current symptom state, the authors found this to be the case, in
that those with high resilience and severe early trauma failed to exhibit
significant symptoms, while the low resilience/high trauma group reported
more severe symptoms. The low trauma group showed intermediate
symptoms regardless of resilience level.
Schaefer et al (2007) studied 256 US missionaries in Europe and Africa, and

found that the CD-RISC was one predictor of the Davidson Trauma Scale
(DTS) score, a measure of PTSD severity (β=-0.20, p<0.01).
Benetti and Kambouropolous (2006) studied a group of 240 young

Australian adults and college students, examining whether trait anxiety and
resilience influenced self-esteem, as measured by the Rosenberg Self Esteem
Scale, and if these effects were mediated by negative and positive affects
respectively, as measured by the PANAS. Their results found this to be the
case and the authors concluded that the impact of resilience on self-esteem is
due to its effect on regulating affective experience.
A cohort of 136 information technology students was studied by Lewis et al

(2008). A relation was shown between CD-RISC and the Schutte Emotional
Intelligence (EI) Scale (r=0.31, p<0.01) and INTENT, a scale measuring
intent to stay in the course (r=0.28, p<0.01). In linear regressions, the CD-
RISC remained a significant predictor of EI, but not of INTENT, after
controlling for other variables.
In Bruwer et al (2008), Cohen’s Perceived Stress Scale (PSS) also correlated

significantly with the CD-RISC (r=-0.28; p<0.01) as did the Beck
Depression Score (r=-0.43, p<0.01).
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Ito et al (2009) noted negative correlations relative to perceived stress (r=-

0.58, p<0.01) and psychiatric symptoms on the K-6 scale in Japanese
students (r=-0.44, p<0.01). Positive relationships (p<0.01) were observed
with regard to Kobasa’s Hardiness (r=0.68) and Antonovsky’s Sense of
Coherence (r=0.50) scales.
In veterans of OIF and OEF, Pietrzak et al (J Aff Dis, 2009) reported

negative correlations between the CD-RISC and PTSD symptoms (r=-0.53,
p<0.001), and depression (r=-0.57, p<0.001). In a second publication
(Pietrzak et al, Depression and Anxiety, 2009), the same group noted that
two of the original CD-RISC factors, personal control and positive
acceptance of change, were negatively associated with depression and
PTSD. In the same series of studies, the authors did not find that resilience
was a predictor of perceived stigma or barrier to mental health care (Pietrzak
et al, Psychiatric Services, 2009).
Giesbrecht et al (2009) found that cognitive reactivity was predictive of

lower resilience four months later.
Yu et al (2009) reported that in 271 Chinese subjects who were HIV +ve, the
CD-RISC was a protective factor against depression, anxiety and stress.
Among cricketers, all four subscales of the Cricket Mental Toughness
Inventory (CMTI) - desire to achieve, r=0.23; resilience, r=0.73; attentional
control, r=0.84; self-belief, r=0.52 - showed positive correlations with the
CD-RISC (Gucciardi and Gordon, 2009).
Otto et al (2010) noted positive correlations between the CD-RISC and the
Marlowe-Crowne Social Desirability, Positive Affect, Global Physical
health scales, while a negative correlation was obtained against the Negative
Affect Scale. Resilience accounted independently of other variables for
some (2.3%) of the variance in global wellbeing.
Karairmak (2010) demonstrated significant correlations for the CD-RISC

versus the Ego Resiliency Scale (r=0.68), Positive Affect Scale (r=0.69),
Rosenberg Self Esteem Scale (r=0.53), and measures of optimism (Life
Orientation Scale, r=0.55) and hope (Dispositional Hope Scale, r=0.68). A
negative correlation was obtained relative to the Negative Affect Scale
(r = -0.44).
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Park et al (2010) observed a correlation between resilience and

posttraumatic stress symptoms in Korean firefighters, although it did not
mediate the relation between trauma exposure and PTSD, as did self-esteem.
Spinal cord injury patients demonstrated significant positive correlations

between the CD-RISC and Satisfaction with Life (SWLS) (r=0.54),
Inventory of Spiritual Beliefs (ISS) (r=0.35) and a negative correlation with
depression (PHQ-9) (r=-0.35), and no association with Functional
Independence (FIM) (White et al, 2010).
Relative to another resilience scale, the RSA of Friborg and Hjemdal, the
CD-RISC correlated significantly (r=0.41) in 373 Iranian adults (Jowkar et
al, 2010).
The Responses to Stressful Experiences Scale (RSES), developed by

Johnson et al (2011) to assess response patterns to more severe stress,
correlated significantly with the CD-RISC in two samples of 224 active duty
Marines and 103 veterans of OIF and OEF (r=0.61 and 0.81).
A study in Korean subjects found that the CD-RISC correlated positively

with the Rosenberg Self Esteem Scale (r=0.558) and negatively with the
Beck Depression Inventory (r=-0.457), Perceived Stress Scale (r=-0.319)
and the Impact of Events Scale-Revised (r=-0.257) (Baek et al, 2011).
Gucciardi et al (2011) conducted a second study in 520 Australian

cricketers, noting significant positive correlations for the 25- and 10-item
versions of the CD-RISC against hardiness and athletic burnout. Against
global hardiness, which was measured by the Personal Views Survey III-R,
there were positive correlations of 0.62 and 0.56 respectively (p<0.01).
Against the three components of the Athletic Burnout Questionnaire,
correlations with the CD-RISC 25 and CD-RISC10 ranged from -0.32 to -
0.46, and -0.38 to -0.40 respectively (p<0.01).
In a paper that described the development of a new scale for adolescents, the
Singapore Youth Resilience Scale (SYRESS) correlated at r=0.88, p<0.01)
with the CD-RISC (Lim et al, 2011).
In a large community sample, the CD-RISC correlated with positive attitude

towards aging as measured by the Philadelphia Geriatric Morale Scale
(PGMS) (r=0.38, p<0.001) (Kavirajan et al, 2011).
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CD-RISC scores correlated negatively with measures of neuroticism and

negative life events, but positively with social support and extraversion in
medical students (Peng et al, 2012).
The CD-RISC was used to demonstrate convergent validity with a new

measure of pain (r=0.42, p<0.005) (West et al, 2012).
In a Norwegian schizophrenia sample, the CD-RISC correlated significantly

with subjective wellbeing (r=0.80, p<0.01), Global Assessment of Function
(GAF) (r=0.87 for the full recovery group and r=0.97 for the remission
group, p<0.01) and the Global Assessment of Relational Functioning
(GARF) (r=0.61, p<0.01 for all subjects) (Torgalsbøen, 2012). Regression
analysis showed that the CD-RISC and GAF explained 67% of the variance
in accounting for subjective wellbeing, with CD-RISC remaining a
significant predictor when controlling for function.
Mansfield and colleagues (2011) studied 3,069 male Navy and Marine
personnel. They found negative correlations between resilience and
measures of suicidal ideation, PTSD, depression and substance use, but not
with combat exposure. Resilience had a significant protective effect against
PTSD and depression in both services and against suicidal ideation in
Marines only.
In single African American, low income, fathers, Coates (2012) observed

positive and statistically significant correlations between the CD-RISC and
measures of spirituality (r=0.56), co-parenting relationship quality (r=0.33)
and motivation (r=0.33), but no relationship with measures of social support,
conviction history and psychological wellbeing. In a later report (Coates et
al, 2013), the same group found that the CD-RISC-10 correlated negatively
with the General Health Questionnaire-12 (GHQ-12), a measure of general
mental health distress.
Bensimon (2012) demonstrated that resilience was positively associated with

posttraumatic growth (PTG) (r=0.14) and negatively with PTSD (r=-0.13) in
500 Israeli students who had been exposed to trauma
Greater resilience was associated with a broader range of coping behaviors
in anticipation of terrorism in the Australian population (Stevens et al,
2012).
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Young adults in Canada who were transitioning out of child welfare were
found to show less depression and less smoking if they had higher CD-RISC
scores, and also greater religious and community involvement. Resilience
was independently associated with depression over and above the impact of
childhood trauma (Goldstein et al, 2013).
Lee and Williams (2013) showed a significant positive correlation between

the CD-RISC and measures of social support and family cohesion in 206
Korean offspring of alcoholic parents. The RISC mediated outcome
(depressive symptoms), serving as the main protective factor after sense of
belonging.
Among Korean patients with metastatic cancer, those with more depression
or anxiety scored lower on the CD-RISC (Min et al, 2012).
Parents of children with cancer, who had lower resilience, were more likely
to have sleep difficulty (OR= 5.19), to be unable to express worries (OR=
4.00), to have lower health satisfaction (OR=5.71), greater distress on the K-
6 (Kessler-6) scale, as well as lower social support and more likelihood of
driving under the influence of alcohol (Rosenberg et al, 2013).
In a study of 20 amputees conducted in the Netherlands, the CD-RISC

correlated positively with all four scales in the WHO-QoL, and negatively
with all scales in the SCL-90R (Bodde et al, 2013).
Adult offspring of a parent with schizophrenia were found to be unsatisfied

with the quality of parenting by the affected parent, but the most resilient in
the sample were those who endorsed greater support from other relatives,
and greater social support in coping with difficulties (Herbert et al, 2013).
Petros et al (2013) studied a sample of 196 healthy English adults and found
strong positive correlations between the CD-RISC and the Schwarzer &
Jerusalem Generalised Self-Efficacy Scale, as well as significant positive
correlations versus the LOT-R Dispositional Optimism Scale, the Berlin
Social Support Scale, and WHO-5 Wellbeing Scale. Negative correlations
were found vs the CES-D-10 Depression Scale and Spielberger Trait
Anxiety Scale, and number of adolescent life stresses as measured by the
Early Life Stress Inventory.
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Senders et al (2014) reported significant correlations between CD-RISC

score and mental health quality of life (r=0.58), adaptive coping (r=0.47),
maladaptive coping (r=-0.58), perceived stress (r=-0.55), using the Brief
Coping Inventory for Problem Experiences (B-COPE), Perceived Stress
Scale (PSS) and Medical Outcome Study Short Form-36 (SF-36). No
significant association was found between CD-RISC and SF-36 physical
health quality of life.
Spies and Seedat (2014) studied South African women infected with HIV,
and found a negative correlation between CD-RISC and depression as
measured by the CES-D (r=-0.28), PTSD measured by the Davidson Trauma
Scale (DTS) (r=-0.23) and childhood trauma (CTQ) (r=-0.22).
In a group of organ donors, Rudow et al (2014) observed significant

correlations between the CD-RISC-25 and measures of purpose in life (PIL),
post-traumatic growth (PTG), extraversion, agreeableness and
conscientiousness, but not openness (NEO).
Significant correlation was found between the CD-RISC and Wagnild and
Young’s Resilience Scale in a German population (Sarubin et al, 2015b).
Wu et al (2015) found that resilience correlated significantly with

posttraumatic growth in Chinese earthquake survivors.
Sanchez-Teruel and Robles-Bello (2015) observed a significant correlation

between the CD-RISC and RS-14 of Wagnild (r = 0.87) in 323 Spanish
college students.
Xie et al (2016) reported significant correlations between the CD-RISC and

the Rosenberg Self-esteem scale (r=0.27), and positive affect (r=0.52) and
negative affect (r=-0.26) on the PANAS, in a large sample of over 2300
Chinese military personnel. Shi et al (2016) noted a significant negative
correlation (r=-0,488) between the CD-RISC-25 and SCL-90-R.
DeSimone et al (2016) reported significant correlations between a new

measure of resilience, the 5x5 RS, and the total (r=0.79) and factor scores
(r=0.23 – 0.77) of the CD-RISC.
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The Impact of Events Scale-Revised (IES-R), which measures PTSD

symptoms, correlated negatively with the CD-RISC (r = -0.30, p = 0.02) in
56 resident physicians (McFarland and Roth, 2016).
The CD-RISC-25 correlated with the Resilience Scales of Wagnild (25 and
14 item versions): r=0.72 and r=0.72) in 421 US college students (Madewell
and Ponce-Garcia, 2016).
A negative correlation (r = -0.78) was observed between the CD-RISC-25

and the Beck Depression Inventory-II (Arbour et al, 2017) in a Canadian
sample with moderate to severe TBI.
CD-RISC factors of ego-resiliency, tenacity, strength and optimism

correlated significantly (r = 0.45 to r = 0.65) with the perseverance and
optimism factors of the Resilience Style Questionnaire (RSQ) in a Hong
Kong sample (Mak et al, 2017).
CD-RISC-10:
McGlone and colleagues (2009) studied the CD-RISC-10 in 27 patients with
epilepsy, using the scale in the context of validating measures of stigma.
They found the CD-RISC to correlate strongly with measures of the positive
aspects of stigma and with resistance to stigma. In other words, more
resilient epileptic subjects either gained more from the challenges posed by
the disease, or showed greater resistance to the problems of stigmatization.
Wang showed a negative correlation between the CD-RISC 10 and the Los
Angeles PTSD Symptom Checklist (LASC) four months after a severe
earthquake, both with respect to total score and the three PTSD subscales.
Mean CD-RISC 10 scores were significantly lower in the PTSD group
(20.8(7.9)) as compared to those without (26.8(6.3)) (Wang et al, 2010).
Shlomi (2010) showed positive correlations between the CD-RISC 10 and

Sense of Belonging and Peer Emotional Support, and a negative correlation
against the CES-D measure of depression.
In 465 Hungarian students, the CD-RISC-10 correlated significantly with the

Ego Resiliency Scales (ER89 and ER11) of Block and Kremen, and the CD-
RISC showed stronger correlation with aspects of resiliency reflective of
stability (conscientiousness, agreeableness and emotional stability) than to
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flexibility (extraversion and openness), whereas for the ER scale, it was

vice-versa. However, for both dimensions, the CD-RISC-10 was
significantly correlated (Farkas and Orosz, 2015). CD-RISC-10 score
correlated negatively with PTSD score on the PCL-C (McCanlies et al,
(2014) in police officers exposed to trauma.
In 314 Spanish dental students, the CD-RISC-10 correlated positively with a

measure of efficacy, and negatively with measures of depression, perceived
stress, tenseness, anxiety exhaustion and cynicism (Montero-Marin et al,
2014).
Depression on the PHQ-8 correlated negatively (r = -.0.33 and r = -.0.48)

with the CD-RISC-10 in a sample of injured inpatients (Rainey et al, 2014).
The CD-RISC-10 correlated significantly with PTG in Chinese university

students with PTSD (r=0.53), as well as with measures of conscientiousness
(r=0.41) and vitality (r=0.40) (Duan et al, 2015). A later study found similar
associations between RISC-10 and Vicarious Post Traumatic Growth
(VPTG) scores in ambulance and medical personnel confronted with major
trauma in their work (r = 0.67, Kang et al, 2018).
A positive correlation was found for the CD-RISC-10 relative to the

Rosenberg Self-esteem Scale (r=0.336), and negative correlations versus the
PHQ-9 (r=-0.316) and the GHQ-12 (r=-.0242) in Nigerian nurses (Aloba et
al, 2016).
In US athletes, the CD-RISC-10 was negatively related to somatic and

cognitive anxiety, and disrupted concentration (Gonzalez et al, 2016).
The Spanish version of the CD-RISC-10 correlated significantly with the

Spanish Brief Resilience Scale (r = 0.56) (Rodriguez-Rey et al, 2015).
A significant correlation (r=0.68 and r=0.66, p<0.001) was observed relative

to the RS-25 and RS-14 of Wagnild in 412 US college students (Madewell
and Ponce-Garcia, 2016).
A negative correlation of r = -.0.63 was found between the CD-RISC-10 and

PSS-10 in Danish hospital workers (Lauridsen et al, 2017).
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CD-RISC-2:
Area residents were studied after the Deepwater Horizon oil spill, and the
CD-RISC 2 was related to levels of depression and anxiety, serving as an
independent predictor of post-disaster symptoms (Osofsky et al, 2011). In
Korean firefighters and rescue workers, the CD-RISC-2 correlated positively
with SF-36 mental and physical health and Global Assessment of Function
(GAF), while a negative correlation was obtained against the Beck and
Hamilton Depression and Anxiety Scales, the Montgomery-Asberg
Depression Scale, the Clinician Administered PTSD Scale (CAPS), and two
self-ratings of PTSD, the IES-R and the PDS (Jeong et al, 2015). Among 40
patients with chronic obstructive pulmonary disease who were studied in
Colombia, the CD-RISC 2 correlated with the Wagnild and Young
Resilience Scale (RS) (r=0.750, p<0.01), and a measure of mental health
(r=0.320, p<0.05) (Vinaccia and Quiceno, 2011).
A highly stressed sample of primary care patients referred to behavioral

counselling was studied by Langhinrichsen-Rohling et al (2017). The CD-
RISC-2 correlated with PTSD (r=-0.40, p<0.001), stress (r=-0.21, p<0.05),
depression (r=-0.52, p<0.001), suicidality (r=-0.38, p<0.01) and anxiety (r=-
0.40, p<0.001).
Spirituality: Some have argued that a relationship exists between resilience

and spiritual beliefs. Wilks (2006) hypothesized that the greater the degree
of intrinsic spirituality, the greater would be resilience. His results in a group
of 298 Alzheimer’s disease caregivers showed a correlation between
Hodge’s Intrinsic Spirituality Scale (ISS) and the CD-RISC (r=0.53,
p<0.001). Later, Wilks and Vonk (2008) reported that private prayer
mediated (enhanced) resilience, while caregiver burden reduced resilience,
in the same sample.
Bitsika et al (2010) failed to show a relationship between the spirituality

factor and measures of depression and anxiety.
Karairmak (2010) demonstrated that a factor-defined spirituality scale

correlated significantly with two other CD-RISC factors (r=0.32 and 0.33).
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White et al (2010) demonstrated a correlation (r = 0.35) between the CD-

RISC and score on the Inventory of Spiritual Beliefs.
In a National Spiritual Beliefs Survey using the East-West Spiritual Beliefs

Scale (EWSBS), Davidson and colleagues failed to demonstrate a
relationship between CD-RISC score and those who subscribe to beliefs in
karma and reincarnation, using an early 11-item subscale, which has not
subsequently been developed further (Davidson et al, 2005). In line with
Wilks (2006), Lee et al (2008) demonstrated that CD-RISC score was a
significant predictor of agreement with traditionally Western spirituality
(β=0.08, p<0.0001), but not with spiritual beliefs of Eastern heritage,
suggesting the relationship between resilience and spirituality may be
complex. In a third report of their US National Survey, Connor et al (2003)
showed that in the 605 survivors of violent trauma, CD-RISC, along with
persistent anger and spiritual beliefs, predicted mental and physical health
status (OR=0.91, 95% CI = 0.88,0.94 and OR=0.80, 95% CI =0.76,0.84).
When looking at predictors of PTSD severity on the DTS, the CD-RISC
score (β=-0.33, p<0.001), with anger and spiritual belief, predicted symptom
severity, such that for every 10-point increase on the CD-RISC, there was a
6 point drop (reduction of severity) on the DTS.
The notion that spiritual or religious beliefs are an essential component of

resilience has been questioned, and some studies of the CD-RISC have
failed to replicate such a factor. In part this may be due to the limited
number of relevant questions in the scale, and also it may be affected by
cultural factors. Thus for example, in one Chinese study (Yu et al, 2007), no
such factor emerged in the CD-RISC, while in another, some elements
emerged as one of two factors in children who survived an earthquake (Fu et
al, 2013), and a study in Singapore derived a spirituality factor on the
SYRESS (Lim et al, 2011). A study from Korea found that lower spirituality
was the leading predictor of poor resilience and depressed and anxious
outpatients (Min et al, 2012).
A study of Iranian university undergraduates showed that resiliency and

spiritual intelligence, as measured by the Abdollah-Zadeh Spiritual
Intelligence Scale, were positively correlated, and that the latter
independently of mental health predicted RISC score (R2=0.18, p<0.01)
(Ebrahimi et al, 2012). The same measure of spirituality was found to
correlate positively with the CD-RISC-25 score a group of 13 Iranian
national hockey players (Dodman and Moradi kor, 2015)
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Refugees from the Chinese mainland to Hong Kong showed a significant

correlation between their scores on the Zubrick Family Resilience Scale and
the CD-RISC (r=0.35, p<0.001) (Yu et al, 2013a).
Coates et al (2013 studied 127 low income African-American men and

found the CD-RISC-10 to correlate positively with the Religious Wellbeing
scale.
Davidson and Lee studied the relationship between resilience and

forgiveness in a national survey of the US population (unpublished data,
2015). Using the CD-RISC-2, they found that those who had experienced
personal violence (n=239), and who had forgiven the perpetrator scored
higher (6.7 (1.3)) than did those who had not forgiven the person responsible
(6.2(1.5)), p=0.007).
In survivors of a Haitian earthquake, spiritual belief and religious practice

related to level of resilience. Those who believed that God was responsible
for the event had higher CD-RISC score (77.3) than did those without such
belief (65.3), and those who practiced the Voodoo religion also had higher
scores (72.5) compared to non-practitioners (64.6) (Blanc et al, 2016).
Aloba et al (2016) noted a significant negative correlation between the CD-

RISC-10 and the Religiosity Orientation Test (r = -0.184) in Nigerian
student nurses. The authors interpreted this finding as indicating a
relationship between greater resilience and greater religious belief or
practice, and considered it to be a form of construct validity for the CD-
RISC.
Cahyani and Akmal (2017) found that spirituality (i.e. purpose,

connectedness and sense of a transcendental power) was associated with
greater resilience and better handling of difficulties among students
preparing their final papers.
Lower scores in the spirituality subscale was found in US veterans with

suicidal ideation (Elbogen et al, 2017).
Chinese medical and ambulance personnel with higher RISC-10 scores were
found to exhibit higher scores on the spirituality subscale of the Vicarious
Posttraumatic Growth Inventory (VPTGI) (r = 0.63) (Kang et la al, 2018).
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Support and Social Relationships: Perceived social support was found to

correlate significantly with the CD-RISC in studies of the Multidimensional
Scale of Perceived Social Support Scale (MSPSS) by Bruwer (2008) (r=0-36
to 0.42 for the four subscales) and in the study by Brown (2008) (r=0.11 to
0.22). In Brown’s study, a hierarchical multiple regression analysis to
predict resilience showed that, of all 11 variables in the model, only cultural
pride reinforcement and support from a special person predicted CD-RISC
score. A study of unemployed men by Phillips (2011) demonstrated a
significant correlation (r=0.57, p<0.01) between the CD-RISC and the
MSPSS.
Clauss-Ehlers and Wibrowski (2007) found the CD-RISC to correlate

significantly with Confidant Availability (r=0.24, p<0.05) and Peer
Availability (r=0.36, p<0.01), but not with measures of Supervisor
Availability or Adequacy, or Peer Adequacy. Ito et al (2009) found positive
correlations between the CD-RISC and Furukawa’s social support scales
(r=0.23 and 0.24, p<0.01).
In veterans of OIF and OEF, Pietrzak et al (J Affective Disorders, 2009)

reported positive correlations between CD-RISC score and unit support
(r=0.40, p<0.001), post-deployment social support (r=0.51, p<0.001), and
negative correlations versus psychosocial difficulties (r=-0.40, p<0.001).
Path analysis suggested that resilience fully mediated the association
between unit support and depression and PTSD.
In 495 earthquake survivors followed up for five years, Ni et al (2015)

observed that different aspects of social support, as measured by the Social
Support Rating Scale, predicted resilience in men and women – in the
former, support-seeking behaviors were predictive, while in the latter, it was
subjective social support.
The CD-RISC-25 correlated significantly with social support (r=0.47) and

social skills (r=0.44) in 412 US college students, while the CD-RISC-10
correlated at levels of r=0.39 and 0.34 respectively (Madewell and Ponce-
Garcia, 2016), using Ponce-Garcia’s Scale of Protective Factors to measure
social support and skills.
Gaddy and associates (2016) observed that, in 132 US military personnel,

there was a significant correlation (r = 0.41) between CD-RISC score in
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subordinates and their perception of authentic leadership on the part of their

supervisors, as defined by self-awareness, moral compass, enhanced
information processing and relational transparency leading to self-
development.
In a sample of 294 subjects who were exposed to Hurricane Katrina and the
Deepwater Gulf Oil Spill, RISC-10 scores correlated significantly with
scores on a community support scale assessing caring/connection, provision
of resources, transformative potential and information/communication (Lee
et al, 2017).
A Spanish sample of 294 caregivers demonstrated a significant correlation (r

= 0.228) between the CD-RISC-10 and the Duke-UNC Functional Support
Scale (Blanco et al, 2017).
Divergent Validity: A report by Connor and Davidson (2003) noted the

absence of a significant correlation between the CD-RISC and a measure of
sexual function in two analyses (r=-0.34 and r=-0.30), in keeping with
prediction. Pietrzak et al found no relationship between CD-RISC and
exposure to combat in their National Guard cohort (r=0.04, ns), which is as
would be expected: exposure to combat in the military is unlikely to be
substantially determined by resiliency. Shlomi (2010) showed no
relationship between the CD-RISC 10 and Childhood Socioeconomic
Position as assessed by the FAS. In school leavers, Stephenson (2012) found
no association between resilience and economic self-sufficiency. Kilic found
no relationship between CD-RISC 10 score and the extent of spinal cord
damage or diagnosis in a cohort of 60 spinal cord injured patients (Kilic et
al, 2013). No association was found between resilience and fetoplacental
blood flow in a cohort of South Africa women attending an obstetrics clinic
(Roos et al, 2014). Although a relationship was expected, and found for,
antenatal anxiety and blood flow, the case for expecting such a finding for
resilience was weaker according to the authors.
A study of the CD-RISC-2 found no relationship (in accordance with

prediction) between the scale and a measure of alcohol consumption, the
AUDIT (Jeong et al, 2015).
Among Chinese women with breast cancer, no relationships were found

between CD-RISC score and a family history of breast cancer, religion,
stage of cancer or time since diagnosis (Wu et al, 2016).
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Decroos et al (2017) developed a measure of team/collective resilience

(CREST), and found divergent validity for the CREST relative the concept
of individual resilience in the CD-RISC-10 in two samples of British and
Belgian athletes (n=345 and n=75).
Lee et al (2017) showed no correlation between the CD-RISC-10 and

cumulative exposure to disaster.
CD-RISC: Predictive Validity, Treatment and Change over

Time
Predictive Validity & Sensitivity to Change: Numerous studies have used the
CD-RISC to assess change during treatment with medication,
psychotherapy, or from some other form of intervention, such as instruction
in stress-management or resilience-building, which are summarized in
chronological order in Tables 11a and 11b. Some studies have also
examined whether the baseline CD-RISC predicts treatment outcome or
health status. One study evaluated a cut point to distinguish between
depressed and non-depressed subjects.
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Table 11a. Changes in CD-RISC 25 Associated with Intervention or Treatment
First author N Interventions Pre and post % change ES *or Sample Country
scores p value
Davidson 92 Antidepressants, 56.0 67.6 21 ES = PTSD USA
(2005) CBT 0.72
Davidson 224 Venlafaxine 55.2 69.0 25 ES = PTSD USA
(2006) Placebo 53.4 63.2 17 0.35
Ven vs.
Pbo
Clauss- 95 Stress management 73.1 76.2 4 ES = College USA
Ehlers 0.21 freshmen
(2007)
Dodding 20 Group treatment 39.0 53.9 38 P<0.005 Depressed USA
(2008) Control 62.8 64.8 3 and healthy
control
groups
Steinhardt 64 Stress management 67.7 75.3 11 P<0.01 College USA
(2008) 70.6 70.6 students
Steinhardt 16 Diabetic 83.2 84.1 1 ES = Diabetics USA
(2009) management 0.10
counseling
Lavretsky 40 Escitalopram 60.2 76.2 27 ES = Depression USA
(2010) Placebo 66.6 68.4 3 0.47 Esc
vs. Pbo
Vetter 94 Post-trauma 70.1 73.9 5 ES = Children Russia
(2010) counseling 0.29 who
survived
Beslan
terrorist
attack
White et al 42 Spinal cord injury 82.2 81.9 82.6 None NS Treatment USA
(2010) rehabilitation not specific
to resilience
Jafari 25 Lifestyle training 56.3 69.1 23 P<0.001 Males with Iran
(2010) vs. Waitlist control 52.9 53.8 2 alcohol and
drug misuse
Lavretsky 37 Tai Chi 60.5 71.5 18 P<0.05 Late life USA
(2010 and Control 56.9 65.5 15 depression
2011)
Sood 40 Stress management 69.6 79.4 14 ES = MD USA
(2011) Waitlist 68.0 67.2 0 1.16 employees
Thabet 99 Community 81.9 84.4 3 NS Women Gaza

(2011) treatment abuse
survivors
Loprinzi 20 Stress management 73.6 81.1 10 P<0.05 Breast USA
(2011) Waitlist 78.2 82.1 5 cancer
survivors
Stephens 61 Resilience training 75.2 78.0 4 P<0.05 Nursing Australia
(2012) vs. 74.5 75.7 2 students
Control
Sharma 33 Stress management 73.4 81.8 11 P<0.001 Medical USA
(2012) center
employees
Rogchanchi 24 Rational emotive 56.6 72.7 28 P<0.001 Student Iran
(2012) therapy vs. 57.2 59.1 4 counseling
Waitlist sample
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Naylor 12 Paroxetine 73.8 74.6 1 NS OEF/OIF USA

(2012) Placebo 80.1 79.2 0 veterans
with sub-
threshold
PTSD
Yu (2013b) 54 Resilience 50.7 59.4 17 ES = Village China
counseling 0.51 residents
HIV + and
HIV -
Chen et al 32 CBT 51.5 70.8 36 Not Adolescent China
(2014) Support 49.3 70.1 43 given Sichuan
No treatment 52.7 53.1 1 earthquake
control survivors
who lost a
parent
Peng et al 30 Penn Resil Pgm 58.5 69.3 18 P<0.01 Medical China
(2014) 30 Control 59.0 58.3 0 NS students
low resil
Penn Resil Pgm 87.0 87.1 0 NS Med
Control 86.5 85.9 0 NS students hi
resil
Krystal et 20 Tiagabine 62.0 70.4 14 ES = PTSD with USA
al (2014) 0.40 sleep
problems
Sood et al 26 Stress mgt and 70.0 73.0 4 P<0.05 MD USA
(2014) resil training within radiologists
(SMART) group
Gowenlock 24 Meditation 75.8 80.8 11 P<0.001 Military USA
(2014) 84.4 within personnel at
group combat
support
hospital
Yu et al 183 Resilience 58.2 62.6 7 ES=0.17 Refugees China
(2014) counseling 57.7 56.3 0 with
Information 59.3 59.1 0 adjustment
Control difficulties
Hoseiny et 60 Methadone 38.1 40.1 5 P<0.05 Opiate Iran
al (2015) maintenance(MM) dependent
MM with CBT 37.0 64.4 73 subjects
Guest et al 88 CBT 74.1 71.2 Reduction Spinal cord Australia
(2015) Control 77.5 75.4 in score injury
Rogers 43 Single 90 minute 77.3 74.1 Decrease P = ns Healthcare South

(2016) educational in score ES= - professional Africa
intervention 0.33 students
workshop
Bird et al 64 Skill building 72.5 68.6 Decrease P = 0.03 Internal USA
(2017) workshops in score medicine
interns
Jeon et al 10 EMDR 8 sessions 50.0 57.6 15.2 P < 0.01 Survivors of Korea
(2017) ES = ferry boat
0.30 sinking
Jung et al 42 On-line mind-body 54.5 59.2 9% ↑ P<0.000 Hospital Korea
(2017) 45 training program employees
vs wait list control 54.0 51.7 4%↓
Ameen 143 20 sessions of 54.7 70.2 30% ↑ Not Traumatized
(2018) community- given Iraqi Iraq
oriented adolescents
psychosocial aged 12-17
support
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Camardese 32 Two kinds of RISC-25 Increased P<0.05 Bipolar

et al (2018) psychosocial Rx Scores not given score pre disorder Italy
to post
Eicher et al 41 Low intensity Rx 11 of 41 Increase NS Cancer Switzerland
(2018) 45 High intensity Rx 17 of 43 of 5 or patients
greater
• ES= Effect Size

• NS= Not Significant
• P= Probability
Table 11b. Changes in CD-RISC 10 and CD-RISC 2 Associated with an Intervention
First author N Interventions Pre and post % ES or p Sample Country

change value
Davidson 224 Venlafaxine vs. 20.5 27.0 19.9 32 ES = 0.34 PTSD USA
(2008) placebo 24.2
Davidson 224 Venlafaxine vs. 4.61 5.68 4.52 23 ES = 0.32 PTSD USA
(2008) placebo 5.15
Vaishnavi 20 Mirtazapine vs. Not given Not ES = 0.46 PTSD USA
(2007) placebo given
Christensen 41 Rehabilitation 31.4 32.8 4 Zero Traumatic USA
(2011) injury
Leventhal et 2,308 School-based 20.8 25.7 24 P<0.001 Rural India
al (2015) resilience course 22.2 23.5 6 schoolgirls
Tan et al 64 Resource 26.3 28.1 7 P=0.07 Older Singapore
(2015) Enhancement community
and Activation residents
Program vs
Control 26.1 25.5 0
Notario- 208 Treatment as Results divided 11%↓ ES = 0.00 Fibromyalgia Spain
Pacheco usual into non NR
(2014) responder (NR) ES = 0.36
and responder 10%↑ R
(R) groups
DeManincor 47 Yoga 5.13 5.74 12% ES = 0.49 Anxiety and Australia
et al (2016) 54 Waitlist 5.11 5.07 p<0.01 depressive
symptoms
Moffett & 105 Teaching module 27 (IQ 25-30) 7% ES = 0.28 First year England
Bartram pre P<0.001 veterinary
(2017) 29 (IQ 26-32) students
post
Lewis et al 339 Collab care 5.8 6.2 7% P<0.05 Subthreshold England
(2017) 358 Usual care 5.8 5.7 depression
in primary
care practice
Curtis et al 17 Iyengar yoga 30.7 32.6 6% NS Spinal cord USA
(2017) injury
Deen et al 5 Rational Emotive 16.8 22.4 32% Not Elite squash Malaysia
(2017) Therapy tested playing
athletes
Slatyer et al 65 Mindfulness self 28.3 29.5 4% NS Nurses Australia
(2017) care (MSCR)
26 Wait list (WL) 27.5 27.3 0
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Harrer et al 75 Internet/App Rx 4.80 5.56 16% P = 0.08 Stressed

(2018) 76 Wait list control 4.79 5.17 8% university Germany
students
In their original report describing the CD-RISC, Connor and Davidson

(2003) showed a significant relationship between CD-RISC and degree of
improvement on the Clinical Global Improvement (CGI) scale, whereby
greater improvement was associated with greater change on the CD-RISC
(F=3.42, df 2, p<0.05).
A subsequent series of uncontrolled studies of antidepressants and cognitive

behavioral therapy have also shown that CD-RISC scores increase over time
in patients with PTSD (Davidson et al, 2005). In this analysis, the CD-RISC
item that assessed the capacity of having a sense of humor under stress was a
strong predictor of remission, and optimism/tenacity also predicted good
response.
A double-blind, placebo-controlled trial of venlafaxine-XR in posttraumatic

stress disorder has shown that the drug produces significantly greater
improvement on the CD-RISC than does a placebo (Davidson et al, 2006a),
with an effect size (ES) of 0.35, which was greater than the ES of all other
measures (e.g., PTSD, depression, quality of life) that were used in the trial.
A second double-blind trial of venlafaxine-XR, sertraline and placebo,
which overall produced weaker treatment effects than the first study, failed
to show significant improvement on the CD-RISC for drug vs. placebo
(Davidson et al, 2006b). A more detailed analysis of the first trial (Davidson
et al, 2006a) showed that the drug produced improvement on many
individual items in the scale (Davidson et al, 2008), including those which
reflect a sense of meaning/purpose, tenacity, hardiness, active coping and
adaptability. The effect size statistic for these items ranged from 0.41 to
0.35, which are of meaningful size for individual item change.
Predictive validity for the CD-RISC has been further demonstrated in PTSD
and depression. In 687 patients with PTSD, the total CD-RISC score at
baseline (pre-treatment) was an independent predictor of remission, after
controlling for the effect of other predictors such as PTSD severity
(Davidson et al, 2006c; Davidson et al, 2012): for every 1-point increase in
CD-RISC score at baseline, the odds of achieving remission increased by
2.7%. The CD-RISC also was found to be related to deep learning and
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problem-centered coping strategies in Spanish undergraduates, and the three

variables all predicted academic achievement (de la Fuente, 2017).
The shorter forms of the CD-RISC also predict response to treatment and
reflect differences in treatment, as well as demonstrate a treatment’s ability
to improve resilience in short-term therapy (Davidson et al, 2008). The 10-
item scale served as a significant predictor of remission and improvement in
PTSD over 12 weeks of treatment with either venlafaxine-XR or placebo
(Davidson et al, 2012). The 2-item scale also predicted outcome in the same
series, as well as detecting greater change after treatment with mirtazapine
than placebo, at a moderate effect size of 0.46 (Vaishnavi et al, 2007).
Studies by other groups have also demonstrated that treatments can improve
resiliency, as measured by the CD-RISC, and/or that baseline CD-RISC
serves as a predictor of outcome. In 102 patients with depression, Camardese
and colleagues (2007) demonstrated that baseline CD-RISC mean (sd)
scores were significantly higher in eventual remitters to treatment than in
those who failed to remit: 53.3 (15.2) vs. 41.2 (19.6).
Clauss-Ehlers and Wibrowski (2007) studied a group of high school

graduates transitioning to college, and reported mean (sd) CD-RISC scores
of 73.1 (14.1) before a preparation course, and as they predicted, an increase
to 76.2 (15.3) afterwards.
In a German study of a small cohort (n=17) of acutely traumatized subjects,

the 1-month post-trauma CD-RISC predicted the likelihood of developing
PTSD at 6 months and was considered to serve as a potentially useful
discriminator (Krähenmann, 2008). In a later German study, lower resilience
was found to predict stress from stigma related to mental illness and to
avoidant coping in this regard (Schibalski et al, 2017).
Steinhardt et al (2008) assigned 30 college students to a four week resiliency

training course, and compared them to matched controls. Between pre- and
post-treatment, CD-RISC scores increased from a mean of 67.7 (10.0) to
75.3 (8.4) in the treated group, while the controls showed no change (70.6
(12.3) to 70.6 (11.7). In a later study, the same group demonstrated a change
in resilience which correlated with change in growth (r=0.67, p<0.001) after
psychoeducation was given to 31 undergraduates (Dolbier et al, 2009).
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In Dodding’s study of group therapy for couples (2008), depressed/anxious

patients showed a 38% increase in score after group therapy, changing from
39.0 to 53.9 (p<0.005). Their asymptomatic partners failed to show any
change (62.8 to 64.8, ns).
A study of 16 African American diabetics found no increase in CD-RISC

score after a counseling program, with the pre and post-treatment means
being 83.2(8.5) and 84.1(8.4) (Steinhardt et al, 2009). However, the baseline
scores were already in line with normative US population scores.
Ninety psychology students enrolled in a positive psychology course at the

Indian Institute of Technology, and after completing the program, there was
a significant increase in score on the CD-RISC 10, from 36.5 (4.7) to 38.1
(4.9) (Singh and Choubisa, 2009). It is noted that these scores are several
points higher than those found in other publications, and the explanation is
not clear.
Lavretsky et al (2010) conducted a double-blind trial of escitalopram, which

is an antidepressant of the SSRI class, in 40 depressed subjects who were
caregivers to family members with Alzheimer’s disorder. They found that
the drug (n=20) produced markedly greater improvement on resilience than
did placebo (n=20), with an effect size (ES) of 0.47. Baseline CD-RISC
scores for the drug and placebo groups were 60.2 (16.7) and 66.6 (17.0), and
at post-treatment the extent of change was +16.2 (17.3) and +1.8 (6.9). Thus
with escitalopram, CD-RISC score increased over baseline by 27%.
Vetter et al (2010) provided a resilience-enhancement intervention to

Russian schoolchildren following a terrorist attack on the Beslan School that
left many dead and injured. The mean score increased from 70.1 (14.8) at
baseline to 73.9 (11.5) at follow-up, with an effect size of 0.29. The
subgroup of children who had been held hostage (n=46) showed a greater
increase, from 65.6 (16.0) to 72.3 (13.5), with an effect size of 0.45. The
non-hostage group (n=48) showed no change (74.5 at baseline, 75.3 at
follow-up). The groups who sustained greatest loss and/or physical injury
showed large improvements in resilience (effect sizes of 0.65 and 0.54
respectively).
Instruction in coping skills was associated with significantly increased CD-

RISC at the end of treatment of 13 Iranian males with substance dependence,
as compared to a wait-list control group of 12 subjects. Pre and post scores
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in the two groups were, respectively, 53 and 70, vs. 52 and 53 (Jafari et al,
2010).
Spinal cord injury patients who were undergoing rehabilitation showed no

change in CD-RISC scores at times 2 and 3, despite improvement in other
measures, e.g., depression (White et al, 2010). Another sample of traumatic
injury survivors failed to show increase in resilience (and self-efficacy),
although depression did improve over a 12 week period of rehabilitation
(Christensen, 2011).
Tai chi treatment was found to produce enhanced resilience when added to
escitalopram in older depressed subjects (n=36), which was significantly
greater than the effect of a control treatment, health education (n=37). Final
scores on the CD-RISC were 71.5 (9.5) and 65.5 (14.3) (p<0.05) (Lavretsky
and Irwin, 2010; Lavretsky et al, 2011).
Sood et al (2011) randomized a group of 40 medical doctors with job-related

stress to either a course of stress management and resilience training,
referred to as SMART (n=20), or to a waiting list control (n=20). At
baseline, CD-RISC scores were 69.6 and 68.0 respectively. At the end of the
study, they were 79.4 and 67.2, with an ES of 1.16 in favor of SMART. Of
the five measures used, the ES for resilience enhancing effects of SMART
was the second highest, thereby speaking to a substantial treatment effect as
detected by the CD-RISC. The authors also pointed out the final post
treatment score of 79.4 brought their sample into line with the general
population norms as reported by Connor and Davidson (2003).
Thabet and colleagues (2011) found a modest, but statistically non-

significant increase in CD-RISC in 99 Gazan women who had been exposed
to domestic violence and took part in a counseling program. It was noted
that, despite surviving marked trauma, their baseline scores on the CD-RISC
were similar to the mean general population score in the US, suggesting that
they already demonstrated a high level of resilience.
Loprinzi and colleagues (2011) administered SMART to survivors of breast

cancer, in a single-blind randomized trial. Relative to the wait-list control,
SMART resulted in an increase of CD-RISC score from 73.6 to 81.1 vs. 78.2
to 82.1 (p<0.05).
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A Korean study of 178 depressed patients found that the CD-RISC predicted
likelihood of response to antidepressant drugs (Min et al, 2012). The
baseline scores in non-responders (NR) was 46.2 (20.8), while in responders
(R) it was 52.7 (20.1) (p=0.04). ROC analysis yielded an AUC of 0.607,
which while low, is statistically significant and provided a cut off score of
49.5 to detect R vs. NR group assignment. Sensitivity was 57% and
sensitivity 65%, both of which would be considered low. In those with low
trait anxiety and high resilience, response was more likely (65%) than in the
low anxiety/low resilience group (25%). In those with high trait anxiety,
response rates were low in both resilience groups (30% and 29%).
Stephens (2012) found that CD-RISC scores increased significantly in a

group of adolescent nursing students who received a Twitter-based
educational package to promote resilience and sense of support and to
decrease perceived stress. The intervention group showed greater resilience
post-treatment, but there was no benefit on perceived stress of support. RISC
scores increased from 75.2 to 78.0, while the controls changed from 74.5 to
75.7. At longer term follow up, the gains were lost.
Yu and colleagues (2012) demonstrated that a resilience focused

intervention among rural Chinese HIV +ve subjects led to an increase in the
CD-RISC score after treatment.
Sharma et al (2012) administered the CD-RISC pre- and post-stress

management training in 33 medical center employees. The mean score
increased over 12 weeks from 73.4 (10.8) to 81.8 (13.8).
Rational emotive therapy (RET) with art therapy (n=12) showed greater
increase in CD-RISC over time than did a wait-list control (n=12) in a group
of 24 Iranian subjects. The treatment group pre and post scores were 56.6
and 72.7, compared to 57.1 and 59.2 for the controls (Rogchanchi et al,
2012). Another study of RET in five athletes showed a 32% in CD-RISC-10
score from pre- to post-treatment (Deen et al, 2017).
A small double-blind placebo-controlled trial of paroxetine in sub-threshold

PTSD failed to demonstrate benefit on any measure, including the CD-RISC
(pre and post scores: 73.8 and 74.6 for drug vs. 80.6 and 79.2 for placebo)
(Naylor et al, 2012).
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Hazardous waste operations and emergency response workers who had

undergone training were found to show significantly lower resilience (75.0)
than a group who had not been trained (78.5); they also showed more sever
PTSD symptoms (Calcote et al 2013). The authors were surprised to find
this difference and offered some possible reasons, including the possibility
that training was not well conducted. Importantly, no data were presented on
the pre-treatment scores to observe change from the resilience training.
CBT given to bereaved adolescents following an earthquake was associated

with significantly greater increase in resilience than was a no treatment
control (Chen et al, 2014). Peng and colleagues (2014) found that the Penn
Resiliency Program increased resilience more than in a control group in
Chinese medical students who entered the study with low RISC scores
(mean 58-59), whereas in those with high baseline resilience (86), there was
no improvement in either treatment group.
An open-label study of tiagabine in PTSD by Krystal et al (2014) revealed

an increase of 14 points from pre- to post-treatment, with an effect size of
0.40.
Meditation practiced twice daily for eight weeks lead to improved resilience
(8 point increase), depression, anxiety and perceived stress in 21 military
medical personnel (Gowenlock, 2014).
Notario-Pacheco et al (2014) observed an effect size of 0.36 on the CD-

RISC-10 for fibromyalgia subjects who had responded to treatment
according to the FIQ, while in non-responders, the ES was 0.00.
A small community study in Singapore showed changes associated with a

resource enhancement program that was greater than in a control group, to a
level that just failed to meet statistical significance, using the CD-RISC-10
(Tan et al, 2015).
A study of CBT add-on treatment for subjects with spinal cord injury failed
to find any benefit on the CD-RISC, or any other measure of outcome
(Guest et al, 2015).
A school-based resilience curriculum resulted in a 24% increased score on

the CD-RISC, compared to 4% in controls. The sample of over 2000 rural
Indian adolescents was large (Leventhal et al, 2016).
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Rogers (2016) did not find any increase in resilience among South African
clinical associate students after a single workshop.
On-line mind-body training proved more effective than wait list control in
87 Korean hospital employees (Jung et al, 2017).
A sample of displaced Iraqi adolescents showed a 30% increase in RISC-25

score after 20 sessions of community-oriented psychosocial treatment
(Ameen, 2018).
Predictor of Health Status
In a group of women who were HIV+ve and who had been exposed to
sexual abuse or multiple abuses, Dale et al (2014) found that for each
increase in score of one point on the CD-RISC-10, there was a significant
increase in the odds ratio (OR=1.08) of having at least 95% adherence to
highly active antiretroviral therapy (HAART) and a decrease in the odds
(OR=0.94) of having a detectable viral load (less than 20 copies/mL). The
authors recommended the use of coping strategies that promote resilience
among this group in order to promote higher adherence and viral
suppression.
Schure et al studied 151 older (above age 55) American Indians, and found
that lower resilience was associated with poorer physical and mental health,
and greater chronic pain.
Among OEF/OIF war veterans, the resilient cluster of people showed better
adjustment than did those whose personality/coping profile indicated either
overcontrol or undercontrol, and the authors suggested that this relationship
was mediated via greater social support, active coping and flexibility (Elliott
et al, 2015).
Liu et al (2015) observed a buffering effect of resilience on the negative

impact of stress on sleep disturbance in 1,471 Chinese community dwelling
adults.
Low baseline CD-RISC-10 predicted higher risk of alcohol misuse after one
year in a national sample of military veterans, and greater increase in RISC
over time predicted lower risk of alcohol misuse (Green et al, 2014).
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In Air Force recruits, less resilient personnel were more likely to be

separated from service due to unsuitability or mental illness. Using ROC, the
Area under Curve (AUC) was 64-65%, indicating moderate accuracy in
predicting outcome (Bezdjian et al, 2016).
The CD-RISC-10 was found to distinguish between Spanish caregivers with

and without depression at a cut off score of ≤23. However the AUC was
only 0.73, which indicates a relatively non-precise classification (Blanco et
al, 2017).
Test Retest Reliability
Connor and Davidson showed acceptable test-retest reliability for the full
CD-RISC (r=0.87). Khoshouei showed test-retest good reliability for the
four factors in a factor analysis (r=0.78 to r=0.88) (Khoshouei, 2009). As
noted, Ito et al (2009) showed good test-retest reliability in Japanese
students. Test-retest reliability was reported by Giesbrecht et al (2009), who
noted mean scores of 66.4 (10.8) at time 1, and 66.3 (9.8) at time 2, four
months later. In Steinhardt’s study (2008), the wait-list control group
showed no change in the CD-RISC over 4 weeks (70.5(12.3) and 70.6
(11.7)). Baek et al (2010) reported a test-retest reliability coefficient of
r=0.70 in Korean subjects. A correlation of r=0.732 was obtained for test-
retest reliability on the CD-RISC 10 in Spanish undergraduates (Notario-
Pacheco et al, 2011). Patients undergoing rehabilitation after spinal cord
injury showed consistent scores in the CD-RISC (82.2, 81.9 and 82.6) across
a 2-3 month period (White et al, 2010).
A test-retest reliability correlation coefficient of 0.90 was obtained for the

CD-RISC 10 in a Chinese sample (Wang et al, 2010), and in another
Chinese sample, of 0.78 (Ye et al, 2017).
In a sample of Spanish patients with fibromyalgia, the CD-RISC-10 was

repeated at six weeks, to yield a test-retest reliability of 0.89, and a
Cronbach’s alpha = 0.88 (Notario-Pacheco et al, 2014).
In a group of traumatically injured subjects, the CD-RISC score did not

change across a 12-month follow up period from hospitalization (t = -60.50,
p= .840, Wilcoxon signed rank test) (Rainey et al, 2014). A similar finding
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was reported in 201 older healthy German women at intervals of six months
by Sarubin et al (2015b) for the CD-RISC-10 (r = 0.81 test-re-test) and CD-
RISC-25.
In the absence of any intervention, CD-RISC-10 score remained the same

over one year in a large nationwide sample of military veterans, changing
only by a score of 0.33 (Green et al, 2014).
Solano et al (2016b) reported an intraclass correlation of 0.84 in 121

psychiatric outpatients who were tested twice.
A form of split-sample reliability has also been demonstrated in the breaking

of cohorts of PTSD patients by randomization before treatment (Davidson et
al 2006), and (by non-randomization) of two missionary groups (Schaefer et
al, 2006). In this process, the resulting CD-RISC scores for the PTSD pairs
were similar. The same was found in the missionary groups.
The CD-RISC-2 was administered at three time intervals in 13

anesthesiology residents, with scores of 6.9, 6.6 and 6.5 reflecting little
change as they adapted to acute occupational stress (Eisenach et al, 2014).
Sharma et al (2018) reported correlations of r = 0.71 between time 1 and

time 2 for the CD-RISC-2 and r= 0.89 for the CD-RISC-10 in Nepali
patients with chronic pain
Biological and Other Mechanistic Studies of the CD-RISC
Further test of the scale’s construct validity comes from biological studies as
described in the following paragraphs. These studies show that the CD-RISC
may serve as a valid marker of resilience as efforts are made to understand
the putative neurobiology of resilience.
In a study of depression, Davidson and colleagues (2005) noted that

improvement in resiliency correlated significantly with the extent of
norepinephrine (NE) transporter occupancy in patients who were treated
with venlafaxine-XR, a drug with substantial NE transporter (NET)
inhibiting effects. We considered this finding to suggest that NE pathways
are integrally involved in mediating resilience, and can perhaps be one point
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of entry for treatments which might enhance resiliency, i.e., drugs which
inhibit the reuptake of NE. Indeed, this has been found to occur as noted
above. This clinical finding resonates with an animal study which showed
the importance of NET activity in regulating resilience.
Camardese et al (2007) examined a possible relationship between the CD-

RISC and cortisol in depression, without finding any significant association.
Another study looked at the relation between CD-RISC and cortisol also
found no significant association (Phillips, 2011); in her study of unemployed
men, Phillips found that cortisol failed to correlate with any variable.
The serotonin transporter (5HTT) is regarded as playing an important part in

the regulation of anxiety-proneness, resistance to the effects of stress and
resilience. The 5HTT promoter polymorphism (5HTTLPR) is under the
influence of genetic control and those with the short allele have, in many
studies, been found to show greater fear or amygdala arousal in response to
neutral or fearful stimuli, as well as, in some instances, poorer response to
certain treatments. A study by Stein et al (2009) showed that the CD-RISC
10 score was reduced in those with the short allele. For each copy of the
short allele (i.e., heterozygous and homozygous), there was a 1.53 increased
odds of falling in the low resilient category of > 1 SD below the mean. A
study by Carli et al (2011) explored the roles of 5HTTLPR status and
childhood trauma on resilience and depression in male prisoners (n=763).
Genotype did not influence resilience or depression, but an interaction
between genotype and childhood trauma was found for both resilience and
depression. The long-allele polymorphism was associated with lower
resilience scores and may confer greater vulnerability in those exposed to
previous severe stress. In a study of older adults, O’Hara et al (2012) failed
to show a relationship between the 5HTTLPR short allele and resilience,
although short allele status was associated with less successful aging.
Graham et al (2013) studied 41 veterans with traumatic brain injury (TBI)
and 26 controls without. They found evidence that the S’S’ genotype of the
5-HTTLPR and TBI status were independently associated with resilience,
but in opposite directions. Veterans with an S’S’ genotype (with or without
TBI) were the most resilient (83.2 and 83.3); those with an L’ genotype but
no TBI were intermediate (75.0), and those with an L’ genotype and TBI
were the least resilient (56.7), all groups differing from the L-genotype with
TBI. An Iranian study (Azadmarzabadi et al, 2018) found that low RISC
scores correlated with under-expression of the 5HTT gene, as well as genes
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for MAO-A and COMT, in 200 subjects who has responded to stressful
events with an exaggerated acute stress reaction.
Arce and colleagues (2009) conducted a forced emotional choice task when
presented with pictures of neutral faces and faces morphed to show sadness,
fear and happiness. Among the findings was an association between high
resilience on the CD-RISC 10 and a bias towards judging neutral faces as
being happy. The assumed tendency of this group to engage in positive
emotions may come to the rescue during times of hardship, unlike those with
low resilience who cope less well in the face of stress.
In an fMRI study of working memory and emotional processing in PTSD

patients and trauma controls, Morey et al (2008) failed to show a significant
relationship between baseline CD-RISC score and neural activity in response
to task-irrelevant visual distractors. Although the extent of these changes
was related significantly to the DTS score, no such relationships were found
with the CD-RISC.
Ha et al (2009) examined responses to different facial expressions in 143

Korean volunteers. They found that tendencies to recognize contemptuous
faces were negatively related to CD-RISC score.
Paulus et al (2010) applied fMRI in response to target face assessment tasks

in 26 university undergraduates. The major result showed that limbic and
paralimbic region activation during face emotion processing is modulated by
level of resilience. Greater resilience is associated with less activation in the
ventromedial prefrontal cortex but more activation in the right anterior
insular cortex. Higher resilience was also associated with less amygdalar
activation.
Das and colleagues (2011) studied the dopamine receptor D4 (DRD4) exon
III variable number tandem repeat (VNTR) polymorphism in 1,148
Australian adults between ages 30-34 years. They found that the 7-repeat
allele protected against adverse effects of childhood abuse (CA) on
resilience. Moreover, they found a relationship between CD-RISC score and
approach/avoidance personality measures, and proposed that when stressors
are present, the 7-repeat allele influences the development of personality in a
way that protects against adverse outcomes. Azadmarabadi et al (2018)
found that overexpression of dopamine signaling genes DRD4, DBH, DAT
(and BDNF) was associated with lower RISC-25 scores in 200 Iranian
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subjects with acute stress syndromes following exposure to either everyday

stress or major trauma.
In a study of rape trauma survivors, Malan (2011) examined telomere length

and found no relationship between this measure and CD-RISC score. (No
relationship was found between telomere length and depression, and only a
marginal relationship was found for telomere length and PTSD).
Daniels et al (2012) studied 70 acute trauma survivors, a minority of whom

had PTSD and assessed a subgroup of 12 subjects with fMRI in the context
of provoking memories of the trauma. In the larger sample, CD-RISC
predicted PTSD status at three months better than did CA, and fully
mediated the relationship between CA and PTSD. In the fMRI group, CD-
RISC score was positively correlated with BOLD signal strength in the right
thalamus and middle frontal area gyri (Brodmann area 47), areas relevant to
the regulation of emotion.
A Korean study (Kang et al, 2013), observed in males (but not females) that
low resilience was associated with a particular COMT genotype, the Val/Val
carrier, in whom the mean CD-RISC was 67.5, compared to the Val/Met and
Met/Met carriers, who scored 70.9, a statistically significant difference.
They also noted that in the low COMT Val/Val group, those with a BDNF
Val/Val genotype scored lowest (64.7). A finding with respect to a CMOT
gene has been described above in a sample of 200 Iranian subjects who were
exposed to stress (Azadmarzabadi et al, 2018). A study which examined
polymorphisms of the COMT gene in athletes found no difference in CD-
RISC-25 scores for those typed as having the Val158Met allele compared to
the Met158Met allele (Van Breda et al, 2015).
Bradley et al (2013) examined the relationship between childhood

environment, the oxytocin OXTR rs53576 genotype and adult resilient
coping as measured by the CD-RISC-10, in 971 African-American adults.
Although RISC score was positively related to positive early childhood and
family environment (and negatively correlated with PTSD, childhood abuse
and lifetime trauma), it was unrelated to the oxytocin genotype.
Dehydroepiandrosterone sulphate (DHEA-S) but not cortisol was found to

correlate with the CD-RISC score in a sample of 32 healthy English adults,
obtained as an opportunistic sample from a university community (Petros et
al, 2013). This relationship remained after controlling for other variables.
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Circadian typology was found to relate to CD-RISC-10 in a community

sample of 1922 Spanish workers and students, where morning-preferrers on
the Morningness-Eveningness Questionnaire scored higher (30.9 (0.3)) than
did evening-type subjects (26.8 (0.3)) (Antunez et al, 2015).
A German study evaluated the relationship between CD-RISC-10 and

attentional bias and control. Results showed that attentional control was
positively related to CD-RISC score. Attentional bias to threat was
negatively related to resilience when attentional control was low, and
positively when control was high. The authors concluded that attentional
processing may promote resilience (Schäfer et al, 2015).
In an fMRI study of 46 right handed volunteers, level of resilience as

measured by the CD-RISC-10 was related to attention to bodily signals
(interceptive awareness) and activation of the insular and thalamus. Those
with the lowest resilience paid less attention yet showed greatest activation
(i.e., neural processing) to aversive bodily perturbations, and the authors
concluded that low resilience was associated with a mismatch between
attention to, and processing of, interoceptive afferents which could result in
poor adaptation to stressful situations (Haase et al, 2016).
Chronobiology was studied in relation to the resilience of Korean college

students. Using the CD-RISC-10, Lee et al (2016) found that morning types
were more resilient than evening or intermediate types. Morningness, better
sleep quality and greater daylight sunshine exposure all predicted resilience.
Physiological (autonomic) reactivity was compared in high and low resilient

subjects based on CD-RISC-10 scores (Lu et al, 2016). Highly resilient
individuals showed better recovery of systolic and diastolic BP and pulse,
and of respiratory sinus arrhythmia when anticipating a stressful public
speaking challenge at two times, as well as greater habituation of BP at time
2.
Among pregnant Chinese women seen at a prenatal visit, resilience was

associated with better sleep, and it also mediated the relationship in a
protective manner between pregnancy-related stress and poor sleep (Li et al,
2016).
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Resilience was related to autonomic reactivity in a stress paradigm of public

speaking among Chinese students (Lü et al, 2016). Those with higher CD-
RISC scores showed greater habituation to repeated stress as measured by
respiratory sinus arrhythmia (RSA) and blood pressure and pulse and more
complete recovery on these measures, compared to the low resilience group.
An Italian MEG study of 38 trauma-exposed subjects with PTSD or no

PTSD demonstrated a significant inverse correlation (r = - 0.45) between
RISC score and connectivity between the Default Mode Networks (DMN)
and Salience Networks (SN) in various regions of the cortex. This
relationship was accounted for by those with PTSD, leading the authors to
conclude that disruption of dialogue between the two network systems
impaired recovery from trauma and was associated with lower resilience
(Brunetti et al, 2017).
Forty-eight healthy US volunteers underwent structural MRI scans, with

segmentation and regional parcellation of images to yield 165 regions.
Significant correlations were found between CD-RISC-25 score and gray
matter (GM) change in hypothesized brain regions: subparietal and
intraparietal sulci, amygdala, anterior and subgenual cingulate cortices.
Resilience was associated with brain morphology of regions involved in
cognitive (executive control) and affective (emotional arousal) processes
related to cortico-limbic inhibition (Gupta et al, 2017). Positive correlations
were also found for resilience and positive affect (r=0.62) on the PANAS.
The CD-RISC-25 was associated with HPA axis function in young children
living with the stigma of parental HIV, specifically higher levels of
awakening salivary cortisol and steeper cortisol slopes in the more resilient
children (Chi et al, 2015). More resilient children felt less stigma and in turn
showed a “healthier” diurnal cortisol rhythm.
Subjects with irritable bowel syndrome (IBS) did not show an interaction
between resilience and IBS severity for ACTH-stimulated cortisol response
using the CD-RISC-25, but such an interaction was observed with the Brief
Resilience Scale (BRS), possibly reflecting the different item contents (Park
et al, 2017).
Highly resilient Chinese medical students differed from low-resilient

counterparts in showing greater bias towards positive than negative
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emotional information on a facial emotion recognition test (Peng et al,

2017).
Psychogenic nonepileptic seizures (PNES) with altered responsiveness are

associated with lower resilience than PNES with intact responsiveness
(scores 55.9 vs 67.8, p<0.03) (Baslet et al, 2017).
In Australian veterans and US civilians with PTSD, CD-RISC correlated

positively with DNA methylation-predicted age (DNAm age), (r = 0.32, and
r = 0.23, p<0.025), i.e. as those with PTSD responded with greater stress
burden (allostatic load), their higher resilience came at a price to health. The
self-efficacy factor items accounted for this relationship. In those who did
not develop PTSD after stress, the relationship between RISC and DNAm
was inverse, i.e. a negative correlation (Mehta et al, 2018).
In a twin study paradigm, Wolf et al (2018) showed a heritability of 49% for

PTSD and 25% for resilience, with the two measures correlating at r = -0.59.
59% of this correlation was attributable to a single genetic factor, while the
remainder was due to a single non-shared environmental factor. Further,
resilience was also influenced by common and unique factors that were
separate from PTSD, and that there was no genetic factor specific to
resilience. The authors proposed a single spectrum of vulnerability, with
high PTSD symptoms at one end and a resilient low-symptom expression at
the other end.
In samples of healthy controls and schizophrenia, Lee found that the CD-
RISC-10 contributed significantly to outcomes of physical health, mental
health, glycosylated hemoglobin (HbA1c) and HOMA-IR, an integrated
measure of insulin resistance, but not to BMI, in a series of GLMs
examining the relationships between trauma severity, resilience and subject
group. Cohen Effect Sizes were generally higher than for other predictor
variables (0.39-0.55).
Translations of the CD-RISC
Approved translations of the CD-RISC currently exist in the following

seventy-seven languages:
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Afrikaans, Albanian, Amharic, Arabic, Assamese, Azeri, Bahasa Indonesia,

Bahasa Malaysia, Bemba, Bangla (Bengali), Bosnian, Cebuano, Chinese
(Taiwan and Peoples Republic), Burmese (CD-RISC-2), Croatian, Creole,
Czech, Danish, Dari, Dutch, Farsi, Finnish, French (France, Belgium,
Canada), German, Greek, Hakha Chin (CD-RISC-2), Hebrew, Hindi,
Hungarian, Icelandic, isiXhosa, isiZulu, Italian, Japanese, Kannada,
Kinyarwanda, Kiswahili, Khmer (CD-RISC-10), Korean, Kurdish, Liberian,
Lithuanian, Macedonian, Malagasy, Malayalam, Marathi, Mongolian,
Nepali, Norwegian, Pashto (CD-RISC-2 and CD-RISC-10), Polish,
Portuguese (Europe, Brazil), Quechua, Romanian, Russian, Serbian,
Slovenian, Somali (CD-RISC-2), Spanish (Europe, Caribbean, South
America, Central America), Swedish, Tagalog, Tamil, Telugu, Thai,
Tigrinya (CD-RISC-2), Turkish, Ukrainian, Urdu, Vietnamese, Welsh.
We are aware of some unauthorized translations of the CD-RISC. To

minimize further use of these, any person who is considering either the
use of a translation or the creation of a new translation is requested to
contact either Dr. Connor or Dr. Davidson. We cannot vouch to the
accuracy, validity or reliability of these unauthorized translations, some
of which have been taken directly from the publication by Davidson and
Connor (2003), which does not provide the complete scale.
Citations that Mention the CD-RISC or Report Original

Research
Abolghasemi A, Rajabi S, Sheikhi M, Kiamarsi A, Sadrolmamaleki V.

Comparison of resilience, positive/negative affect, and psychological
vulnerability between Iranian infertile and fertile men. Iran J Psychiatry
2013; 7: 9-15.
Abrams TE, Ogletree R, Ratnapradipa D, Neumeister M. Resiliency theory

in psychosocial burn research; A qualitative analysis. Poster presented at
National Conference of American Burn Association, Chicago, April 20-25,
2015.
Ahmad S, Feder A, Lee EJ, Wang Y, Southwick SM, Schlackman E,

Buchholz K, Alonso A, Charney DS. Earthquake impact in a remote South
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Asian population: psychosocial factors and posttraumatic symptoms. J

Traumatic Stress 2010; 23: 408-412.
Ahmed A. Post-traumatic stress disorder, resilience and vulnerability.

Advances in Psychiatric Treatment. 2007; 13: 369-375. (Review article)
Alemi Q, Stempel C, Koga PM, et al. Risk and protective factors associated
with the mental health of young adults in Kabul, Afghanistan. BMC
Psychiatry 2018; 18:71. Doi.org/10.1186/s12888-018-1648-4.
Allan JF, McKenna J, Dominey S. Degrees of resilience: profiling

psychological resilience and prospective academic achievement in university
inductees. British Journal of Guidance & Counselling 2014; 42: 9-25.
Almedom AM, Glandon D. Resilience is not the absence of PTSD any more
than health is the absence of disease. J Loss and Trauma 2007; 12: 127-143
(Review article).
Aloba O, Olabisi O, Aloba T. The 10-item Connor-Davidson Resilience

Scale: factorial structure, reliability, validity, and correlates among student
nurses in Southwestern Nigeria. J Amer Psychiatr Nurses Assoc 2016; 22:
43-51.
Alonso-Tapia J, Rodriguez-Rey R, Gerrido-Hernansaiz H, et al. Coping

assessment from the perspective of the person-situation interaction:
Development and validation of the Situated Coping Questionnaire for Adults
(SCQA). Psicothema 2016; 28: 479-486.
Al-Shammeri ASS, Abu Bakr NKA. Modeling the causal relationship

between parental treatment methods, psychological resilience and life-
satisfaction. J Education and Practice. 2017; 8: 88-95. [NOTE: THIS
STUDY USED AN UNAUTHORIZED 29-ITEM VERSION OF THE
SCALE].
Altaha N, Kraus S. Kill the Indian, Save the Man: Native American
Historical Trauma in College Students. Dissertation accessed at
http://eprints.fortlewis.edu/45/2/Noel_FINAL_META_PDF. PDF.
Amble TC, et al. The impact of resilience on anxiety in African-American

breast cancer survivors and cancer-free women. Poster presentation at
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Annual Conference for the National Association of Black Psychologists,

Houston, TX, 2007.
Ameen RF, Cinkara E. The impact of language learning on internally

displaced and refugee resilience. Europ J Educational Res 2018; 7: 529-538.
Ameen RF. The impact of psychosocial support activities on the resilience

of conflict-affected adolescents in Iraq: A sample of Nineveh Governorate.
Res Humanities Soc Sci 2018; 8: 48-56.
Anderson KM, Bang E-J. Assessing PTSD and resilience for females who
during childhood were exposed to domestic violence. Child & Family Social
Work 2012a; 17: 55-65.
Anderson KM, Renner LM, Danis FS. Recovery, resilience and growth in
the aftermath of domestic violence. Violence Against Women 2012b; 18:
1279-1299.
Andresen R, Caputi P, Oades L. The stages of recovery instrument:

development of a measure of recovery from serious mental illness. Austr NZ
Journal of Psychiatry. 2006; 40: 972-980.
Ang SY, Uthaman T, Ayre TC, et al. Association between demographics and
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1

Connor-Davidson Resilience Scale (CD-RISC) ©

Cite as: Davidson JRT. Connor-Davidson Resilience Scale (CD-

Authorized Versions of the CD-RISC

In the original validation study, mean scores in specific populations were

For a summary of all reports with the CD-RISC-10 and CD-RISC-2,

Unauthorized Versions of the CD-RISC

Directions for Scale Administration, Scoring and

Directions: The CD-RISC is designed as a self-rating scale, although where

Interpretation of Score: CD-RISC scores appear to be influenced by two

For the CD-RISC-25 in the US general population (n = 577), median score is

Similar results were obtained in another US population (n=577) by Davidson

Results from a general population survey in Hong Kong (n = 10,997)

For the CD-RISC-2 (n = 10,997), Ni et al (2015 and personal

Reading Ease and Reading Grade Level

A review is provided of the psychometric data on validity, reliability and

Demographic Features of the CD-RISC

GENDER & MARITAL STATUS:

2017). In Chinese medical students, Peng et al (2012) found significantly

A study of 100 university students in Iran failed to show a difference in

OTHER DEMOGRAPHIC VARIABLES:

not by Lamond et al (2008) or Boell (2016). Higher income was related to

In one large (n=764) community study of the CD-RISC 10, demographic

Mean Scores of CD-RISC in Different Populations

Community populations: In their original report, Connor and Davidson

Yu et al (2009) 25 560 65. 4 (13.9) China Community sample

Peng et al (2012) 25 1,998 61.7 (10.6) China Medical Students

Table 1c Mean (SD) CD-RISC 2-Item Scores in General Population Samples

Adolescents, Students and Young Adults: There have been a number of

Russian schoolchildren (mean age 13 years) who survived a terrorist attack

A group of 401 Australian university students, mean age 23.6, demonstrated

In a Canadian study of homeless youth (mean age 18.2, range 15-21),

Notario-Pacheco et al (2011) reported good psychometric properties for the

Stephens (2012) evaluated 70 adolescent nursing students, grouped by

Hartley (2012) assessed a student counseling clinic sample of college

These and other scores are summarized in Tables 2a-c.

Ito et al (2009) 25 220 55.8 (14.8) Japan Undergraduates mean age 20

Vetter et al (2010) 25 94 70.1 (14.0) Russia Schoolchildren ages 10-16 who

Authors Scale Number Mean (SD) Location Diagnostic group

Aloba et al (2016) 10 449 26.7 Nigeria Student nurses

Authors Scale Number Mean (SD) Location Diagnostic group

Psychiatric Groups: Mean (SD) scores in a range of psychiatric groups are

Several studies have examined the CD-RISC in populations with

Authors Scale Number Mean (SD) Location Comments

Ni et al (2015) 25 495 China Sichuan earthquake survivors five years

Authors Scale Number Mean (SD) Location Comments

Langhinrichsen- 2 120 3.94 USA primary PTSD

In a sample of abstinent substance abusers who either had, or had not,

These scores are summarized in Table 4.

Authors Scale N Mean (SD) Location Comments

Camardese et al 25 102 53.3 (15.2) Italy Major depression which responded to

Choi et al (2015) 25 62 60.5 Korea Euthymic bipolar disorder patients

CD-RISC scores have been reported in subjects with other psychiatric

Authors Scale Number Mean (SD) Location Comments

Authors Scale Number Mean (SD) Location Comments

Authors Scale Number Mean (SD) Location Comments

Mean CD-RISC scores have been reported as follows: generalized anxiety

In a geriatric group, community subjects had higher resilience scores than

In two groups of Australian patients with schizophrenia (mainly), corrected

of 57.1 in a small group of patients with schizophrenia (Hansen and