{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:52:21Z","timestamp":1780102341372,"version":"3.54.0"},"reference-count":53,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T00:00:00Z","timestamp":1606608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Background: Resilience is defined as the capacity to cope successfully with change or adversity. The aims of our study were to investigate levels of resilience in Italian healthcare professionals (HCPs) during the Coronavirus disease 2019 (COVID-19) pandemic and to identify potential predictors of resilience. Methods: We performed a web-based survey of HCPs (n = 1009) working in Italian hospitals during the COVID-19 pandemic. The survey contained a 14-item resilience scale (RS14) and questionnaires to evaluate depression and anxiety symptoms. Non-HCP individuals (n = 375) from the general population were used for comparison. Results: HCPs showed significantly lower resilience compared to the control group (p = 0.001). No significant differences were observed after stratification for geographical area, work setting, role, or suspected\/confirmed diagnosis of COVID-19. In a linear regression analysis, RS14 was inversely correlated with depression (R2 = 0.227, p &lt; 0.001) and anxiety (R2 = 0.117, p &lt; 0.001) and directly correlated with age (R2 = 0.012, p &lt; 0.001) but not with body mass index (BMI, R2 = 0.002, p = 0.213). In male HCPs, higher depression score (odds ratio (OR) 1.147, p &lt; 0.001) or BMI (OR 1.136, p = 0.011) significantly predicted having low resilience. In female HCPs, higher depression score (OR 1.111, p &lt; 0.0001) and working in a COVID-19 free setting (OR 2.308, p = 0.002) significantly predicted having low resilience. HCPs satisfied with personal protective equipment had higher levels of resilience (p &lt; 0.010). Conclusions: Our findings suggest that resilience was lower in Italian HCPs than in the general population after the first COVID-19 wave. Specific factors can be identified, and targeted interventions may have an important role to foster resilience of HCPs.<\/jats:p>","DOI":"10.3390\/bs10120183","type":"journal-article","created":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T21:00:57Z","timestamp":1606683657000},"page":"183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Levels and Factors Associated with Resilience in Italian Healthcare Professionals during the COVID-19 Pandemic: A Web-Based Survey"],"prefix":"10.3390","volume":"10","author":[{"given":"Lucia","family":"Lisi","sequence":"first","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Ciaffi","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0893-103X","authenticated-orcid":false,"given":"Antonella","family":"Bruni","sequence":"additional","affiliation":[{"name":"Neuropsychiatric Rehabilitation, Villa Patrizia Hospital, 10045 Piossasco, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8229-2443","authenticated-orcid":false,"given":"Luana","family":"Mancarella","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Brusi","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Gramegna","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Ripamonti","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Quaranta","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Borlandelli","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1066-4671","authenticated-orcid":false,"given":"Gaetano","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Anaesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8017-8858","authenticated-orcid":false,"given":"Agostino","family":"Chiaravalloti","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy"},{"name":"IRCCS Neuromed, 86077 Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2352-1146","authenticated-orcid":false,"given":"Pasquale","family":"Viola","sequence":"additional","affiliation":[{"name":"Audiology Unit, Department of Experimental and Clinical Medicine, University of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Ruscitti","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-4529","authenticated-orcid":false,"given":"Giacomo","family":"Caio","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"D\u2019Onghia","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"D\u2019Amuri","sequence":"additional","affiliation":[{"name":"Internal Medicine Academic Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cimellaro","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Facchini","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"La Regina","sequence":"additional","affiliation":[{"name":"Internal Medicine &amp; Clinical Risk Management Unit, ASL5, 19121 La Spezia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5745-0315","authenticated-orcid":false,"given":"Luca","family":"Spinardi","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Neuroradiology Unit, S. Orsola Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0867-5873","authenticated-orcid":false,"given":"Roberto","family":"De Giorgio","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Giacomelli","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Paola","family":"Landini","sequence":"additional","affiliation":[{"name":"Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Berardi","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40123 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Meliconi","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40123 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ursini","sequence":"additional","affiliation":[{"name":"Medicine &amp; Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40123 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.psym.2014.10.005","article-title":"Physical disease and resilient outcomes: A systematic review of resilience definitions and study methods","volume":"56","author":"Johnston","year":"2015","journal-title":"J. Psychosom. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.drugalcdep.2008.03.007","article-title":"Does resilience moderate the associations between parental problem drinking and adolescents\u2019 internalizing and externalizing behaviors?","volume":"96","author":"Lee","year":"2008","journal-title":"Drug Alcohol Depend."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2648.2007.04412.x","article-title":"Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review","volume":"60","author":"Jackson","year":"2007","journal-title":"J. Adv. Nurs."},{"key":"ref_4","unstructured":"Edmonstone, J. (2013). Personal Resilience for Healthcare Staff, when the Going Gets Tough, Radcliffe Publishing."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1038\/s41586-020-2012-7","article-title":"A pneumonia outbreak associated with a new coronavirus of probable bat origin","volume":"579","author":"Zhou","year":"2020","journal-title":"Nature"},{"key":"ref_6","unstructured":"WHO (2020, May 17). Director-General\u2019s Opening Remarks at the Media Briefing on COVID-19\u201311 March 2020. Available online: https:\/\/www.who.int\/dg\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020."},{"key":"ref_7","unstructured":"WHO (2020, November 18). WHO Coronavirus Disease (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int\/?gclid=Cj0KCQjwn7j2BRDrARIsAHJkxmzAoKqHqHfKLNTzlSN9vL6NKpoZWXUmP_wXL03mphsjLlPPvpJndVAaAliwEALw_wcB."},{"key":"ref_8","unstructured":"International Monetary Fund (2020, October 04). The Great Lockdown: Worst Economic Downturn since the Great Depression. Available online: https:\/\/blogs.imf.org\/2020\/04\/14\/the-great-lockdown-worst-economic-downturn-since-the-great-depression\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.bbi.2020.05.040","article-title":"Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain","volume":"87","author":"Castellanos","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R.S., Choo, F.N., Tran, B., Ho, R., and Sharma, V.K. (2020). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav. Immun.","DOI":"10.1016\/j.bbi.2020.04.028"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1056\/NEJMp2008017","article-title":"Mental health and the Covid-19 pandemic","volume":"383","author":"Pfefferbaum","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_12","unstructured":"FNOMCEO (2020, October 30). Elenco dei Medici Caduti nel Corso dell\u2019epidemia di Covid-19. Available online: https:\/\/portale.fnomceo.it\/elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"m1211","DOI":"10.1136\/bmj.m1211","article-title":"Managing mental health challenges faced by healthcare workers during covid-19 pandemic","volume":"368","author":"Greenberg","year":"2020","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1016\/j.ajem.2020.04.030","article-title":"Preserving mental health and resilience in frontline healthcare workers during COVID-19","volume":"38","author":"Santarone","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11920-020-01166-z","article-title":"The psychological impact of epidemic and pandemic outbreaks on healthcare workers: Rapid review of the evidence","volume":"22","author":"Preti","year":"2020","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Liang, Y., Wu, K., Zhou, Y., Huang, X., Zhou, Y., and Liu, Z. (2020). Mental health in frontline medical workers during the 2019 novel Coronavirus disease epidemic in China: A comparison with the general population. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186550"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"60","DOI":"10.5502\/ijw.v3i1.4","article-title":"Resilience in the health professions: A review of recent literature","volume":"3","author":"McCann","year":"2013","journal-title":"Int. J. Wellbeing"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"113190","DOI":"10.1016\/j.psychres.2020.113190","article-title":"The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public-A systematic review and meta-analysis","volume":"291","author":"Luo","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1126\/science.1222942","article-title":"The science of resilience: Implications for the prevention and treatment of depression","volume":"338","author":"Southwick","year":"2012","journal-title":"Science"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V.G., Papoutsi, E., and Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav. Immun.","DOI":"10.2139\/ssrn.3594632"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1037\/0735-7028.38.6.603","article-title":"In pursuit of wellness: The self-care imperative","volume":"38","author":"Barnett","year":"2007","journal-title":"Prof. Psychol. Res. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e423","DOI":"10.3399\/bjgp16X685261","article-title":"Resilience of primary healthcare professionals: A systematic review","volume":"66","author":"Robertson","year":"2016","journal-title":"Br. J. Gen. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1186\/s12913-020-05208-3","article-title":"Resilient Health Care: A systematic review of conceptualisations, study methods and factors that develop resilience","volume":"20","author":"Iflaifel","year":"2020","journal-title":"BMC Health Serv. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e216","DOI":"10.7717\/peerj.216","article-title":"The relationship between resilience and personality traits in doctors: Implications for enhancing well being","volume":"1","author":"Eley","year":"2013","journal-title":"PeerJ"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Knox, B.S., Duffy, M.E., Bunting, B.P., Parr, H., De Almeida, M.D.V., and Gibney, M. (2012). Associations between obesity (BMI and waist circumference) and socio-demographic factors, physical activity, dietary habits, life events, resilience, mood, perceived stress and hopelessness in healthy older Europeans. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-424"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wu, Z., Liu, Y., Li, X., and Li, X. (2016). Resilience and associated factors among mainland Chinese women newly diagnosed with breast cancer. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167976"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Nishimi, K., Choi, K.W., Cerutti, J., Powers, A., Bradley, B., and Dunn, E.C. (2020). Measures of adult psychological resilience following early-life adversity: How congruent are different measures?. Psychol Med., 1\u201310.","DOI":"10.1017\/S0033291720001191"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/jpm.12313","article-title":"The intersection of gender and resilience","volume":"23","author":"Hirani","year":"2016","journal-title":"J. Psychiatr. Ment. Heal. Nurs."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1080\/10911350903275358","article-title":"Resilience and coping with trauma: Does gender make a difference?","volume":"20","author":"Morano","year":"2010","journal-title":"J. Hum. Behav. Soc. Environ."},{"key":"ref_30","unstructured":"(2020, July 28). Novel Coronavirus, Available online: http:\/\/www.salute.gov.it\/portale\/nuovocoronavirus\/homeNuovoCoronavirus.jsp."},{"key":"ref_31","unstructured":"Istituto Superiore di Sanit\u00e0 (ISS) (2020, August 12). COVID-19 Pandemic-National Update April 28, 2020. Available online: https:\/\/www.epicentro.iss.it\/coronavirus\/bollettino\/Bollettino-sorveglianza-integrata-COVID-19_28-aprile-2020.pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e033962","DOI":"10.1136\/bmjopen-2019-033962","article-title":"Do oncology researchers adhere to reproducible and transparent principles? A cross-sectional survey of published oncology literature","volume":"9","author":"Walters","year":"2019","journal-title":"BMJ Open"},{"key":"ref_33","first-page":"1","article-title":"Evidence-based medicine self-assessment, knowledge, and integration into daily practice: A survey among Romanian physicians and comparison between trainees and specialists","volume":"20","author":"Bolboac","year":"2020","journal-title":"BMC Med. Educ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ijsu.2020.05.042","article-title":"COVID-19: Results of a national survey of United Kingdom healthcare professionals\u2019 perceptions of current management strategy-A cross-sectional questionnaire study","volume":"79","author":"Iqbal","year":"2020","journal-title":"Int. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.2196\/jmir.6.3.e34","article-title":"Improving the quality of web surveys: The checklist for reporting results of internet E-surveys (CHERRIES)","volume":"6","author":"Eysenbach","year":"2004","journal-title":"J. Med. Internet Res."},{"key":"ref_36","unstructured":"Wagnild, G. (2016). The Resilience Scale User\u2019s Guide for the US English Version of the Resilience Scale and the 14-Item Resilience Scale (RS\u201314), Resilience Center."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2147\/PRBM.S115657","article-title":"Reliability and validity of the Italian version of the 14-item Resilience Scale","volume":"9","author":"Callegari","year":"2016","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/ene.12932","article-title":"Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis","volume":"23","author":"Sacco","year":"2016","journal-title":"Eur. J. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Beck, A.T., Steer, R.A., and Brown, G.K. (1996). BDI-II: Beck Depression Inventory Manual, Psychological Corporation. [2nd ed.].","DOI":"10.1037\/t00742-000"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/BF01186280","article-title":"Issues and recommendations regarding use of the Beck Depression Inventory","volume":"11","author":"Kendall","year":"1987","journal-title":"Cogn. Ther. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1093\/annonc\/mdq750","article-title":"Defining Hospital Anxiety and Depression Scale (HADS) structure by confirmatory factor analysis: A contribution to validation for oncological settings","volume":"22","author":"Annunziata","year":"2011","journal-title":"Ann. Oncol."},{"key":"ref_42","unstructured":"Snaith, R.P., and Zigmond, A.S. (1994). The Hospital Anxiety and Depression Scale Manual, Nfer-Nelson."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1348\/014466501163904","article-title":"Normative data for the HADS from a large non-clinical sample","volume":"40","author":"Crawford","year":"2001","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/BF02310555","article-title":"Coefficient alpha and the internal structure of tests","volume":"16","author":"Cronbach","year":"1951","journal-title":"Psychometrika"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1308\/rcsann.2006.88.6.603","article-title":"Medical statistics: A guide to data analysis and critical appraisal","volume":"88","author":"Lewsey","year":"2006","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.pedhc.2016.09.005","article-title":"Resilience","volume":"31","author":"Hornor","year":"2017","journal-title":"J. Pediatr. Health Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1111\/j.1467-6494.2009.00599.x","article-title":"Positive affect and psychobiological processes relevant to health","volume":"77","author":"Steptoe","year":"2009","journal-title":"J. Personal."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.cpr.2010.03.003","article-title":"Resilience and mental health","volume":"30","author":"Davydov","year":"2010","journal-title":"Clin. Psychol. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1108\/S1479-3555(2010)0000008009","article-title":"Karasek\u2019s (1979) job demands-control model: A summary of current issues and recommendations for future research","volume":"8","author":"Kain","year":"2010","journal-title":"New Dev. Theor. Concept. Approach. Job Stress"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1093\/annonc\/mdt250","article-title":"Informal caregiving to older cancer patients: Preliminary research outcomes and implications","volume":"24","author":"Goldzweig","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_52","first-page":"225","article-title":"The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah","volume":"11","author":"Bavafa","year":"2019","journal-title":"J. Inj. Violence Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.nedt.2018.10.002","article-title":"The effectiveness of interventions to improve resilience among health professionals: A systematic review","volume":"71","author":"Cleary","year":"2018","journal-title":"Nurse Educ. Today"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/10\/12\/183\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:39:15Z","timestamp":1760179155000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/10\/12\/183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,29]]},"references-count":53,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["bs10120183"],"URL":"https:\/\/doi.org\/10.3390\/bs10120183","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,29]]}}}