Unpacking the Heterogeneity of Resilience in Female Survivors of Trauma: A Two-Step Mixture Modeling Approach on Neurobiological and Psychological Markers
Keywords:
Resilience, Trauma, Latent Profile Analysis, Neurobiology, Hair Cortisol, Heart Rate Variability, PTSD, Female SurvivorsAbstract
Objective: This study aimed to identify distinct bio-psychological latent profiles of resilience among female trauma survivors by integrating psychological and neurobiological markers and to examine how trauma exposure predicts profile membership. Methods and Materials: This cross-sectional observational study included a sample of N=452 adult female trauma survivors recruited from support centers in Egypt. Participants completed culturally validated Arabic versions of the Childhood Trauma Questionnaire (CTQ), the PTSD Checklist for DSM-5 (PCL-5), and the Connor-Davidson Resilience Scale (CD-RISC). Neurobiological data included hair cortisol concentration (HCC) as a marker of chronic hypothalamic-pituitary-adrenal axis activity and resting high-frequency heart rate variability (HRV) as an index of parasympathetic regulation. A two-step mixture modeling approach was employed, using Latent Profile Analysis (LPA) to identify resilience classes, followed by multinomial logistic regression to assess predictors of class membership. Findings: The LPA revealed an optimal three-class solution. The Dysregulated/Low Resilience profile (21.0% of the sample) was characterized by low self-reported resilience, high HCC, and low HRV. The Compensatory/Moderate Resilience profile (48.9%) demonstrated moderate scores across all psychological and biological indicators. The Adaptive/High Resilience profile (30.1%) exhibited high self-reported resilience, low HCC, and high HRV. Multinomial logistic regression showed that higher severity of childhood trauma (CTQ) and current PTSD symptoms (PCL-5) significantly increased the odds of belonging to the Dysregulated and Compensatory profiles relative to the Adaptive profile. Conclusion: Resilience among female trauma survivors is a heterogeneous construct comprising distinct bio-psychological profiles, necessitating a multidimensional approach for accurate assessment and intervention.
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