A symptom-based definition of resilience in times of pandemics: patterns of psychological responses over time and their predictors

Background: It has been suggested that resilience is best conceptualized as healthy and stable functioning in the face of a potentially traumatic event. However, most research on this field has focused on self-reported resilience, and other patterns of response when facing adversity, in cross-sectional designs. Objective: Alternatively, we aimed to study changing patterns of psychological responses to the COVID-19 pandemic in the general population, based on patterns of symptoms, and factors contributing to those patterns. Method: A national representative sample of Spain (N = 1,628) responded to an internet-based survey at two assessment points, separated by 1 month (April and May 2020), during the official national confinement stage. Based upon whether participants exhibited absence/presence of distress (i.e., significant trauma-related, depression, or anxiety symptoms) at one or two of the assessment times, patterns of psychological responses were defined by categorizing individuals into one of the four categories: Resilience, Delayed distress, Recovered, and Sustained distress. Results: Analyses of the levels of disturbance associated with the symptoms provided support to that four-fold distinction of patterns of responses. Furthermore, resilience responses were the most common psychological response to the pandemic. Multinomial regression analyses revealed that the main variables increasing the probability of resilience to COVID-19 were being male, older, having no history of mental health difficulties, higher levels of psychological well-being and high identification with all humanity. Also, having low scores in several variables (i.e., anxiety and economic threat due to COVID-19, substance use during the confinement, intolerance to uncertainty, death anxiety, loneliness, and suspiciousness) was a significant predictor of a resilient response to COVID-19. Conclusion: Our findings are consistent with previous literature that conceptualizes resilience as a dynamic process. The clinical implications of significant predictors of the resilience and the rest of psychological patterns of response are discussed.