Psychological resilience and post-traumatic stress disorder: a systematic review and meta-analysis of the effects of intentional and unintentional trauma before the COVID-19 pandemic

Abstract

Background:Post-traumatic stress disorder (PTSD) represents a significant public health burden. Growing evidence suggests that psychological resilience (PR) may act as a protective factor against the development of PTSD. Trauma type may also influence the relationship between PR and PTSD. This meta-analytic study aims to assess the strength of this relationship by focusing on research conducted prior to the COVID-19 pandemic to avoid confounding effects introduced by the pandemic’s unique and widespread stressors.MethodsA comprehensive literature search for case–control studies published between 2008 and 2019 was performed. Studies conducted after 2019 were excluded to maintain methodological consistency and avoid the pandemic’s effects. Heterogeneity and sampling bias analyses were conducted, followed by pooled effect estimates and 95% confidence intervals using random-effects models. Subgroup and sensitivity analyses were also included to investigate the effects of trauma type and age on the relationship between PR and PTSD.ResultsThirteen studies were selected for the analysis (n = 5689). The overall effect of the relationship between PR and PTSD was statistically significant (p < 0.001), with the robustness and stability of the results corroborated. Subgroup analyses showed a differential effect based on trauma type and age (p < 0.001).ConclusionsThe results support the hypothesis that lower PR is associated with higher susceptibility to PTSD. Additionally, trauma type and age were found to be significant factors influencing this relationship. Our study’s cross-sectional design and the variability in the data reported by the studies limited the conclusions. Future research should aim to further explore these findings and investigate potential long-term effects of different trauma types.